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Infection Control & Prevention in Long-Term Care: A Comprehensive Resource Manual
A Comprehensive Resource Manual

The publishers of Long-Term Living (formerly Nursing Homes Magazine), the leading publication for facilities offering senior supportive care and intensive post-acute services, has teamed up with Inco and Associates, LLC, the preeminent infection control consultation and education service provider, to bring you this new guidebook - Infection Control & Prevention in Long-Term Care: A Comprehensive Resource Manual.

A product of more than 16 years of infection control training and experience, Infection Control & Prevention in Long-Term Care is designed to help you develop policies and procedures to create a sustainable and effective infection control program in your healthcare facility. The guidebook seeks to address all of the major issues that every program should tackle, but you are encouraged to customize its contents to suit your hospital or nursing facility's specific needs.

Major Topics Include:

• Getting your infection control and prevention program started
• Orienting your new hires and volunteers
• Understanding isolation practices: respiratory hygiene, cough etiquette, and the three categories of transmission-based precautions
• Creating a bloodborne pathogen exposure control plan that complies with OSHA regulations
• Developing a suitable tuberculosis control plan for your facility
• Instituting comprehensive policies for all residents: immunizing and decontaminating them
• Disposing of or storing infectious waste
• Formulating an annual employee health review program
• Reacting to an outbreak: identifying and investigating the causes
• Addressing bioterrorism: how to prepare for and respond to an anthrax threat or influenza pandemic

The author presents this information succinctly, with illustrative examples, lists, charts, and diagrams. U.S. Occupational Safety and Health Administration and National Institute for Occupational Safety and Health regulations and policies are fully explained and sourced, as are the published findings of other infection control experts. The checklists and protocols in the appendices can be used as training tools, and the book's many tables and charts alert you to significant warning signs, instructing you on how to react appropriately in a variety of situations.

Readers take away from this book a thorough understanding of the how to create a long-term infection control preparedness program and handle virtually every aspect of it — from identification and investigation to eradication. And, using the book's many tools, readers can easily make the policy guidelines work in their own clinical environment, starting today.

Bonus CD-ROM: containing all of the interactive training tools. You can easily customize all of the lessons and examples presented in this manual to establish the policy and guidelines that will work in your particular facility, starting the day you receive Infection Control and Prevention in Long-Term Care: A Comprehensive Resource Manual..

About the Author

LINDA SPAULDING RNC, CIC has had a long career as an RN in acute-care hospital settings. Her interest in infection control began in 1992, and she has run her own Infection Control consulting business, InCo and Associates, for the past 15 years.  She serves as a nurse consultant to hospitals, clinics, nursing homes, physician's offices, prisons, airlines, fire departments and other local state and private businesses and industries. Ms. Spaulding's areas of expertise include all aspects of infection control and all licensing requirements mandated by agencies such as CMS, JCAHO, and OSHA.

Ms. Spaulding has been interviewed frequently on local Honolulu TV, and in local newspapers and medical magazines on subjects such as flu outbreaks, infection control practices, handwashing, Norovirus, avian influenza and the threats of biological terrorism.  She was awarded the 2003 National Educator of the Year Award by Infection Control Today magazine.

She has developed and lectured in a variety of educational programs and has published numerous articles in medical journals. Currently, she is working with a hospital in Florida and many long-term care facilities to develop an Emergency Preparedness and Disaster Management Program. Ms. Spaulding works closely with the State Department of Health and the CDC, and she is actively involved in the Hawaii, Florida and national APIC associations. She has served as President, Vice-President, Secretary and Education Chairperson for APIC-Hawaii.  Most recently, she participated in rewriting the APIC Professional Standards for Infection Control Practitioners, which is scheduled for publication later this year.

