Older people are more digitally savvy, but aged care providers need to keep up
 
Senior citizens are an important consumer group which is only going to increase in number in the future.  The time has come for aged care operators and the technology industry to engage in meaningful efforts to meet their needs.

​Older adults are more digitally connected than ever, even though their uptake of internet-based technologies remains lower than for younger aged groups.
 
Today’s senior citizens are likely to spend their spare time tweeting about their social lives and face-timing their grand kids.  This is good news because research shows that social interactions benefit us.
 
The drive to join the digital community is no doubt influenced by social media becoming an important platform for news and information, sharing experiences and connecting with friends and family. Nevertheless, age related gaps in digital engagement (“the digital divide”) still exist.  And research shows people who live in aged care environments are at risk of being excluded  from the digital world.

​A digital community
 
Moving into aged care can affect a person’s ability to remain connected to their local community.  The facility might be some distance away from the neighbourhood in which they have lived. They may be unable to travel to maintain relationships. 
 
Low levels of social connectedness and participation are related to poor health and higher mortality risks as well as a significant reduction in quality of life.  Family can provide an important source of social contact and support, but geographic distance can again make frequent visits difficult.
 
Digital engagement in later life might not always be desired or possible.  But access to online resources can enhance older adults’ well-being through improved access to information and ore frequent social interactions.
 
The social internet
 
An early study reported psychosocial benefits from providing computer training in internet use for aged care residents.  These include improvements in life satisfaction and lower levels of depression and loneliness.  In another study, a once weekly video conference with a family   member had a positive impact on loneliness and perceived social support.
 
But there is little information on informal and unstructured use of the internet by residents because the use of digital technologies in aged care remains largely invisible.  Residents are omitted from many surveys and reports.
 
In a recent Swiss study, where all residents in a facility were offered wi-fi access, 14 percent used the internet.  This percentage is similar in that age group living in the community

​Staying connected
 
In a recent survey of telephone interviews with over 70 members of the public who had a family member or friend living in residential aged care, researchers spoke to family and friends rather than seniors because they wanted to hear about residents who had physical and mental challenges, as well as healthy seniors who tend to volunteer for research.  To reduce the risk of bias, they did not mention that they wished to talk to people about technology use.
 
The research highlighted the enthusiasm with which many older people have adopted digital technologies.  Nearly half of the 80 or so residents spoken about owned a computer or smart phone.  The average age of residents was 86 years, and the oldest was 102. Sometimes the  family had purchased a device for the resident specifically to make communication easier. 
 
Mobile phone calls, texts and emails were the most common methods of communication using these devices.  Technology not only enabled residents to interact with family and friends they seldom saw (for example, those overseas), but also resulted in increased interactions with those who visited more often.  While dementia and other serious health issues reduced the likelihood of uptake, the frequency of personal visits was not affected by technology use.

Family help
 
Importantly family members were essential to residents’ digital connectedness.  They often bought the device, set up software and troubleshooted any technical problems.  They were also involved in the day-to-day use of technology.  For example, some residents used video conferencing but needed assistance to initiate the call.
 
Interviewees endorse the use of digital devices if they were used to supplement social contact, rather than supplanting it.  The majority reported that they were not aware of computers being available for residents in common areas of the facility they visited.
Aged care operators do not generally provide Wi-Fi access to residents.  They have to arrange this with their own internet provider.  These deficits are of concern because residents don’t always have family or friends to help them become digitally connected.
 
Devices were often criticised for their small keys and buttons which are difficult to manage for arthritic hands and by people with vision impairments.  Older users, it seems, must try to adapt their abilities to devices to devices that have been designed for younger people.
 
Senior citizens are an important consumer group which is only going to increase in number in the future. The time has come for aged care operators and the technology industry to engage in meaningful efforts to meet their needs.
 
 
 
Author:  Dr Wendy Wrapson, Senior Research Fellow, Auckland University of Technology
 
Ref:  Aged Care NZ issue 02 2012

An individualised approach to one’s wellbeing is especially important during stressful times when there have been plenty of eventful, unprecedented changes around us.  Our physical, mental, emotional and spiritual wellbeing all need support, and a one size fits all approach is not always helpful.
 
Entering the senior phase of one’s life journey is such a privilege – but it brings with it a range of unique challenges.  For some, they’re fortunate enough to have their physical bodies and minds remain strong and vital.  While for others physical strength becomes a challenge, and their mental clarity is not what it used to be.
 
Many of the elderly find it increasingly more difficult to cook for themselves – they find themselves on their own after decades of looking after a family – and it becomes just too much work to cook for one person.
 
