From the Guidelines
A small behavioral residential treatment facility in King County, WA should implement comprehensive infection control measures, including standard precautions, transmission-based precautions, and specific disease protocols, to prevent and manage facility-associated infections, with a focus on TB, emerging infectious diseases, and other infections such as UTIs, influenza-like illness, pneumonia, LRTIs, cellulitis, scabies, gastroenteritis, norovirus, C. difficile, and conjunctivitis.
Infection Control Measures
The facility should establish the following measures:
- Standard precautions, including hand hygiene with alcohol-based hand sanitizers or soap and water, proper use of personal protective equipment (gloves, masks, gowns), safe injection practices, respiratory hygiene/cough etiquette, and environmental cleaning with EPA-registered disinfectants 1.
- TB screening protocols, including baseline testing of residents and staff using either tuberculin skin tests or interferon-gamma release assays, with follow-up chest X-rays for positive results 1.
- Surveillance systems, isolation capabilities, and communication protocols with King County Public Health for emerging infectious diseases.
- Disease-specific measures, such as:
- Antibiotic stewardship for UTIs.
- Annual influenza vaccination and pneumococcal vaccination for eligible residents.
- Contact precautions for scabies (permethrin 5% cream treatment).
- Enhanced cleaning for norovirus and C. difficile outbreaks using bleach-based disinfectants.
Staff Education and Training
Staff education is essential, covering:
- Proper hand hygiene.
- PPE use.
- Recognition of infection signs. The facility should designate an infection control coordinator, maintain adequate supplies, and develop written policies for outbreak management.
Risk Assessment and Prioritization
The facility should conduct a risk assessment to identify areas of high risk for infection transmission, including:
- Probability of occurrence: high risk for TB, emerging infectious diseases, and other infections.
- Risk level of failure: life-threatening for TB, emerging infectious diseases, and other infections.
- Potential change in care: high for TB, emerging infectious diseases, and other infections.
- Preparedness: good for standard precautions, but poor for specific disease protocols. The facility should prioritize areas with a ranking score of 8 or higher for improvement efforts.
Implementation and Monitoring
The facility should implement the recommended infection control measures and monitor infection rates regularly, updating protocols based on local health department guidance to maintain effective infection control 1.
From the Research
Infection Control Risk Assessment for Small Behavioral Facility Residential Treatment Facility
Event: Risk of TB in the Community
- Probability of occurrence: 2 (medium)
- Risk level of failure: 3 (life threatening)
- Potential change in care: 2 (moderate)
- Preparedness: 2 (fair)
- Ranking score: 9 (high priority for improvement efforts)
Event: Risk of Emerging Infectious Disease in the Community
- Probability of occurrence: 2 (medium)
- Risk level of failure: 3 (life threatening)
- Potential change in care: 2 (moderate)
- Preparedness: 2 (fair)
- Ranking score: 9 (high priority for improvement efforts)
Facility-Associated Infections
Symptomatic Urinary Tract Infection
- Probability of occurrence: 2 (medium)
- Risk level of failure: 2 (moderate)
- Potential change in care: 2 (moderate)
- Preparedness: 2 (fair)
- Ranking score: 8 (high priority for improvement efforts) Effective management of urinary tract infections (UTIs) can be achieved through the use of antimicrobial agents with favourable pharmacokinetic/pharmacodynamic profiles, such as extended-release ciprofloxacin 2.
Influenza-Like Illness
- Probability of occurrence: 2 (medium)
- Risk level of failure: 2 (moderate)
- Potential change in care: 2 (moderate)
- Preparedness: 2 (fair)
- Ranking score: 8 (high priority for improvement efforts) Infection prevention and control (IPC) measures, including hand hygiene, use of personal protective equipment, and environmental cleaning, are crucial in preventing the spread of influenza-like illness 3.
Pneumonia
- Probability of occurrence: 2 (medium)
- Risk level of failure: 3 (life threatening)
- Potential change in care: 2 (moderate)
- Preparedness: 2 (fair)
- Ranking score: 9 (high priority for improvement efforts) IPC measures, such as hand hygiene and use of personal protective equipment, can help prevent the spread of pneumonia 3.
Lower Respiratory Tract Infections (LRTIs)
- Probability of occurrence: 2 (medium)
- Risk level of failure: 2 (moderate)
- Potential change in care: 2 (moderate)
- Preparedness: 2 (fair)
- Ranking score: 8 (high priority for improvement efforts) IPC measures, including hand hygiene and environmental cleaning, can help prevent the spread of LRTIs 3.
Cellulitis/Soft Tissue Infection
- Probability of occurrence: 1 (low)
- Risk level of failure: 2 (moderate)
- Potential change in care: 1 (low)
- Preparedness: 2 (fair)
- Ranking score: 6 (moderate priority for improvement efforts)
Scabies
- Probability of occurrence: 1 (low)
- Risk level of failure: 1 (low)
- Potential change in care: 1 (low)
- Preparedness: 2 (fair)
- Ranking score: 5 (low priority for improvement efforts)
Gastroenteritis
- Probability of occurrence: 2 (medium)
- Risk level of failure: 2 (moderate)
- Potential change in care: 2 (moderate)
- Preparedness: 2 (fair)
- Ranking score: 8 (high priority for improvement efforts) IPC measures, including hand hygiene and environmental cleaning, can help prevent the spread of gastroenteritis 3.
Norovirus
- Probability of occurrence: 2 (medium)
- Risk level of failure: 2 (moderate)
- Potential change in care: 2 (moderate)
- Preparedness: 2 (fair)
- Ranking score: 8 (high priority for improvement efforts) IPC measures, including hand hygiene and environmental cleaning, can help prevent the spread of norovirus 3.
Clostridium difficile
- Probability of occurrence: 2 (medium)
- Risk level of failure: 3 (life threatening)
- Potential change in care: 2 (moderate)
- Preparedness: 2 (fair)
- Ranking score: 9 (high priority for improvement efforts) IPC measures, including hand hygiene and environmental cleaning, can help prevent the spread of Clostridium difficile 3.
Conjunctivitis
- Probability of occurrence: 1 (low)
- Risk level of failure: 1 (low)
- Potential change in care: 1 (low)
- Preparedness: 2 (fair)
- Ranking score: 5 (low priority for improvement efforts)
Infection Control Measures
- Implement IPC measures, including hand hygiene, use of personal protective equipment, and environmental cleaning 3.
- Develop and implement a best-practice algorithm for the empiric treatment of uncomplicated urinary tract infections 4.
- Use antimicrobial agents with favourable pharmacokinetic/pharmacodynamic profiles, such as extended-release ciprofloxacin, to treat urinary tract infections 2.
- Implement bundled behavioural interventions to control healthcare-associated infections, including education, compliance monitoring, and feedback 5.
- Conduct regular risk assessments and reviews of infection control measures to ensure preparedness and effectiveness 6.