Infection Control and Prevention in Nursing Homes
Are nursing homes doing enough to stop the spread of deadly infections? Poor infection control can lead to serious illness, outbreaks, and even death among vulnerable residents. Knowing the right protocols—and making sure they’re followed—is key to prevention. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Bonnie McCormick to talk about how infections spread in nursing homes, what prevention looks like, and what families should expect from proper infection control.
McCormick:
I would say families can help by practicing good hand hygiene when visiting, but also staying up to date on their vaccinations, like their flu shots, their Covid Ovid 19 Vaccina vaccination, avoiding visiting when they’re sick. They’re seeing this. They need to be the advocate because their loved one can’t always speak for themselves.
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I’ll be your host for this episode. Talking about infection prevention in nursing homes from a generalized standpoint. We’re gonna talk about, we’re gonna be talking about universal precautions, making sure to wash your hands and making sure that, you take your Lee Press on nails.
Off before you go into your work on the shift, but we’re not doing that alone. We have the fantastic Bonnie McCormick with us to help us through this process.
We are pleased to have on Bonnie McCormick to talk about infections generally in nursing homes. Bonnie McCormick is a seasoned nurse. With nearly 32 years of experience bringing a strong clinical background in both hospital and long-term care settings. She also has extensive expertise in the managed care industry.
For experienced legal nurse consulting services related to long-term care cases, visit Sunshine Nurse Consulting.
Since 2018, Bonnie has worked as a legal nurse consultant and as a certified life care planner, a dedicated patient advocate Throughout her career, she remains committed to improving healthcare outcomes. Bonnie resides in Jacksonville, Florida with her husband and four. Sons and we are so happy to have her on the show today.
Bonnie, welcome to the show.
McCormick:
Thank you.
What are the most common infections in nursing homes?
Schenk:
It’s not uncommon that I get calls from potential clients and their loved one is in ICU with sepsis or septic shock, and. That’s almost always, as far as I know, there is an underlying infection. Okay. In your experience, what are some of the more common types of infections that you see in nursing homes that will cause a person to end up in the ICU with that sepsis, septic shock?
McCormick:
I would say that there’s a top three or four. The most common infections would be urinary tract infections soft tissue infections, gastrointestinal infections, like c diff or, one of these or even respiratory infections. Those I think would probably be the most common that we see.
Review the latest research on the impact of preventive health measures in elderly populations.
How can staff prevent infections from spreading?
Schenk:
Okay. So walk me through then. From, walk me through the types of prevention methods that a nursing home staff member can take to prevent the UTI to prevent the c diff to prevent the gastrointestinal infections. What are they doing on their end?
McCormick:
Ideally and theoretically, staff can prevent infections by following strict infection control protocols, like proper hand hygiene, using personal protective equipment.
PPE when necessary, regularly disinfecting the surfaces and the medical equipment, ensuring proper catheter wound care. Sometimes having to isolate the residents with contagious, illnesses. Most nursing homes do have vaccination programs for their residents and their staff, and that can help.
Whenever you have a lot of people who are somewhat elderly and immunocompromised infection is always gonna play a role in their quality of life.
Learn more about recent findings on respiratory complications among nursing home residents.
What infection control policies should every facility follow?
Schenk:
Typically. How, like you, you mentioned infection control protocol. What typically is involved in, in, in a typical policy for infection control?
I understand using PPE and stuff like that, but is it PPE as soon as you walk in the building? Is it PPE only when you’re interacting with people? Can you explain, walk me through the typical protocol.
McCormick:
PPE should be used anytime you have, you’re going to be coming in contact with anybody’s bodily fluids.
So you know, if someone is going to be changing an adult brief, changing out catheter emptying the catheter bag, helping someone use the restroom, giving you know, oral hygiene, any of those type that you’re going to be. Interacting with someone’s bodily fluids, you absolutely have to wear gloves and wash your hands after you take them off and use a alcohol-based sanitizer.
Hand sanitizer that is proper. Basically what we call universal precautions. When you have someone who has something like c diff, which is very contagious, and is a hospital, usually hospital acquired illness, you have to take into account that they probably need to be isolated so that doesn’t spread.
Explore emerging clinical evidence on infection-related mortality in long-term care settings.
And as far as the respiratory infections, we went through this whole thing with COVID-19. Remember the. Who doesn’t remember that? That has to be taken into account as well when you have respiratory infections that there should be some kind of mask used. And sometimes depending on the infection, you may have to use full body.
