Control of infection in nursing homes: a risk-management approach

The concept of risk addresses the probability that an untoward incident will occur. In the healthcare setting, professionals have a responsibility to identify risks over which they have some control and to take appropriate measures to minimise those risks. This process is referred to as risk management when actively undertaken. During our work with clinical and non-clinical staff in nursing homes, it became increasingly clear that old ritualistic habits remained and compromised effective infection control practice. To try to develop a more effective management of the risks associated with this environment, we worked with a number of homes to enable them to develop and implement a modified risk-management process in relation to infection control practice. The staff carried out a brief risk review, including assessment of: (a) Possible risk exposures; (b) Appropriate methods of control; (c) Selecting and implementing the best method of control; (d) Evaluating and monitoring improvements in risk reduction and patient outcomes. Tools were devised and utilised in three main areas: (1) Risks to the patient; (2) Risks to the staff; (3) Environmental risks and controls. These interventions are currently being evaluated. As there is little baseline data in this type of care environment, evaluation of the impact of these interventions will take some time to assess.