Despite these individual differences, the common thread among most people in their senior  years is that everything is slowing down.

In this article I would like to address three easy ways to ensure that eating a healthy plate of food is both affordable and manageable in most circumstances.

The first way to ensure that one is eating a balanced meal is to look at your hand – the palm to be precise.  A handy little measuring guide is to imagine the piece of chicken, fish, beef, lamb or vegetable protein fitting nicely inside the palm. This general guide will ensure that a person is getting sufficient protein into their body every day.
 
Eating too little protein happens more often as one gets older. For many people it’s due to expense, dental changes or health conditions that make swallowing difficult.  However, the need for adequate protein is important for the build and repair work that happens every day on our bodies.
 
Some easy and affordable options to ensure that one is eating sufficient protein is to include scrambled eggs at breakfast rather than cereal.  Protein at breakfast is always a good choice as it helps to regulate blood sugars and gives individuals a solid start to their day.  Over time, combining protein and a good fat such as butter on a whole wheat slice of toast will provide an added bonus of improved energy.
 
If a nice warm bowl of oats porridge is preferred for breakfast, one can add some protein by mixing in a teaspoon of chia seeds, half a mashed banana and honey to sweeten.   Do remember however, to add extra water/milk when you cook the porridge as the chia seeds absorb the liquid and swell.
 
Another idea is to drink a daily smoothie made with raw nuts, half a banana, a three quarter cup of milk of your choice (plant based/nut-based milks can be used), a quarter teaspoon of ground cinnamon and a teaspoon of honey.  Blend with two to three ice blocks and you have a delicious, creamy breakfast/lunch or dinner.  This recipe makes enough for one adult.

An individualised approach to one’s wellbeing is especially important during stressful times when there have been plenty of eventful, unprecedented changes around us.  Our physical, mental, emotional and spiritual wellbeing all need support, and a one size fits all approach is not always helpful.
 
Entering the senior phase of one’s life journey is such a privilege – but it brings with it a range of unique challenges.  For some, they’re fortunate enough to have their physical bodies and minds remain strong and vital.  While for others physical strength becomes a challenge, and their mental clarity is not what it used to be.
 
Many of the elderly find it increasingly more difficult to cook for themselves – they find themselves on their own after decades of looking after a family – and it becomes just too much work to cook for one person.
 
Despite these individual differences, the common thread among most people in their senior  years is that everything is slowing down.

In this article I would like to address three easy ways to ensure that eating a healthy plate of food is both affordable and manageable in most circumstances.

The first way to ensure that one is eating a balanced meal is to look at your hand – the palm to be precise.  A handy little measuring guide is to imagine the piece of chicken, fish, beef, lamb or vegetable protein fitting nicely inside the palm. This general guide will ensure that a person is getting sufficient protein into their body every day.
 
Eating too little protein happens more often as one gets older. For many people it’s due to expense, dental changes or health conditions that make swallowing difficult.  However, the need for adequate protein is important for the build and repair work that happens every day on our bodies.
 
Some easy and affordable options to ensure that one is eating sufficient protein is to include scrambled eggs at breakfast rather than cereal.  Protein at breakfast is always a good choice as it helps to regulate blood sugars and gives individuals a solid start to their day.  Over time, combining protein and a good fat such as butter on a whole wheat slice of toast will provide an added bonus of improved energy.
 
If a nice warm bowl of oats porridge is preferred for breakfast, one can add some protein by mixing in a teaspoon of chia seeds, half a mashed banana and honey to sweeten.   Do remember however, to add extra water/milk when you cook the porridge as the chia seeds absorb the liquid and swell.
 
Another idea is to drink a daily smoothie made with raw nuts, half a banana, a three quarter cup of milk of your choice (plant based/nut-based milks can be used), a quarter teaspoon of ground cinnamon and a teaspoon of honey.  Blend with two to three ice blocks and you have a delicious, creamy breakfast/lunch or dinner.  This recipe makes enough for one adult.
 

​While cancelled plans are disappointing, it is understandable that many people don't want to take the risks and/or deal with the inconveniences that may accompany travel these days – irrespective of the reason.
 
When it comes to travelling whether it's a simple vacation or moving a loved one across the country one needs to fully assess the risks to an elderly person’s health care before making plans.
 
Here are several tips on how to travel with an elderly person.
 
Frailty is a debilitating state where a loved one is weak, low in energy, and every movement is slowed down.  Recently it has been acknowledged by the medical community that frailty is a medical condition and not simply someone ‘getting old’.  Those suffering in a fragile condition may also have chronic pain that would further affect their mobility issues, and could present a challenge for any form of travel.
 