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Table of Contents

HOW TO USE THIS MANUAL
Introduction
1. Infection Control & Prevention
2. New Hire Orientation
3. Isolation Practices
4. Bloodborne Pathogens Exposure Control
5. Tuberculosis Control
6. Resident Care
7. Waste Management
8. Employee Health
9. Department Policies & Procedures
10. Outbreak Investigations
11. Emergency Preparedness

CHAPTER 1: INFECTION CONTROL & PREVENTION

• Introduction
• Purpose & Objectives of Infection Control
• Infection Control Practitioner
• Infection Control Plan
• Form 1.1: Infection Control Risk Assessment
• Facility Surveillance Methods
• Policy 1.1: Infection Control Team
• Form 1.2: Infection Control Competency Assessment
• Form 1.3: Meeting Minutes
• Policy 1.2: Surveillance System Policy
• Form 1.4: Infection Surveillance — Skin Infection
• Form 1.5: Infection Surveillance — Ear, Eye, Nose & Mouth Infection
• Form 1.6: Infection Surveillance — Respiratory Tract Infection
• Form 1.7: Infection Surveillance — Urinary Tract Infection
• Form 1.8: Infection Surveillance — Systemic Infection
• Form 1.9: Infection Surveillance — Gastrointestinal Tract Infection
• Policy 1.3: Reporting Communicable Diseases
• Table 1.1: Diseases That Must Be Reported

CHAPTER 2: NEW HIRE ORIENTATION

• Introduction
• General Orientation to Infection Control for New Hires, Contract Workers & Volunteers
• Form 2.1: Acknowledgment of Orientation
• Fact Sheet 2.1: Hepatitis B
• Fact Sheet 2.2: Hepatitis C
• Fact Sheet 2.3: HIV/AIDS — 8 Things You Need to Know
• Fact Sheet 2.4: Mycobacterium Tuberculosis
• Appendix 2.A: Preventing Allergic Reactions to Natural Rubber Latex In the Workplace
• Appendix 2.B: Preventing Needlestick Injuries in Health Care Settings

CHAPTER 3: ISOLATION PRACTICES

• Introduction
• Summary of the 2007 Isolation Guidelines
• Modes of Transmission
• Standard Precautions
• Three Categories of Transmission-Based Precautions
• Policy 3.1: Standard Precautions
• Policy 3.2: Respiratory Hygiene & Cough Etiquette
• Policy 3.3: Contact Precautions
• Figure 3.1: Donning PPE
• Figure 3.2: Removing PPE
• Policy 3.4: Droplet Precautions
• Policy 3.5: Airborne Precautions
• Table 3.1: Duration of Airborne Precautions
• Policy 3.6: Multidrug-Resistant Organisms
• Policy 3.7: Methicillin-Resistant Staphylococcus Aureus
• Table 3.2: Standard Precautions
• Table 3.3: Contact Precautions
• Policy 3.8: Vancomycin-Resistant Enterococcus
• Policy 3.9: Recreational Therapy
• Policy 3.10: Scabies
• Policy 3.11: Lice
• Appendix 3.A: Type & Duration of Precautions Needed for Selected Infections & Conditions

CHAPTER 4: BLOODBORNE PATHOGENS EXPOSURE CONTROL

• Introduction
• Form 4.1: Annual Needle Safety Evaluation
• Policy 4.1: Bloodborne Pathogen Exposure Control Plan
• Management of Health Care Personnel Potentially Exposed to HBV, HCV or HIV
• Policy 4.2: Hepatitis B Immunization Plan
• Form 4.2: Hepatitis B Vaccination Tracking
• Form 4.3: Hepatitis B Vaccination — Consent or Refusal
• Fact Sheet 4.1: Hepatitis B
• Appendix 4.A: Standard Precautions Barrier Checklist — Certified Nursing Assistant
• Appendix 4.B: Standard Precautions Barrier Checklist — Dietary
• Appendix 4.C: Standard Precautions Barrier Checklist — Environmental Services
• Appendix 4.D: Standard Precautions Barrier Checklist — Laundry Department
• Appendix 4.E: Standard Precautions Barrier Checklist — Maintenance
• Appendix 4.F: Standard Precautions Barrier Checklist — Nursing