The yellow gowns that are the ha not hazmat suits, but there are yellow gowns that you can wear that cover up your scrubs. If you’re going into a room that has, another type like RSV or any of those type of illnesses that can be. Passed back and forth between the residents. So the CDC and CMS both have really good guidelines on infection control and nursing homes should be following them to a t.
Understand the risks of delayed diagnosis on urinary tract infections and sepsis in older adults.
Schenk:
You mentioned that c diff might require that a resident be isolated. What sometimes what are some other infections that might require that you quarantine a resident.
McCormick:
Obviously tuberculosis, that’s a big one. And covid as well. That’s when, those are probably the big ones.
We don’t see, sometimes we see a whole rush on tuberculosis. In this country it’s not as bad as in other countries, but tuberculosis has always been a pandemic and it’s been epidemic all over the world. So if it’s something really contagious like that, then obviously they probably shouldn’t be in a nursing home and they probably should go.
Discover new insights on infection control policy improvements in nursing homes.
Schenk:
Yeah. So tell me then about, okay, so you have a resident that has c diff or COVID-19 or some type of infectious, a respiratory disease. What, when we say they need to be isolated, what typically does that mean? Is it just like they all right, roommate, you gotta get out Or does it mean in the movie, what is it, the movie outbreak, they’re like duct taping, plastic and stuff kind.
Kind of walk me through that process.
Listen to our legal discussion on when nursing homes can be held liable for infections and the standards of care involved.
McCormick:
In a typical COVID-19 environment, no, there’s not outbreak where you have, the people in the moon suits and, all right, it’s not quite like that, theoretically the CDC has said, a six foot distance for COVID-19. And if you have a roommate then I.
Sometimes you can keep that distance and you have, but it’s not ideal to have two people who are in, someone who’s infectious in a room with someone who’s not infectious. But it can be done if you are really strict with, your proper hand hygiene, your PPE and separation. It’s not always possible to do that in close quarters.
So if someone needs to be isolated, ideally they would have their own room.
Learn how pandemic regulations have changed legal responsibilities by reading our blog on coronavirus laws for nursing homes.
What role does hand hygiene play in infection control?
Schenk:
So you mentioned universal precautions. What are some myths about universal precautions that maybe that you found? So for example you gotta sing the birthday song twice, washing your hands. Are there any like that the public should know about?
McCormick:
Well, it’s interesting. I’ve taught universal precautions in nursing homes for years and years as a consultant for the state of Colorado. And I would go into these places and people would think just because they ran their hands underwater, and wiped ’em off on their jeans, their scrubs, that was hand washing.
And it’s really not. You really do need to use soap with warm water and scrub your hands so that the, you’re actually scrubbing the germs off of your hands and into the sink. It’s literally a mechanical. Motion of taking those germs and running it in under the water, using soaps as an exfoliant, basically to, to get the germs off of your hands and into the sink.
Watch our video FAQ to find out whether a urinary tract infection can be a sign of nursing home neglect.
And then when you’re done with that, drying off with a clean towel and using that towel to open the door if you’re in a bathroom, because a lot of people don’t wash their hands, and then you’re just contaminating yourself again. When you leave the bathroom. And the other thing that’s, it, some of the myths are that about hand washing that you just, it’s not important or you just have to run your hands under the water.
And I always recommend even if you wash your hands and dry them and do the towel on the doorknob and all that, to use an alcohol-based hand sanitizer after. Because at least that way, you’re getting two different ways of killing germs. You’re getting the germs off of your hands by washing them in the sink, and then you’re using an alcohol-based sanitizer to actually kill any other germs that may still remain on your hands.
Explore the serious health consequences that occur when a urinary tract infection leads to death.
Schenk:
I was recently reading a survey. From Georgia of a nursing home, and it’s gotta be really bad when the surveyor like really gets in depth on certain things. ‘Cause at least in Georgia, the surveys are not really like super specific on things. It’s like very general. But this particular survey was like, nurse A had press on nails, fake nails that were three inches long.
And they were cited for the hygiene statute. I, I don’t know that was a, this they must have really made the survey matic. ’cause like I feel like that’s something that, that wouldn’t go in a typical survey. But anyway I guess universal precautions and nursing would say don’t have extremely long fake fingernails.
McCormick:
The protocol in, I have an ICU background hospital, ICU background. None of those nail products are allowed in a hospital environment. You’re not allowed to have gel nails, acrylic nails, press on nails, none of that. You can only have natural nails. And if want, you can have a layer of clear nail polish on there, just.
For strength purposes, but those type of additives to your hands are just little germ catchers. And also another thing is excessive jewelry. If people have on a ton of rings and bracelets and this and that. Bacteria and can get hung up in the jewelry. And if you don’t scrub those really well, then you’re not really getting your hands clean.
