Infection Control and the Infection Log

Standard precautions, in someone's living room

Standard precautions apply to every patient, every visit, regardless of diagnosis. What changes in the home is that you control none of the environment.

Hand hygiene before and after patient contact, before a clean procedure, after any exposure risk, and before re-entering your bag
Carry your own soap and hand sanitizer; do not rely on the house having either
Gloves for any contact with blood, body fluids, broken skin, or mucous membranes
Gown, mask, eye protection as the task requires — bring them rather than deciding you can manage without
Never recap needles. Sharps go straight into an approved container.
Clean and disinfect reusable equipment — stethoscope, BP cuff, thermometer — between patients
Set up on a clean barrier and take it away with you

The mechanics of keeping your bag from becoming the vector are on Proper Bag Technique.

Transmission-based precautions

When a patient has a known or suspected transmissible infection:

Find out what it is before you go, and plan the visit accordingly
Schedule them last in the day where practical
Take in only what you need; leave the bag in the car
Do not take the healthcare bag into homes of patients with MRSA, VRE, or similar — or into infested homes
Bag soiled reusable items that cannot be cleaned in the home, sealed, on the floor of the car, and transport them back for disinfection

The infection log

If a patient is started on an antibiotic, an infection log must be completed.

That is the trigger. Not a positive culture, not a diagnosis of infection — the antibiotic.

Have this ready before you open the log

The oral antibiotic order
Any testing that was done
Was a culture taken? If so, what organism?

Gathering it first saves reopening the log three times.

Completing it

Two ways in:

File → New from within the patient's chart
Midway down the assessment, on the right-hand side, a button asks whether you want to record an infection

While you are in the log:

Generate the new order from inside it — it pulls across, so you do not enter the order twice
Assign the RN Case Manager to follow up

Why it matters beyond the chart

Infection data is aggregated and reviewed for patterns across the agency — which organisms, which circumstances, whether anything is being transmitted between homes. A log nobody completed is a pattern nobody can see.

What to watch for on any visit

Wound: increasing redness, warmth, swelling, pain, purulent or malodorous drainage, breakdown of previously healing tissue
Urinary: dysuria, frequency, urgency, cloudy or malodorous urine, new confusion in an older adult
Respiratory: new or changed cough, sputum, shortness of breath, fever
Devices: redness or drainage at a central line, PICC, catheter, or PEG site
Systemic: fever, chills, malaise, new confusion, loss of appetite

In an older adult, new confusion is often the first and only sign of infection. Take it seriously before you attribute it to dementia.

Report findings to the physician the same day, get the order, and complete the log.