On August 10th, we partnered with the Canadian Standards Association (CSA) to host an official public consultation on improving infection prevention and control (IPAC) in long-term care.
Improving and standardizing operational concerns like cleaning and disinfecting processes, waste removal and use of technology, as well as facility considerations like HVAC, plumbing, medical gas systems and design of the physical environment is a critical component of the forthcoming national standards of long-term care. This new national standard of IPAC, currently in development, has been coined ‘Operation and infection prevention and control of long-term care homes (CSA Z8004).
We brought together our own CanAge Members with field experts and passionate advocates to discuss how (IPAC) and operations be updated in long-term care homes to enhance the safety and living conditions of older adults.
Going forward, we’ll be hosting more of these types of consultations, including one in the near future focused on national standards of care and services in long-term care, in collaboration with Health Standards Organization (HSO).
As always, our Members will continue to be first in line to lend their voices to these important conversations! Join now to stay informed.
What follows is a summary of key themes and takeaways from the Aug 10 session.
General
- Infection control standards need to be integrally linked to care standards
- Consider the point of view of the person. We have moral responsibilities when talking about care. It’s not a factory assembly line, but rather, a home.
- Need for Person-centered care to make things more home-like; One group defined Home-like as being “people you know, fewer people/strangers, having personal space, having outdoor spaces. Residents need sunshine and personal space.”
- Size of LTC (long-term care) Homes:
- Different standards exist depending on the size of the institution? – Yes!
- New care homes should be up to standards that look well into the future.
- Intuitive design should be considered and developed.
- Most of the standards for care facilities are based on physical difficulties and not cognitive difficulties, resulting in additional difficulties for those with cognitive decline. E.g. door handles on automated doors create confusion when they don’t have a function.
THEMES
Infrastructure
- Balance of privacy vs personal interaction
- Private rooms (which allow for personal items and furniture)
- assist in keeping people apart for infectious reasons, mental health, and social reasons.
- Furniture: either be able to bring their own or have better/more options for materials that are easy to clean but still comfortable and fashionable.
- Standards needed for mattresses and pillows (to name a few). Need to monitor and check items in a person’s room and all common spaces for aging, odor…
- Private Washrooms are a must.
- Provide options for couples to live together.
- Construct floors with doors that can create specific zones in case of outbreaks
- Centralize nursing stations
- Minimize all through traffic – think about them as a neighbourhood – you don’t take a meandering route – ie. meals should be direct to rooms, not having to go through a variety of areas. Cohorting of staff where staff that are in one area of the home:
- a) leads to person centered care but
- b) reduces transmission of infection Staff working on one floor or one pod at a time.
- HVAC: proper heating, AC, and filtering for odors and at the microbial level.
- HVAC: Responsibility for maintenance is not always clear. No fresh air returned.
- Air isolation rooms with negative pressure in the room (exists in acute care units) – maybe include in some specific contexts in LTC
- Some infections spread by spores (not microbes) need to be physically washed (not killed with alcohol). E.g. C. difficile
- Rooms without sinks are problematic.
- Climate change and extreme weather events:
- Extreme Heat or Winter Storms – Making sure pipes can survive in extreme weather, making sure units have AC, updating and educating on exit plans and evacuation strategies.
- Windows: windows should be allowed to be opened. Fresh air, nature, birds…
- Easy access to outdoor spaces: very necessary! Access should be provided without having to have a staff take you (wherever possible.)
- Safety concerns – need an improved way to protect wanderers/ with dementia, while being protected and traced/tracked safely. Current wander protection systems shuts off the resident from many spaces and outdoor facilities and can lead to social isolation.
- Floor covering and fabrics. IPAC encourages shiny clean surfaces, but this is not very homelike and can cause issues for those with dementia such as glare.
- Physical spaces, individual kitchens and dining rooms for each ward.
- Separate entrances to get to each wing. Common areas are separate. Meal service is isolated.
IPAC Training and Specifics
- Build IPAC capacity within each home so there is an IPAC practitioner for each home. A dedicated IPAC practitioner in each home would be responsible for education and to provide advice to staff, residents, and visitors.