As a caregiver one may be used to helping the older person with daily activities.  Travelling is no different so don’t forget the skills learned whether you are on the road or in the sky.  For example, ask the person what they want and listen to what they say.  Accommodating the small requests and ensuring they are comfortable will go a long way to ensuring a pleasurable trip for all.
 
Know the risks of air travel
 
Air travel poses certain risks to the frail and elderly.  Below is an abridged list that one should  be aware of.
 
Hypoxia – this is essentially a change in cognition due to the changing air pressures. This is frustrating in that it can be undetectable except through magnetic resonance scans.  One might sense something is off if the elderly person acts delirious during or after the flight.

Stroke – The leading cause of inflight death is cardiac related.  If the older person has had a store in four or less weeks, they should not fly.  The trip should be postponed (ideally until the patient tis fit and well) or the trip should be made on the ground.  Similarly, if they have had a myocardial infarct within three months, they should not be flying.

Deep vein thrombosis and pulmonary embolism – in layman’s terms, if one sits for a long time one decreases blood circulation and increases the risk of blood clots.  These clots may present later after the travel experience.
 
The Australian Centre for Disease Control (CDC) offers this advice for travellers, “air travel may increase a person’s risk for VTE (Venous thromboembolism) by two – to four fold”.  They go on to point out other studies found:
 
 “A similar increase in risk is also seen with other modes of travel, such as car, bus, or train, implying that the increase in risk is caused mainly by prolonged limited mobility rather than by the cabin environment”.
 
Effect on body gases – the pressure changes within the cabin also affect the gases inside a person’s body.  Travellers should avoid carbonated drinks and gas-producing foods like beans, chewing gum, cabbage and brussel sprouts.
 
Ear and sinus problems – severe ear pain, tinnitus, or vertigo occurs in nine percent of air travellers.  That statistic is for all ages, so the elderly has an even higher chance of being impacted. Any persons with a middle ear and sinus problems will have an extremely painful experience and possibly cause damage to their health.
 
Motion sickness – those in a frail condition are most prone to motion sickness.  The sudden lift off and any turbulence along the way may leave them feeling nauseous.   This can lead to dehydration and a host of other scenarios.   Those travelling with them should plan ahead and administer any anti-nausea band or anti-nausea medicine prescribed by their doctor before boarding.
 
Other measures one can take is to pre-select seats away from the engines and closer to the plane’s centre of gravity (ie the inside seats slightly behind the wings).  Some experts also recommend flying at night to reduce the visual elements.
 
Temperature regulation – aircraft tend to be highly air-conditioned to lower the risk of infection, so don't forget the simple items like light jackets to control the persons core temperature.
 
Road Trips
 
When going on the road with an elderly person, carers need to remember the basics.  Plan on  frequent stops, every two hours.  Sitting for a prolonged period is hard on the body and will increase fatigue.

​It is likely that all travellers will need the restroom anyway, so plan on each of these stops adding an hour to the trip.  The older person is moving slowly but you need to be sensitive to their health condition.
 And last but not least, if there is any doubt about how the person may be impacted by flying or driving long distances it might be a good idea to look into alternative travel services such as medical transport.
 
Ref:  Aged Care New Zealand Issue 2 2021

​A New Zealand Health survey conducted suggests that despite a growing awareness of COPD, only 64 per cent of respondents had ever heard of it. Yet, according to NZHIS Mortality Data, COPD is the third leading cause of chronic morbidity and mortality and over 610,000 are affected.
 
COPD is a progressive lung disease that makes breathing difficult due to partially obstructed air flow into and out of the lungs.  It results from an inflammatory and destructive process in the lungs stimulated by exposure to toxins, primarily due to a history of smoking cigarettes.
 
Healthy older adults’ bronchial tubes and alveoli are elastic, thus, when they breathe in and out the lungs inflate and deflate much like a balloon.  In contrast, patients with COPD experience limited airflow through their airways, due to either a loss of elasticity and/or inflamed, damaged or mucous-clogged airways.  Because the airways are partially blocked, breathing becomes difficult and the lungs begin to lose their ability to effectively take up oxygen and remove carbon dioxide.
 
Symptoms of COPD include chronic cough, often referred to as smoker’s cough; excessive mucous production; wheezing; shortness of breath; tightness in the chest; and a decrease in exercise capacity.
 
The leading cause of COPD is cigarette smoking; in fact, most patients with COPD are either current smokers or have a history of smoking.  According to the New Zealand Lung Foundation, an estimated 80 to 90 percent of COPD deaths are attributed to smoking, and smoking cessation is the most effective means of disease prevention.  Other causes include long-term exposure to indoor and outdoor air pollutants, occupational chemicals, fumes, dust, and second-hand smoking.  In rare cases, a genetic component may increase susceptibility.

