May 232012

If your elderly parent has a communicable disease whether it is a cold or HIV, there are standard precautions you should take to prevent the transmission of the illness to others, including yourself.

Caring for Someone with an Infection

It is also important to protect yourself from getting an infection from the person for whom you are providing care. Washing your hands is always the number one thing you can do but consider the following also:

Clean equipment by rinsing in cool water to remove any particles (warm water may cause particles to stick to the equipment). Then wash with hot, soapy water, rinse well, and dry thoroughly. If you are dealing with a very virulent infection, you may want to rinse with cool water, spray with a ten percent bleach-water solution and allow it to sit for a couple of minutes before washing in hot soapy water. Boiling for “sterilization” is usually unnecessary.

Urinary drainage bags a.k.a. catheter bags ideally should be left connected to the catheter to prevent contamination. However, during the day mobile people often switch to a smaller leg bag that can be hidden under a skirt or pants leg. Leg bags and the larger night bags can be cleansed with soap and water. Rinse with a tablespoon of vinegar in a cup of water to help keep down oder and infections. Allow to air dry.

Dispose of body wastes down the toilet being careful to avoid splashing. Wash linens and clothes soiled with body waste separate from other laundry.

If the parent you are caring for receives medications from a multi-dose syringe such as an insulin pen, it is best to have the person receiving the medication remove the needle from the pen if possible to protect yourself. With a standard syringe and needle, never remove, bend, break or recap the needle after use.

In healthcare settings sharp objects such as syringes with needles are disposed of in biohazard containers and the containers are incinerated according to strict guidelines. Small versions of these biohazard containers are available in most pharmacy’s but should never be thrown out with your home trash. If you elect to use these, you will need to find out where you can drop them off for disposal. Your pharmacist, physician, hospital or local home healthcare agency can direct you where to take them.

If you are caring for someone with an infection that can be transmitted by blood such as HIV or hepatitis B, consider having any used needles disposed of as a medical facility would.

For most homes people can use any rigid, puncture-proof receptacle with a small opening, such as a bleach bottle, will do and is acceptable practice. Place a small amount of bleach in the bottle, drop the syringe, with needle intact into the bottle. When full replace the cap and tape it well with a strong tape. I always reminded my patients that things fall off garbage trucks all the time and the last thing you want is a child getting into a bottle full of used needles. Never use bottles, glass or plastic, that can be returned to the store.

When someone in the home is receiving wound care the soiled bandages should be placed in a bag which is then tied up and placed in another bag for disposal. If the bandages are dripping wet, talk with your healthcare provider about using a more absorbent dressing. If there is a chance of a blood-born infection, soiled bandages might need to be burned. Discuss this with your healthcare provider.

Clothes and bedding should be laundered separately in hot, soapy water with a ten percent bleach solution added to the detergent.

Do not share thermometers, razors, razor blades, toothbrushes, douche or enema equipment.

Do not share eating and drinking utensils. Clean them after use with hot soapy water. Using a dishwasher is good.

When flushing a toilet germs are sprayed into the air, even with the lid down. Toothbrushes should be covered or placed in the medicine cabinet or in a drawer.

Faucets in bathrooms and kitchens should be cleaned daily with a disinfectant.

Obviously the best way to prevent infection is through cleanliness. The foundation of it all is good hand washing.

May 222012

Unfortunately it happens. We all get sick from time to time. The best thing to do is have someone else take over the
care of your parent if possible and for you to stay away from your elderly parent.

If you must provide care there are some precautions you should take. Always wash your hands prior to giving any care or before handing them anything. As an extra precaution where disposable gloves but remember, gloves do not take the place of hand washing. And in this case sanitizer will not take the place of soap and water. If there is a risk of your illness being airborne you should wear a mask when you are within three feet of your elderly parent. I know masks are uncomfortable but for the elderly a cold can be pneumonia and possibly death.

You will also want to wipe down any surfaces you touch such as doorknobs, telephones, handles of appliances, and faucets with either a commercial disinfectant cleaner or a ten percent bleach-water solution you mix yourself. Bleach is an easy and cheap disinfectant and is actually more effective at killing germs when diluted than straight out of the bottle. (Who knew?) It is also a corrosive and will eat through stainless steel so wipe surfaces off with water after spraying.

The chlorine in bleach degrades rapidly when exposed to light and should be discarded after twenty-four hours. Mix it in an opaque bottle to prevent light from entering. Bleach expires. Bleach begins degrading after six months and looses twenty percent of effectiveness each year. Never, ever, ever mix bleach and ammonia. This combination forms a poisonous gas that can kill you! Never add bleach to commercial disinfectants because of possibly dangerous chemical reactions.