Read about a recent scabies outbreak in an Illinois nursing home and what families can do when signs of neglect appear.
How can families help prevent infections in nursing homes?
Schenk:
What would you say? What? If you have a family that has a loved one in a nursing home and they’re concerned, what would you, what advice would you offer them in terms of Hey, here’s how you can prevent infections in your loved one?
McCormick:
I would say families can help by practicing good hand hygiene When visiting, I’m big on, I’m in the Florence Nightingale school of nursing where good hygiene, good hand hygiene is paramount.
But also staying up to date on their vaccinations, like their flu shots, their COVID-19 vaccina vaccination avoiding visiting when they’re sick. Or if they, wanna wear a mask if their loved one is particularly susceptible to respiratory infections. You can always wear a mask. But just really encourage proper hygiene.
And they should also advocate for their family members, to ensure that the facility follows infection control procedures. And if they have a caregiver with three inch nails and who’s not wearing gloves, how can you wear gloves with three inch nails, and. If they’re seeing this, they need to be the advocate because their loved one can’t always speak for themselves.
Understand the legal process and steps to take when seeking help for nursing home abuse in Georgia.
How are residents with infections typically treated?
Schenk:
So we talked about prevention. We talked about, these are the things that we can do to prevent the infections. Let’s talk about the signs and symptoms of infection. So typically, what are you, what kind of causes alarm bells to go off in your head as a nurse and a resident where you suspect an infection of some kind?
McCormick:
As a nurse, I always look at vital signs first. Do they have a fever? ’cause that’s a big sign of infection. But not everybody is gonna run a fever when they have an infection, especially an elderly person whose immune system is not working the way that a younger person’s immune system is working.
Of course I’m gonna look at their vital signs and see if something is off. But as a family member, if it’s someone, your loved one, you’re going in there and you notice that they’re just acting different, like maybe their mental status is. Off, and that’s not their baseline, just something off of their baseline.
You can get a gut feeling for something is going on. A big red flag for me, for UTI is a change in cognition. So when elderly people get urinary tract infections and they do a lot. One of the first signs is actually they have a change of mental status. And so anytime somebody’s mental status changes, you have to really dig in and see what is going on with that person and look at the bigger picture.
Because there’s, it may not be something but it, like I said, there’s a lot of stuff that goes on in nursing homes and a lot of infection that floats around. And so you don’t wanna let those signs and symptoms go by the wayside.
Learn about the most common infections found in nursing home residents and how to recognize early warning signs.
Schenk:
I think that’s so interesting that, the one of the one of the first, excuse me, one of the first telltale signs of.
Of UTI is that behavioral change. It’s the person is seeing their ex-spouse from 50 years ago out the window kind of thing, as opposed to say foul colored, smelling urine, or cloudy urine or with pneumonia. There’s, they’re not coughing up along or something. It’s that, it’s the cognition and the behavior change that should start to signal, Hey, let’s look and see what type of infection that could be.
Discover preventive strategies in our podcast on how to prevent sepsis in Georgia nursing homes.
McCormick:
And that’s because their bodies are not responding the way they used to. As people age and as they decline in their health, their bodies do not respond as quickly. They don’t run the fever as quickly. They don’t their lungs aren’t strong enough to start coughing up the gunk that’s gonna collecting in their lungs.
They may be weak. And so that’s why sometimes the, that’s probably happening, the urine is probably getting cloudy and they’re probably getting some blood in the urine. But until someone’s actually looking at it, one of the best ways to know if you’re just sitting in the room is just talk to the person and see if they’re changed.
That’s one of the best ways.
Find out how families and facilities can work together in preventing UTIs in Georgia nursing homes.
Schenk:
Bonnie, thank you so much for coming on the show and sharing your knowledge with us. I.
McCormick:
Thank you for having me. I enjoyed it very much
Schenk:
Folks. I hope that you enjoyed this episode. I hope that you found it educational. If you have any ideas for topics that you would like for me to talk about, please let me know.
If you have any ideas for guests that you would like for me to talk to, please let me know that as well. Also please be sure to try and win the coffee mug or just tell me that you won a coffee mug. I think at this point, I’m not sure if anybody has won. A coffee mug yet, and there are several boxes of coffee mugs at my house that are taking up room and my wife is gonna get mad at me.
So be sure to enter the contest to win the coffee mugs. If you enter, I promise you it’s highly likely that you will win. New episodes of the podcast, come out every Monday. And with that folks, we’ll see you next time.
Bonnie McCormick’s Contact Information:
- Sunshine Nurse