Running head: INFECTION CONTROL DURING INTER-AGENCY TRANSFERS 1

Infection Control During Inter-Agency Transfers

Katherine Sellards, RN

Western Washington University

NURS 402 Translational Research for Evidence-Based Practice

Christine Espina, DNP, MN, RN

Tom Carson, MSN, RN

March 13, 2017

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Abstract

Background: Whatcom County experienced an increase in outbreak of norovirus placing long-

term care facility (LTC) residents and employees, emergency medical services (EMS), and

emergency room employees at an increase risk for contracting and spreading infection.

Purpose: The purpose of this paper was to evaluate current research in order to discover

effective infection control practices for inter-agency transfers of infectious patients. Methods:

An extensive CINHAL search for data was performed in order to find research related to inter-

agency transfers of infectious patients. A variety of literature regarding LTC facilities, EMS,

infection control practices and hospital transfers were reviewed. Findings: In reviewing the

literature, it was ascertained that there is a lack of compliance with universal standard

precautions, inadequate decontamination procedures of equipment and a lack of communication

between agencies and EMS. Implications: Decrease the spread of infections by increasing

knowledge of infection control precautions, improving communication between healthcare

facilities and transporting services and upgrading patient transfer forms.

Keywords: infection control, transfers, long-term care facility, hospital, emergency

medical services
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Infection Control During Inter-Agency Transfers

Concerns regarding inter-agency transfers of infectious patient and the need for effective

infection control measures were discussed in an interview with Joni Hensley, RN, BSN,

(personal communication, February 14, 1017), public health nurse with the Whatcom County

Health Department. In the interview, Joni explained that in 2008, there was an outbreak of

norovirus among the community that greatly affected long-term care facilities (LTC), emergency

service workers and emergency room employees. She also stated that in 2014 a second outbreak

of norovirus occurred affecting the same facilities to the degree of almost having to shut down.

In light of the recent increase in influenza cases this season, it has become paramount in

protecting the community, vulnerable populations, LTC facilities, EMS workers and hospitals

from preventable illnesses. A close inspection of current infection control practices and

communication between the agencies and EMS could find some areas in need of improvement to

better protect against future outbreaks and the spread of infection.

Purpose

The goal of this project was to review the most current evidence-based practices available

regarding inter-agency transfers of infectious patients using effective infection control practices

to reduce the risk of infection within the agencies, EMS, hospital employees and ultimately the

community. However, due to lack of research directly related to inter-agency transfers of

infectious patients, this project will review attitudes, behaviors and current practices among the

healthcare community in various practice settings and recommend measures to alter current

practices to promote for a safer environment.

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Methods

An in-depth search for evidence-based practices regarding infection control during

transfers of infectious patients between healthcare facilities was conducted using Western

Washington University library research resources. Due to the lack of data directly related to

inter-agency transfers of infectious patients, searches were made for infection control practices in

hospitals, long-term care facilities and EMS services independent from each other. Search terms

used were long-term care facility, hospitals, transfers, discharge, infection control practices,

droplet precautions, emergency medical services, and influenza. A variety of experimental

studies, epidemiological studies, quantitative and literature reviews were collected for

evaluation. The level of evidence is categorized as evidence from single descriptive or

qualitative studies and evidence from the opinion of authorities and/or reports of expert

committees.

Findings/Synthesis of Literature

All healthcare professionals should observe and practice the standard precautions of hand

hygiene by using soap and water as the ideal technique for preventing spread of bacteria. Basic

infection control practices and isolation precautions are guidelines used within the realm of the

healthcare community in order to protect patients, healthcare workers and the general public

from the spread of infection. An article by Farrugia and Borg (2012), discusses the continued

issue of healthcare-associated infections and relate it to improper standard infection control

practices and non-adherence to infection and isolation precautions. The article also states that

healthcare providers believed that there was a lack of communication with the infection control

teams, which was attributed to an inadequate amount of updated or improved practices

concerning infection control (Farrugia & Borg, 2012).

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Teter, Millin and Bissell (2015) conducted a study of current hand hygiene practices

among Emergency Medical Services (EMS) to evaluate the possible risk of spread of infection to

patients. It was found that due to the conditions in which EMS workers perform and because of

the lack of accessibility to a clean water resource while in the field, EMS providers impose a

great risk of cross-contamination to themselves and the people they serve (Teter, et al., 2015).

The health of the patients that EMS providers respond to are already compromised and by not

following standard hand hygiene protocols, EMS providers are exposing not only themselves,

but the patients they care for to many different types of organisms that increase the risk for

infection.

Not only is it imperative to evaluate proper hand hygiene frequency and technique,

current decontamination procedures of EMS vehicles and equipment should also be examined. In

a study comparing current standard cleaning practices of EMS equipment and the introduction of

a hydrogen peroxide wipe, the findings revealed that contaminated surfaces were markedly

reduced after the introduction of the hydrogen peroxide wipes. Decontamination per current

practices did not significantly reduce viral loads of the seeded surfaces. Intervention with

activated H2O2 wipes significantly reduced the viral loads when compared with surfaces before

any decontamination and when compared with decontamination per current practices (Valdez,

Sexton, Lutz, & Reynolds, 2015). Valdez et al. (2015) also noted that areas of the vehicle, such

as seats, steering wheels and seatbelts had not been decontaminated between calls which

increases the concerns for cross-contamination. This causes some concern, because even though

the areas of the vehicle in which the patients are treated are decontaminated, if other areas such

as the ones listed above are not, decontamination procedures are not adequate in protecting from

the spread of bacteria.