Do not put off seeking medical assistance for yourself if you are ill. Delaying treatment can cause a prolonged recovery time or lead to a more serious illness. If you are a full-time caregiver chances are your stress level is high and your immune system is not quite up to par. Take care of yourself. Get plenty of rest.

If you suspect your parent is coming down with an infection do not delay getting them to the doctor. As mentioned before, elderly often have compromised immune systems making it harder for them to recover from even minor illnesses.

Tomorrow we will look at what to do if your parent has a contagious illness.

May 212012

Yesterday we looked at some methods to break the chain of infection. Today we continue that discussion.

Get a pneumonia vaccination and a yearly flu vaccination. A tetanus shot every ten years is also recommended. Always complete antibiotic therapy unless instructed otherwise by your parent’s health care provider.

For someone with a productive cough, have them spit the mucus into a tissue and have a receptacle nearby for disposal. For a dry cough or sneeze, cover your mouth and nose with the bend of your arm, rather than your hand.

Good oral care is extremely important in the prevention of respiratory infections. Studies have found that people who get aspiration pneumonia are more likely to get it from inhaled saliva than from inhaled food. Your mouth meets all of the first 5 links in the chain of infection especially if there is plaque build-up. It is warm, dark and moist in there, a germs idea of paradise!

Unfortunately, mouth care is the most neglected area for those who cannot do it themselves. If the person is not able to brush their own teeth, using toothettes, lemon-glycerin swabs and finger toothbrushes are easy to use. Mouth care is so important that I have written a whole article on it here.

If you are providing care for a parent who has had a heart valve replacement they may need antibiotic therapy started before a procedure or dental treatment is done. Be sure to ask their physician or dentist.

If your parent has tubes of any kind, follow your health care provider’s instructions on cleaning and care. Care of IV’s, PICC lines, tracheotomy tubes, and other invasive devices are beyond the scope of this blog. Please consult a health care professional for instruction and advice on caring for them.

Urinary catheters are a major source of urinary tract infections. Avoid them if possible. If an indwelling catheter is in place you can reduce the risk of infection by daily cleaning with soap and water, avoid over manipulation of the tubing, keep the bag below the level of the bladder or clamp the tubing if the bag must be raised such as for turning. It is better to use a closed system where the bag stays attached to the catheter as opposed to switching to a leg bag during the day. Adequate hydration will help keep the bladder flushed. (If an elderly person starts becoming confused, weaker, or falls, check for a urinary tract infection).

Gastric feeding tube sites should be cleaned daily with soap and water. Avoid over manipulation as it may irritate the gastric lining.

While the incidence of homecare personnel bringing infection into your home is low, here are some insider tips to lower the risk:

Show them where they can wash their hands as soon as they arrive.

Ask to be one of the first patients they see that day. However, if your loved one has an infection, they should be seen later in the day to lower the risk of spreading it to other home bound patients.

If they sound like they are sick or have sick children, ask them to reschedule or send someone else.

Only in the last few years has the tracking of homecare acquired infections begun. In the home setting the patient may have an increase in host factors such as chronic illness, immunosuppression, advanced age. The goal is still to protect the patient.

What happens when you fail to break the chain and infection occurs? That will be the subject of tomorrow’s post.

May 202012

Yesterday you learned about what makes up the chain of infection: an infectious agent, a reservoir, a portal of exit, a mode of transmission, a portal of entry and a susceptible host. And you know that an interruption in any area can stop the infection from spreading. Today we will look at what you can do to stop the spread of potentially lethal germs.

Steps caregivers can take to break the chain:

Lower your elderly parent’s risk for coming into contact with microorganisms by avoiding people who are obviously sick with colds, influenza, pneumonia, etc. Ask a person not to visit if they think they might be sick or if they have been around someone who is sick. This seems obvious but even nurses and doctors go to work sick and they know better! Do not be afraid to ask someone to come another day when they are not sick. Most people will understand.

Wash your hands before and after giving care, preparing meals, toileting, coughing, sneezing, etc. Have visitors wash their hands, especially if they are professional healthcare providers. Keep liquid soap and paper towels at the sinks in the kitchen and bathroom. You can read more about the importance of hand washing here.

Put hand sanitizer everywhere: the kitchen, living room, bedrooms, and in your vehicle. Hand sanitizer does not kill all germs, especially MRSA (Methicillin-resistant Staphylococcus aureus), and you should wash with soap and water when available. When using hand sanitizer rub your hands together vigorously until dry. It is the friction as well as the alcohol in the hand sanitizer that kills the germs.

