Providers urged to use new IPC resource

The peak body for infection prevention and control professionals is encouraging aged care providers to utilise a new manual from the national healthcare standards agency that aims to put aged care residents at the centre of infection prevention and control interventions.

Released by the Australian Commission on Safety and Quality in Health Care at the end of August, the Aged Care Infection Prevention and Control Guide says, “Putting older people at the centre of IPC and enabling them to take part in their own care involves considering their needs … at all levels of decision-making.”

The authors add: “These considerations should be balanced with maintaining an environment where care can be delivered in a manner that minimises the spread of infection and the impact on others receiving and providing care.”

The development of the Aged Care IPC Guide recognised the uniqueness of the aged care setting and the need for an individualistic IPC approach, President of the Australasian College for Infection Prevention and Control Associate Professor Stéphane Bouchoucha said.

“ACIPC views the NHMRC Aged Care IPC Guide as an industry-tailored resource to support, lead and enhance practices across the sector,” he told Australian Ageing Agenda.

“The guide is certainly a step forward in the approach to bettering IPC in aged care and providing resident-centred care.”

Professor Bouchoucha said the maunal added to a suite of IPC resources designed to support IPC in aged care settings such as the NHMRC Aged Care IPC Guide, the Communicable Diseases Network Australia outbreak guidelines, the Aged Care Quality and Safety Commission aged care tools, and ACIPC’s Aged Care Community of Practice.

Aged care providers are encouraged to utilise the resources specialised to the sector, make them well known to their teams, and tailor them to the specificity of their settings. These resources provide some great information that needs to be adapted to the context to provide residents and their loved ones better outcomes and keep them free from preventable infections.

During the Covid-19 pandemic, many IPC interventions were criticised for being too extreme and prolonged. Residents spent weeks in isolation, confined to their rooms, separated from family and friends. Many experienced a decline in mental health and social wellbeing.

While the authors of the 199-page guide describe isolation as “an effective method for reducing the spread of infections”, they acknowledge that “prolonged periods of isolation can cause harm to the physical and psychological health of older people and can be challenging for older people with cognitive impairment”.

The guide recommends that the decision to implement isolation measures such as visitor restrictions should always be informed by a risk-based approach. “Employing a risk-based approach requires consideration of the hazards, the available controls, and the impacts of applying the controls.”

Elsewhere, the guide strongly recommends vaccination programs for aged care workers and residents. “Being up to date with vaccination decreases the risk for individuals (both young and old) of the serious effects of infections and also reduces the risk of transmission of infections to others.”

However, the authors stress – unless required under state or territory public health regulation – vaccination should not be enforced. “It should, however, be strongly encouraged, and programs that facilitate easy and timely access to vaccines should be put in place for both older people and aged care workers.”

Other prevention measures in the commission’s guide – which has also been informed by the Aged Care Quality and Safety Commission, the Department of Health and Aged Care, and the World Health Organisation – include the need for regular monitoring.

“Monitoring infections and IPC-related activities helps aged care organisations identify infection problems, the sizes of the problems and the factors that may be contributing to the problems.”

The authors also recommend antimicrobial stewardship. “Older people receiving aged care services experience higher rates of infection and have a higher overall rate of antimicrobial use compared to the general population.” Aged care services that prescribe, administer or oversee medication management must “maintain an AMS program to promote the appropriate use of antimicrobial medicines”.

Listing the core components of an effective IPC system, the authors include:

• standard and transmission-based precautions, including the correct use of personal protective equipment
• hand hygiene
• equipment reprocessing
• environmental cleaning
• waste management
• linen management
• sharps managements
• workforce health and safety
• aseptic technique
• management of infectious people
• workforce education and training
• continuous quality improvement.

Expanding on education and training, the authors say: “Aged care organisations have a responsibility to provide access to ongoing education and training for their workforce. IPC education and training should be provided by the aged care organisation, for all workers, as part of orientation, and continuous education as required to ensure workers have the necessary skills, qualifications and competencies to perform their roles.”

Processes for IPC systems in aged care should consider the key roles and responsibilities of:

• the IPC leads (or the person responsible for IPC)
• management teams
• the aged care workforce
• the older person.

For IPC systems to be effective in residential aged care, providers need to maintain connections to local health service networks, say the authors, including:

• local hospitals
• public health units
• primary health units
• general practitioners
• specialist medical practitioners
• other specialist services, including allied health.

As the authors highlight: “the structure of IPC systems for aged care will differ depending on the service context, the older person’s care needs and the workforce.”

Decisions about IPC systems and practices should, say the guide’s authors, be informed by sound clinical judgement and discussions with everyone involved in aged care: providers, workers, carers, families, other healthcare professionals and – crucially of all – older people themselves.

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