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In addition to non-compliance with standard universal precautions and inadequate

decontamination protocols, lack of communication between EMS services and healthcare

facilities is also an area of concern. As pointed out in Emergency Transfers of the Elderly from

Nursing Facilities to Critical Access Hospitals: Opportunities for Improving Patient Safety and

Quality, an inadequate amount of patient data is received and reported at time of hand-off

between EMS and healthcare facilities, thus leading to a decrease in safe practices and often a

delay in care (Pearson & Coburn, 2013). It was noted that in some instances, little to no patient

information was received from nursing care facilities on arrival to the emergency department and

a difference in reporting styles between EMS and ED proved to be confusing and led to an

insufficient amount of data needed to provide quality care for the patient (2013). An incomplete

hand-off between service providers could lead to overlooking key symptoms of infection,

delaying isolation precautions and consequently exposed healthcare employees and other patients

to infection.

There was a lack of research in regards to inter-agency transfers and effective infection

control precautions, however an epidemiological study was reviewed regarding intra-hospital

transfers and risk for nosocomial infections. Eveillard, Quenon, Rufat, Mangeol, and Fauvelle

(2001), determined that intra-hospital transfers placed the patient at a higher risk for nosocomial

infections than non-transferred patients. The idea behind this finding is that patient care areas

harbor different types of bacteria or higher bacterial levels than others. Thus, intra-agency

transfers places the patient at risk for exposure to bacteria that they may not have been exposed

to if they remained in the original unit. For a patient in which their health has already been

compromised, this could slow the healing process and decrease patient outcomes. One must
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consider that because there is a high risk of infection in intra-agency transfers, the data shown

can translate into a higher risk of infection among inter-agency transfers.

Recommendations

One recommendation for protecting the community against preventable illnesses is to

continue the campaign to promote for seasonal influenza immunization. On occasion, the

seasonal influenza vaccine has not been effective, however it continues to be the most impactful

measure for decreasing outbreaks of influenza.

A recommendation for better communication practices between healthcare workers helps

to relay vital information concerning the patients infectious status, allowing the healthcare

workers to make informed decisions on which proper personal protective equipment should be

worn. Also, requiring at least yearly mandatory in-services to communicate policies regarding

isolation precaution and infection control practices will increase adherence to these policies.

Infection control teams should participate in face-to-face discussions, provide written

educational materials, computer-based learning modules, and re-education on infection control

policies for healthcare employees to ensure that all providers are furnished with accurate and up

to date data regarding the best evidence based practices for reducing spread of infections.

Another area to assess for improvement is the verbal communication between the

transferring and receiving healthcare agencies and the transporting service. During a verbal

report between the healthcare agencies any infections should be communicated to the receiving

facility so that the facility can effectively prepare and take precautions when needed. The same

information should be provided to the transporting service so that de-contamination of the

transferring vehicle can be conducted after the transport. In addition to that, a re-evaluation of
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the patient transfer forms should be conducted to ensure that pertinent information related to

infections is included to reinforce that appropriate patient data is being conveyed.

A recommendation to increase the research regarding inter-agencies transfers of

infectious patients and effective infection control practices would increase the knowledge base

and provide for the best evidence based practices to reduce spread of infections.

Implications for Practice

By implementing the recommendations provided, the various healthcare agencies and

transporting teams would increase their knowledge of effective infection control practices and

improve their hand-off communication skills for transport while decreasing the spread of

infection and allowing for a safer environment.

Conclusion

In researching effective infection control practices and inter-agency transfers, it is clear

that there is a lack of evidence that would provide for best practices regarding this issue.

However, from the data collected it was found that there is a lack of adherence to standard

infection control practices, lack of communication between agencies and transport teams, a need

for improving decontamination procedures after transports and enhancing the patient information

transfer form if healthcare workers are to safeguard the health and well-being of patients and the

community against spread of infections.

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References

Eveillard, M., Quenon, J., Rufat, P., Mangeol, A., & Fauvelle, F., (2001). Association between

hospital-acquired infections and patients transfers. Infection Control & Hospital

Epidemiology, 22(11), 693-696.

Farrugia, C. & Borg, M. (2012). Delivering the infection control message: A communication

challenge. Journal of Hospital Infection 80(3), 224-228.

Pearson, K. B., & Coburn, A. F., (2013,January). Emergency transfers of the elderly from

nursing facilities to critical access hospitals: Opportunities for improving patient safety

and quality. (Issue brief No. 32). Retrieved from: http://www.flexmonitoring.org/wp-

content/uploads/2013/07/PolicyBrief32-Transfer-Protocols-withAppendix.pdf

Teter, J., Millin, M. G., & Bissell, R. (2015). Hand hygiene in emergency medical services.

Prehospital Emergency Care, 19(2), 313-319. doi:103109/10903127.2014.967427

Valdez, M. K., Sexton, J. D., Lutz, E. A., & Reynolds, K. A. (2015). Spread of infectious

microbes during emergency medical response. American Journal of Infection Control.

43(6), 606-611. doi:10.1016/jajic.2015.02.025