Infection Prevention in the Long-Term Care Showering and Bathing Areas

With the advent of the Requirements of Participation in Long-Term Care, one of the more challenging parts concerns the QAPI (Quality Assurance/Performance Improvement) criteria. Basically, baselines are being set for quality, and once set, improvement is to be expected moving forward.

As facilities look for ways to improve on the Infection Prevention criteria, one of the areas certain to gain focus is the hygiene/central bathing areas. Due to the workload in these areas and the equipment used, there can be cause for concern that proper cleaning and disinfecting is being practiced. Daily, clients, by the dozens, are being cleaned and cared for in these areas. Duties performed include immersion bathing, showering, toileting, bowel and bladder training, pedicures and more. The equipment used for these tasks is often used on several different clients each. If there is to be improvements in the Infection Prevention efforts of facilities, proper cleaning of said equipment must be performed between each client.

From a Quality of Care perspective, this is extremely important for several reasons. First, the obvious, some clients in facilities may have infections such as UTI’s or C-Diff. Second, incontinence is common in the showering/bathing task and can affect not only the equipment, but the floors and other surfaces. Other reasons include basic cleanliness, care of the equipment and the overall well-being of the client. There are several efficient ways to clean the equipment. It’s important the choice of a cleaner have cidal effects on common strains like Staph and Pseudomonas as we well as the above, C-Diff. Basic quaternary cleaners generally achieve these results. The most important aspect of cleaning the equipment however, and the most difficult, is proper training of staff and commitment the cleaning be performed correctly and allow for proper kill times.

Then, there is the equipment used. In a perfect world, all equipment used for these tasks would have smooth surfaces, top to bottom, easily cleaned, but that’s not the case. However, some are much easier to clean than others, and moving forward while addressing QAPI issues, the ease of equipment cleaning must be considered. Long standing issues still prevalent today include mesh surfaces, cloth/absorbent materials, right angle/nook and cranny spaces and soft/cushioned materials that crack too easy. Minimizing these features in your hygiene equipment can be a clear and quantifiable improvement of your Infection Prevention efforts. The issues of conventional equipment can be addressed effectively, however, the time and labor of doing so is much more arduous.

There are products designed to address Infection Prevention specifically and as part of an overall improved hygiene process. These products are largely designed with smooth, easy-to-clean surfaces, minimize crevices and avoid absorbent materials of any kind. Groups marketing these products include: ProCare Medical, Lopital, Pioneer Medical and Arjo to name a few. Facilities currently focused on improvement of hygiene care with a spotlight on Infection Prevention could greatly benefit from equipment engineered this way. This type equipment will require additional investment, but, and very important, if just one infection is prevented per year, the shrewdness becomes clear.