CHAPTER 5: TUBERCULOSIS CONTROL PLAN

• Introduction
• Challenges Toward TB Elimination
• Policy 5.1: Tuberculosis Control Plan
• Table 5.1: Tuberculosis Exposure Control Plan
• Table 5.2: Factors Affecting Treatment Decisions During Medical & Diagnostic Evaluation by TST
• Table 5.3: Indications for the Two-Step TST
• Table 5.4: Ventilation Recommendations in New or Renovated Health Care Settings
• Table 5.5: Risk Classifications
• Policy 5.2: Annual TB Testing for Residents
• Policy 5.3: Postexposure to TB (Contact Investigation)
• Appendix 5.A: Tuberculosis (TB) Risk Assessment Worksheet
• Appendix 5.B: Quality Control Procedural Observation TST Checklist

CHAPTER 6: RESIDENT CARE PRACTICES

• Introduction
• Policy 6.1: Handwashing
• Policy 6.2: Immunization of Residents
• Policy 6.3: Cleaning of Stethoscopes
• Policy 6.4: Disinfection of Bedpans & Urinals
• Policy 6.5: Respiratory Therapy
• Policy 6.6: Incontinence Care
• Policy 6.7: Diapers & Underpads
• Policy 6.8: Disinfection of Measuring Graduates
• Policy 6.9: Disinfection of Suction Equipment & Ventilation Bags
• Policy 6.10: Suctioning Procedure
• Policy 6.11: Recreational Therapy
• Policy 6.12: Refrigerator Temperature Checks

CHAPTER 7: WASTE MANAGEMENT

• Introduction
• Definitions
• Policy 7.1: Infectious Waste Management
• Policy 7.2: Hazardous Materials
• Policy 7.3: Disposal of Contaminated Sharps

CHAPTER 8: EMPLOYEE HEALTH

• Introduction
• Purpose of the Employee Health Program
• Policy 8.1: Employee Health Program
• Form 8.1: Annual Employee Health Review
• Form 8.2: Influenza Vaccine — Declination Form
• Table 8.1: Personnel with Infectious Diseases
• Policy 8.2: Occupational Exposure Program
• Director of Human Resources Responsibility
• Table 8.2: Primary Side Effects Associated with Antiretroviral Agents
• Table 8.3: Recommended Postexposure Prophylaxis — Exposure to Hepatitis B Virus
• Table 8.4: Recommended HIV Postexposure Prophylaxis — Percutaneous Injuries
• Table 8.5: Recommended HIV Postexpsoure Prophylaxis — Mucous Membrane Exposures & Nonintact Skin
• Appendix 8.A: Additional Information Regarding Exposures
• Appendix 8.B: Occupational Exposure Management Resources

CHAPTER 9: DEPARTMENTAL POLICIES & PROCEDURES

• Introduction
• Policy 9.1. Food Handling
• Policy 9.2: Environmental Services
• Policy 9.3: Maintenance

CHAPTER 10: OUTBREAK INVESTIGATIONS

• Introduction
• Policy 10.1: Outbreak Investigation
• Form 10.1: Outbreak Investigation — Sample Line Listing

CHAPTER 11: EMERGENCY PREPAREDNESS

• Introduction—Bioterrorism
• Bioterrorism Preparedness
• Characteristics & Taxonomic Classification of Biological Agents
• _ Table 11.1: Biological Disease Characteristics
• _ Table 11.2: Biological Weapons
• Routes of Entry into the Victim
• Policy 11.1: Distinguishing Between an Epidemic of Natural Origin & a Biological Weapons Attack
• Introduction (Pandemic Flu)
• Appendix 11.A: Long-Term Care & Other Residential Facilities
• Pandemic Influenza Planning Checklist
• Appendix 11.B: Responding to Anthrax Threats

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