Pardon me while I step briefly off topic. Recently there have been news reports of kids drinking hand sanitizer to get drunk. This might lead you to concern about having hand sanitizer around especially if your elderly parent has some confusion or dementia. I was surprised to learn that hand sanitizers contain ethyl alcohol as opposed to isopropyl or rubbing alcohol. So in theory, someone could get drunk off of the ethyl alcohol but it would not be by accident. That stuff is nasty and it would take more than one bottle to get drunk. So the likely hood of teenagers or kids drinking hand sanitizer to get drunk is extremely low.

I have worked with both the developmentally delayed and the mentally ill and have had both drink hand sanitizers without any adverse reaction. Now they did not drink more than a bottle and I am sure if they had the results could have been different. But unless your parent is an alcoholic, the chances of them willingly drinking enough hand sanitizer to get drunk are slim. I would not let this slight threat stop me from using hand sanitizer to prevent the much larger risk of infection. If they do drink hand sanitizer call poison control, 1-800-222-1222, and follow their instructions.

Back to our chain breaking.

Practice good skin care, hygiene, and protection from injury. Pad the siderails on beds; cover any areas on wheelchairs that might cause injury. Treat skin tears and wounds by cleaning and keeping them covered. Use insect repellent when outside and treat bug bites promptly to relieve itchiness and prevent scratching. Keep your own nails short and smooth to avoid skin tears and scratches.

Encourage good nutrition, especially protein intake as this promotes healing of wounds. Fruits and vegetables are also important in maintaining health. Keep the home at a comfortable temperature. Ensure adequate ventilation to avoid moisture buildup and stale air, especially if you are in a newer, energy efficient home or are using kerosene heater.

More tomorrow…..

May 192012

The elderly are at higher risk for infections due to several factors including decline in the function of their immune system, poor nutrition, lack of activity, as well as medications and other illnesses that inhibit their ability to fight off infections. The best defense is a good offense and that starts with realizing what you are up against.

Drug resistant bacteria, swine flu, avian flu, e-coli, flesh-eating bacteria, West Nile Virus, it seems like we have a new bug to fear every month. And so-called “super bugs” that were once the purview of hospitals are now being acquired in the community setting. These are bad enough in a healthy adult but they are often deadly for our elderly parents.

As hospital stays are shortened, more procedures and surgeries being done on an outpatient basis, the need for good infection control guidelines in the home and community is becoming increasingly more important. To complicate matters even more, home care has gone high-tech with tracheotomies, ventilators, dialysis, intravenous medications and other invasive procedures. Our population is living longer and with chronic illnesses that require the skilled care of nurses, therapists and aides in the home to educate and assist with care.

With the lack of 24 hour professional monitoring, it is up to the family and/or caregivers to be the first line of defense in the prevention of infection as well as the recognition of the early signs and symptoms. Something as simple as a cold can be deadly to someone with chronic breathing problems such as COPD. A small scratch in the elderly can rapidly become septic requiring emergency treatment. (Sepsis is a bacterial infection spread throughout the body and is more commonly called blood poisoning). Good infection control cannot be over-emphasized.

The Chain of Infection

Infection requires a chain of six steps to occur and a break in the chain lessens the likelihood of infection occurring. Those six steps are an infectious agent, a reservoir, a portal of exit, a mode of transmission, a portal of entry, and a susceptible host.

1. Infectious agent: a microorganism, usually bacteria, virus or fungus, or the more common term, germ. The virulence or strength of the germ is determined by its ability to invade and multiply in normal, healthy individuals. While an organism may not be virulent for a healthy individual, in a compromised person such as the elderly it becomes pathogenic (causes illness).

2. Reservoir: There must be a favorable environment for growth and replication. This is the source of the infection such as a sick person, a contaminated object or a carrier species (insect, rodent, animal).

3. Portal of Exit: This is the route the infectious agent takes out of the reservoir such as through the nose, mouth, sexual organs, feces and through blood.

4. Mode of Transmission: This is how it moves from reservoir to host. Contact or touching an infected person such as kissing, sexual intercourse, and shaking hands, or an infected object such as shopping cart handles, phones, computer mouse and door handles. Droplet transmission through sneezing, coughing, and being spit on. Things routinely taken into the body such as air, food and liquids. Insects, rodents and animals don’t actually cause disease, they merely transfer it to us via biting, blood and feces.

5. Portal of Entry: This is how the infection enters the body such as through the mucous membranes of the nose or mouth and through a cut or injury to the skin.

6. Susceptible Host: Someone who is at risk. This includes those who are lowered immunity, fatigued, stressed, anemic, not immunized, poor nutritional status and those with underlying disease.

Tomorrow, we’ll look at breaking the chain, the first step in prevention.