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Keep it clean

Hygiene in the last two decades has improved for a lot of those living in aged care, but as research shows, the rise in multi-resistant bacteria is still a major concern. 

For 20 years, Christina Kenneally, a now-retired nurse, has worked in aged care facilities throughout Australia. During that time she has seen a wealth of changes including a sustained and renewed focus on hygiene.

“The change has been remarkable in aged care residences around Australia,” Kenneally says.

“Twenty years ago you wouldn’t have hand sterilisers in bathrooms and constant messages telling you to be aware of spreading germs and to continually wash your hands.

“We had multiple people stacked in one room that would lead to the spreading of the flu and other minor diseases very quickly as you went from one resident to the next.

“Now, we have very clean residences, proper medical care and generally only one person to a room that ensures not only privacy for the resident but greatly reduces the chances of any spread of infections.

“That is not to say that illnesses and infections won’t be an issue now or in the future, but the standards and regulations have improved vastly and everyone is far more conscious of the need to keep things clean and be respectful of others.

“While no system is perfect, I think we have made great inroads throughout my time of working in aged care facilities.”

According to statistics from the Australian government, more than 180,000 Australians receive permanent residential care with more than 70 per cent of those falling into the high care category. There are in excess of 2500 residential aged care providers across the nation with approximately 75 per cent falling into the private not for profit category. There are another 350 government facilities.

But the real figure is that 40 per cent of Australians aged between 65 and 73 require assistance with everyday and physical activities. Whether these people choose to enter an aged care facility voluntary is another matter but with a country like Australia where our population is ageing faster than we are giving birth, the care of the elderly will only increase.

“Residential aged care facilities are people’s homes but they are also public places as well that see hundreds if not thousands of visitors come through every week,” Patrick Reid, chief executive officer of LASA, says.

“Maintaining the health and wellbeing of residents and demanding staff standards is somewhat easier to achieve than when dealing with visitors, especially when relatively unknown. Facilities do remind staff and visitors in relation to general health, for example not to visit when sick but it is not possible to guarantee compliance from visitors.”

But while every measure is taken to keep aged care facilities clean and disease free, it is not possible to maintain or prevent illnesses spreading from time to time.

A survey published in the Medical Journal of Australia in 2011 assessed more than 100 residents across three aged care homes and found 12 per cent of the study group tested positive for E. Coli infection.

Dr Timothy Inglis and Dr Christopher Bear, wrote an article in the Medical Journal of Australia entitled ‘Multi-resistant Escherichia coli in aged care: the gathering storm’: “The challenges of aged care are many and will continue to grow as the number of people in need of residential care expands. There are many potential contributors to the emergence of multi-resistant bacteria in residents of aged care facilities: multiple hospital admissions, excessive use of antibiotics (in terms of courses, duration and antimicrobial spectrum), incontinence, dementia, venous stasis ulcers, and difficulty implementing infection control practices in institutions where residents are free to move outside their rooms and mingle with others.

“A control method for multi-resistant bacteria that relies on surveillance and targeted infection control measures may seem appealing, but in reality is likely to be costly, impractical and ineffective. An alternative strategy is to use multiple measures targeting improvements in the skilled nursing care of those at identifiably higher risk of multi-resistant bacterial infection, without prior surveillance culture.

“But with an estimated multi-million dollar annual cost of multi-resistant bacteria control measures, and a residential aged care sector facing many challenges, we will be forced to explore all options. This should include considering a more public health-based approach, as long-term care facilities lie outside the remit of conventional hospital infection control.”

E.Coli can cause an elderly person serious health problems. The infection can easily be passed from person to person via unwashed hands after going to the bathroom. The reality is that simple hand washing can stop the spread of many diseases.

“Aged Care Standards administered by the Aged Care Standards and Accreditation Agency encompass regulatory compliance that insists organisations have systems in place to identify and ensure compliance,” Reid says.

“This is coupled with additional measures in specific areas around clinical care, specialised nursing, medication management, nutrition and hydration continence management, oral and dental care. There is a specific standard covering the physical environment and this standard encompasses fire and emergencies, infection control, laundry and catering. Additional to this there are specific standards covering occupational health and safety and education and continuous improvement for staff.”

Damien James, founder and chief executive officer of Aged Foot Care, has also been working extensively in aged care residences across Australia since 1997.

After graduating with a podiatry degree and losing both his grandparents, he was keen to work with the elderly. His business has expanded to the point where he is now working with 327 facilities and employs 47 staff across Australia.

“From my own experiences, the industry has changed a lot for the better,” James says.

“We take great care working with the elderly to ensure that they feel safe and ensure an efficient, healthy and clean treatment. What I have also seen is the change in regulations regarding hygiene.

“When I first started, there was always a musty smell in aged care facilities and a lot of people crammed into one room with only a curtain separating them. Thankfully, you don’t see that anywhere anymore and there is a lot more emphasis on cleanliness and hygiene.

“I think everything has improved from the circulation of age in the facilities, the quality of the meals to the re-enforced emphasis about washing your hands at all times. Of course, nothing is foolproof but we have seen a lot of improvements which can only benefit the quality of life for aged care residents.”

Inglis TJ, Beer CD. Multiresistant Escherichia coli in aged care: the gathering storm. Med J Aust 2011; 195(9):489-490. Copyright 2011 The Medical Journal of Australia – reproduced with permission.

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One comment

  1. Some of us do still have share rooms with only a curtain separating them, but we can still manage hygiene and prevent cross infections.