​COPD is an umbrella term that includes both emphysema and chronic bronchitis.  Patients with emphysema are referred to as pink puffers and experience shortness of breath to a loss of elasticity and eventual damage to the air sacs, leading to impaired exhalation and a build-up of gas in their lungs. These patients are typically thin, often exhibiting significant weight loss due to the increased energy requirements associated with laboured breathing.  In contrast, patients with chronic bronchitis are referred to blue bloaters and are typically normal weight or overweight and oedematous and experience persistent cough, increased mucous production, and shortness of breath due to inflammation, scarring, and eventual narrowing of the airways.
 
The term COPD is used to refer to these two conditions because patients often exhibit features of both.  As the disease progresses, an individual’s ability to breathe worsens, and some patients may require supplemental oxygen or mechanical ventilation.  Although COPD is largely preventable, it is not curable and lung damage is irreversible.  Therefore, treatment focuses on smoking cessation, symptom management, improved conditioning and increasing a patient’s ability to lead an active life.
 
Maintaining a healthy weight is vital
 
For most people breathing is unconscious and perceived as effortless. Yet, for many adults with COPD, breathing requires a conscious effort. Because of this added effort, patients can increase their resting energy expenditure (REE) by 10 to 15 percent.  As a result, if they do not compensate for their increased energy needs used by adding more calories to their diet, they will lose weight.
 
In addition to increased REE, patients lose weight due to decreased dietary intake because of an inherent inability to eat rather than a lack of appetite.  Reasons for poor nutritional intake include the following:

• Difficulty swallowing or chewing due to dyspnoea
• Chronic mouth breathing, which can alter the taste of food
• Chronic mucous production
• Coughing
• Fatigue
• Morning headache or confusion due to hypercapnia
• Anorexia
• Depression, and
• Side effects of medications

 
The purpose of nutrition care for this population is to provide adequate energy to minimise the risk of unwanted weight loss, avoid loss of fat-free mass (FFM), prevent malnutrition, and improve pulmonary status.  Research shows that COPD is a disease that not only affects the lungs but can also have systemic consequences, as well as result in severe weight loss and FFM depletion.
 
Combined, loss of weight and FFM can adversely affect breathing by reducing the strength and function of respiratory and skeletal muscles.  The risk of malnutrition is a common concern among patients with COPD who lose an excessive amount of weight and FFM. Malnutrition can impair pulmonary function, increase susceptibility to infection, lower exercise capacity, and increase the risk for mortality and morbidity.

​Antioxidant, vitamin and mineral considerations
 
Research indicates that cigarette smoke contains free radicals and other oxidants that can lead to oxidative stress, subsequent inflammation, and reduced airflow to the lungs.  For this reason, antioxidant therapy has been proposed for its ability to minimise free radical damage and reduce inflammation. In fact studies have shown that patients who continue to smoke have low concentrations of serum vitamin C. According to findings from the National Health and Nutrition Examination Survey, a positive relationship exists between an increased dietary intake of vitamin C and pulmonary function.  Researchers have found that smokers, as well as patients experiencing acute exacerbations, had lower plasma levels of certain antioxidants (eg ascorbic acid, vitamin E, beta-carotene selenium) and that this imbalance between oxidants and antioxidants leads to oxidative stress and inflammation and could be a significant contributing factor to the systemic effects characterised by the disease.
 
Although the research is not sufficient to conclude that anti-oxidant therapy can slow COPD’s rate of progression, findings indicate that the consumption of fresh fruits and vegetables is positively associated with improved pulmonary function, fewer symptoms, and possibly reduced oxidative stress.  Keeping in mind that elders may develop vitamin and mineral deficiencies due to reduced dietary intake is also important.
 
Many patients with COPD are prescribed glucocorticoids to help reduce airway inflammation and improve breathing.  However, one of the side effects of glucocorticoid use is bone mass loss and eventual osteoporosis, leading to an increased risk of fractures.  Several risk factors can cause osteoporosis, and patients with COPD typically have many of them, such as the use of glucocorticoids, smoking, vitamin D deficiency, low BMI, malnutrition, and decreased mobility.  According to a recent that examined the impact of COPD on osteoporosis development, 36 to 60 per cent of patients with COPD eventually develop osteoporosis.  For this reason, patients who are starting a long-term inhaled or oral glucocorticoid therapy are encouraged to supplement it with calcium and vitamin D since bone loss occurs rapidly upon initiating treatment.

