by C. Lyn Walter

Created on: February 06, 2010

Preventing the transmission of infection in long term care is accomplished by preventing resident, employee and visitor exposure to infectious diseases. The Infection Preventionist, formerly known as Infection Control Practitioner, is usually a Registered or Licensed Vocational Nurse with special education and experience in Infection Prevention and Control. Their primary focus is to prevent and control the spread of infection.

The Preventionist works with many diverse and vulnerable populations in long-term Care, monitoring and planning for the control and prevention of communicable diseases such as Influenza, Infectious Gastroenteritis, Upper and Lower Respiratory Infections, Urinary Tract Infections, Scabies, Skin infections, Wound Infections, Tuberculosis, Multidrug Resistant Organisms and Blood Borne Pathogens such as Hepatitis B, C, HIV and AIDS. This is a comprehensive position, one that requires a nurse with expertise in the field of Infection Prevention to manage effectively.

Disease prevention, surveillance, health promotion and maintenance begin with nursing education and include the dissemination of timely information on Infection Prevention to all employees. Once the staff is educated to the basics of Infection Control and Prevention they are in a position to protect themselves, residents, families and visitors as well.

Preventing the transmission of infection in long term care is accomplished by preventing environmental exposure to infectious diseases, thereby preventing outbreaks that place residents, employees and visitors at risk. Interrupting transmission of infectious agents in everyday situations is known as Breaking the Chain of Infection. This term uses a metaphor to create a visual interpretation; each link in the chain depends on the last and the next, in order to continue. Break one link and the connection is interrupted.   

To further explain there are six links in the chain of infection. They consist of: An infectious agent/a reservoir/a portal of exit/a mode of transmission/ a portal of entry and a susceptible host.

An example could be;

Mary has the H1N1 influenza virus but it has not yet caused any signs and symptoms; she is infectious 24-48 hours before she even knows she is sick. Mary is the infectious agent, she is also the daughter of a resident in a nursing home. While visiting her mother she casually rubs her nose (the reservoir for the infectious influenza) she then reaches out with her hand (Portal of exit) and shakes hands with her mother’s nurse. The nurse picks up the infectious influenza virus on her hands (Mode of transmission) and when she goes back to the nurse’s station, she rubs her eye (Portal of entry) with her now contaminated hand. The nurse (the Susceptible Host) has completed the chain of infection.

There was nothing done to break the chain of infection from the time Mary, began the process. How could the Chain of Infection have been broken?  

Mary could have washed her hands or used an alcohol sanitizer before and after rubbing her nose and before shaking hands with the nurse.

The nurse could have washed her hands after leaving the mother’s room and after shaking hands with Mary.

The nurse could have washed her hands before rubbing her eyes or touching any other mucous membranes, i.e. eyes, nose or mouth.

Breaking the Chain of Infection is the most important aspect of Infection Prevention and Control in nursing homes as it is in other settings. Educating health care workers, employees, patients and visitors to basic Infection Prevention is vitally important if we are to “Break the Chain of Infection”.  

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