- Education around infections and IPAC helps keep people motivated. Make educational resources more user friendly. Encourage self care through education.
- PPE training should not just be for on-site staff but also available to anyone who wants to visit the home – visitors, caregivers, outside suppliers such as hairdressers and optometrists
- Training needs to be available in a variety of ways not just online
- Retraining needed annually at a minimum
Antimicrobial Stewardship
- Screening: improving and updating systems that are automated and use less human resources; example: to supervise cleaning, utilize tools that can determine the cleanliness of a surface. Improve tracking and screening of individuals entering LTC.
- Should reconsider how UTIs, or similar conditions are managed. Currently, many are over diagnosed and antibiotics are given frequently. This decreases the good bacteria in the body which leads to more resistant organisms.
Cultural and Spiritual Challenges
- Allow for the use of cultural/spiritual practices (bearing in mind smoke and fire suppression, flammable materials, disinfection of surfaces, etc.)
Technology
- LTC Homes need better technological (IT) support.
- It is critical to address Internet dead zones.
- Accessibility to things like an Ipad per person to allow for social connection during pandemics in times of crisis to help connect people to their loved ones.
- Adopt best practices from other countries. Example: in Denmark, continuing care homes use incontinence briefs that send a sensor when they need to be changed. Another example is AARP equity by design principles – spaces and places should be equitable, accessible and safe.
- Learn from the successes that we did see in many homes
- Would like to see an auditing process for cleaning ex: using a surface reader to determine cleanliness of surface.
- Assistive tech/ageing in place tech – how can technology be optimized to help with IPAC, what exists currently and how can we encourage new tech? Can robotics be utilized?
Staffing
- Need for specialized staff training with proper wages and compensation.
- Address the issue of permanent vs. part time workers. A part-time worker has to work at more than one home to make a living. This increases the risk of infection.
- One success: homes where a Multidisciplinary team approach was evident and being used; the team took it upon themselves to lead and best practices going forward; they felt they had clinical and moral duties to serve. Took it upon themselves to cover and support team members when they were ill, they were all there for each other coming together as teams of leaders providing care. How wonderful it happened, but why did it take a crisis to bring them all together in this way?
- Other resources for staff such as training, psychological resilience, ongoing support, etc.
Dementia
- People living with dementia make up 80% of residents, but there is limited space for them.
- Safety concerns – need an improved way to protect people living with dementia who wander between rooms, while being protected and traced/tracked safely. Current wander protection systems shuts off the resident from many spaces and outdoor facilities which can lead to social isolation.
- Management of dementia throughout its life course. Dementia is an under-recognized/appreciated medical condition that is often misinterpreted. In LTC, this complicates infection and control.
Funding and Political Will
- Resources and funding are very important to accompany these new standards
- Political will and clout are needed to get the new standards implemented.
- Political will and clout are also needed to reduce the hodge podge of standards and oversight across the country.
- Again, look to the successes and best practices in other countries – Denmark spends a larger percentage of its budget on Long-term Care than Canada.
Vaccinations
- Either strict reporting and disclosing of status or
- Mandatory vaccinations for all staff and all visitors including outside services that come into the home (podiatry, hairdressing, eye care).
Social
- Ensure older people and caregivers have been asked and consulted for their voices to be heard,and make extra efforts to give groups that don’t have that much voice to make sure they’re heard (i.e. marginalized folks).
- Look not only at the medicalized practices but also the social types of practices, make sure the isolation isn’t going to happen again, ensure connections to family, friends, volunteers, etc. Remember to pay attention to social issues!
- Emotion-based care vs clinical-based care is a balancing act
- Spending time with residents but entering rooms with full PPE – hard to identify staff, how to create a human look?
- One idea was to use a 7am huddle to check in with everyone, used humour to relieve tension
- Need a standard for education for the family and resident prior to entry to a Long-term Care Home. Perhaps a training and education tool. Need to set family expectations before a resident is admitted.
- Family communication is key so they know what’s happening and who’s taking care of the residents. Both during regular times and during times of crisis.
- There is a need to see family caregivers as an essential part of LTC care teams.