8 DECEMBER - JANUARYELDERCARE REVIEWTo begin, let's review the basics of skilled nursing facilities (SNF). These are the primary locations of residence for the elderly population, who are no longer able to independently care for themselves in their home environment. Residents are often admitted to SNF following a hospitalization for an illness, an injury, or a decline in function, and they may reside in the facility for a short time of recovery while others remain indefinitely. Most SNFs are composed of semi-private rooms, so once admitted, a resident will likely share a room with another resident; one may compare this to a college dorm in its similarity. SNFs have shared dining spaces and common areas for activities and events. The majority of SNF residents are elderly people with aging bodies and systems, including their immune systems. Infections are not caused by aging, but as the body ages, all systems fail to function as well as they once did. Residents are admitted with a list of diagnoses and an accompanying list of medications they must regularly take as prescribed. The effects of disease processes, coupled with the effects of medications and the effects of aging, can predispose residents to increased infection susceptibility.Because of the dorm-like living environment, aging effects, and varied diseases and illnesses present when a person enters a skilled nursing facility, residents who live in SNFs are at a greater risk of acquiring transmissible infections than elderly persons living in their own homes. In the facility, infection prevention and control practices must be married to homelike living as well as healthcare facility infection control practices. What does this mean? Unlike in a hospital, residents in SNFs are encouraged to bring personal items and decorations from home to create their own homelike space. Because this is a residence and community, residents are encouraged not to stay in their rooms but to engage in activities, exercise, dining, and socialization outside of their rooms. Think college dorm life again. The intent of a skilled nursing facility is to provide healthcare that meets medical, physical, social, spiritual, and emotional needs for each resident in order to provide the best quality of life possible at this point in their life's continuum. Resident rooms are not like hospital rooms but are geared toward personalization. Federal regulations for skilled nursing facilities created by the Centers for Medicare and Medicaid Services (CMS) address isolation to control the spread of infection this way: "isolation should be the least restrictive possible for the resident under the circumstances." Skilled nursing facility staff realize that keeping a resident in isolation for an extended period of time to prevent the spread of an infection greatly reduces the resident's quality of life and can be detrimental to their overall health and wellbeing. To combat infection risks, SNFs combine knowledge of the environment, resident population, and medical histories to understand unique infection prevention and control challenges. Microorganisms, specifically bacteria, are ubiquitous. Many residents who live in SNFs have been treated for an infection caused by bacteria within the past year. Often, after the acute infection is resolved, these bacteria remain in or on the INFECTION CONTROL AMONG THE ELDERLY IN TODAY'S SKILLED NURSING FACILITIESBonnie ChustzBy Bonnie Chustz, MSN Ed, RN, CIC, LTC-CIP, Corporate Director, Education & Professional Development, Centers Health Care
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