Bringing hospital IPC rigour to aged care
Like their registered nurse (RN) colleagues in emergency care, RNs in residential aged care facilities (RACFs) are the frontline workers responsible for the health and safety of residents.
Unlike their colleagues in emergency care, their environment is much less clinical, making it hard to achieve the same rigour when it comes to infection prevention and control (IPC).
“Aged care facilities are, by definition, considered social care settings, not healthcare facilities,” said Professor Ramon Shaban of the University of Sydney.
“They are designed to resemble a home environment to the fullest extent possible. Certainly, that is a positive from an experiential point of view, but in the context of IPC, it can present a challenge.
“There are a lot more communal areas for socialising and eating, for example, which makes much easier to spread infection.”
While IPC matters in both settings, its pertinence is amplified in aged care, where users tend to have more health complications.
Around 80% of Australians aged 65 and over live with a chronic health condition and 28% live with three or more, giving them greater susceptibility to communicable disease.
During COVID-19, outbreaks in aged care settings were among the deadliest, with disproportionally high rates of infection and death compared to the general community.
Thankfully, COVID-19 was a turning point for aged care, where a heightened level of IPC rigour is now seen in all facets of the sector.
However, there is still room for improvement, with more than half of Australian aged care facilities reporting a lack of specialist IPC staff and just 23% having a dedicated IPC committee.
Technology can help fill the gaps
Professor Shaban together with Professor Kate Curtis and their colleagues are hoping to address this issue with a world-first tool, known as HIRAID Aged Care.
Funded by the Medical Research Future Fund, the tool will help nurses make systematised assessments and optimal decisions when managing IPC in residential aged care facilities.
Initially designed for emergency departments (EDs) — where it is now being used successfully — Shaban and colleagues are currently modifying it specifically for aged care settings.
“We are in the process of researching the tool’s efficacy in an aged care context. But we are confident that it will help nurses assess patients in a systematised way and predict adverse, infection-related events — much like it has done in emergency care already,” Shaban said.
The tool works by going through patient history, individual patient risk and IPC red flags, and in turn providing a structured interventions and diagnostics framework.
By bringing structure to the assessment process, the tool can also help RNs communicate more effectively with other healthcare professionals.
“It brings commonality to IPC management in terms of processes, language and actionable output. Overall this will help nurses provide better care, improving both patient satisfaction and their own job satisfaction,” Shaban said.
Avoiding unnecessary hospital transfers
Aside from the lingering aftertaste of COVID-19, a major impetus for this research was to minimise the need for aged care residents to take unnecessary hospital trips.
A 2021 report found that 25% of aged care residents were hospitalised overnight in 2018–19, with respiratory issues relating to influenza, pneumonia and lung disease the most common reason.
Aside from being costly to the healthcare system — with the average cost of an overnight hospital stay totalling $4680 — unnecessary transfers can be harmful to individuals.
Studies have shown that older people are particularly vulnerable to adverse events in emergency departments (ED) and the risk increases the longer they spend there.
Hospital stays, more generally, also come with increased hazards for this age group. These include delirium, malnutrition, pressure ulcers, depression, falls, restraint use, functional decline, adverse drug effects and death.
Shaban hopes his tool will reduce inappropriate hospital transfers among aged care residents.
“We expect it will minimise adverse events by predicting them early and preventing them using best practice interventions, tailored to the individual and their circumstance,” he said.
The tool is currently being developed and will soon move into clinical trials, where it is expected to demonstrate similar results to its ED equivalent.
On the proviso that good results are achieved, the tool will then be made available to all residential aged care facilities throughout Australia.
Given the breadth of infection-related hospitalisations currently afflicting the sector, it is hoped the tool will play a key role in raising national standards in the quality of aged care delivery.
“IPC is such an important pillar in aged care, but it is not always given the attention and investment it deserves.
“We hope that HIRAID Aged Care will change that and support nurses with the tools they need to achieve hospital-like levels of rigour in IPC management,” Shaban concluded.
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