​The importance of proper nutrition
Proper nutrition can help reduce carbon dioxide levels and improve breathing.  Specifically, it is important to focus on the percentages of total carbohydrate, fat, and protein that patients consume to see how their diet composition impacts their respiratory quotient (RQ), defined as the ratio of carbon dioxide produced to oxygen consumed.  To put it simply, following metabolism, in the presence of oxygen carbohydrate, fat and protein are all converted to carbon dioxide and water.  However, the ratio of carbon dioxide produced to oxygen consumed differs per macronutrient; the RQ for carbohydrate is 1 fat is 0.7, and protein is 0.8.  From a nutritional stand point, this means that eating carbohydrates will yield the most carbon dioxide, while eating fats will yield the least carbon dioxide.  Hence, prescribing a high-fat, low carbohydrate diet would reduce patient RQ levels and carbon dioxide production.  In fact, patients who have difficulty increasing ventilation following a carbohydrate load or patients with severe dyspnoea or hypercapnia may benefit from ahigh-fat diet.
 
Protein needs should be assessed on an individual basis.  Intake should be high enough to stimulate protein synthesis, prevent muscle atrophy, and maintain lung strength but should not contribute excess calories to the diet.  The general rule of thumb is about 1.2 to 1.7 g/kg of protein daily, or approximately 20 per cent of total caloric intake.  As for fluids, patients who are not on a fluid-restricted diet should be encouraged to drink liquids (2 to 3 litres per day) to keep mucous thin and help clear the airways.
 
There is still debate as to the effectiveness of nutrition therapy in improving anthropometric measurements, lung function, and exercise capacity in patients with COPD.  According to the Global Initiative for Chronic Obstructive Lung Disease, nutrition supplementation coupled with exercise may increase efficacy.  Although exercise is probably the last thing most patients with breathing problems want to think about, engaging in regular exercise has been shown to improve overall strength and endurance, reduce symptoms of dyspnoea and fatigue, improve cardiovascular function, and breathing.  In addition, well-conditioned muscles use less energy, which can help stabalise REE levels.
 
 
Authors: Ilaria St. Florian, MS, RD
 
From Aged Care NZ Issue 02 2021

​The health, wellness, safety and overall care of residents in aged care facilities has always been of the utmost importance, but the onset of COVID 19 has led to a distinctive elevation of the cleaning crew.
 
Aged care cleaners have always been important, but now everyone recognises it.  Cleaners have never been so appreciated and are now finally getting the recognition they deserve and the resources they should always have had.
 
People in facilities are acknowledging the cleaning staff and understanding that they’re doing as difficult a task as what the care worker does and as vital,  if not more.  And residents are appreciating the cleaners, which is positive for the workforce.
 
Examining the challenges and solutions of cleaning techniques and products within aged care facilities can help provide a safe and high quality health system that offers ultimate care required and elevate the overall standard for people living in aged care facilities.

​Cleaning – general procedures
 
Cleaning is important for infection control – particularly in work areas – because deposits of dust, soil and microbes on surfaces can transmit infection.  Contaminated areas such as operating rooms or isolation rooms must be cleaned after each session, and spot cleaned after each case or thoroughly cleaned as necessary.
 
The following basic principles should be followed:

• written cleaning protocols should be prepared, including methods and frequency of cleaning: protocols should include policies of the supply of all cleaning and disinfectant products
• standard precautions (including wearing of protective equipment (PPE), as applicable) should be implemented when cleaning surfaces and facilities (see “Standard and additional precautions”)
• cleaning methods should avoid generation of aerosols
• all cleaning items should be changed after each use and cleaned and dried before being used again.  They should also be changed immediately following the cleaning of blood or body fluid/substance spills.  Single use cleaning items are preferred, where possible, such as lint free cleaning cloths.
• spays should not be used as they do not touch all parts of the surface being cleaned.
• detergents should not be mixed with other chemicals
• all cleaning solutions should be prepared fresh before use.

 
Cleaning – specific  procedures
 
Surface cleaning
 
Floors in aged care facilities should be cleaned daily or, as necessary, with a vacuum cleaner fitted with a particulate-retaining filter.  The filter should be changed in accordance with the manufacturer’s instructions.
 
The exhaust air should be directed away from the floor to avoid dust dispersal.
 
A ducted vacuum cleaning system can also be used; as long as safe venting of the exhaust air is ensured.

Damp dusting using a lint free cloth is essential.  Brooms disperse dust and bacteria into the air and should not be used in patient or clinical areas.  Dust retaining mops which are specifically treated or manufactured to attract and retain dust particles, do not increase airborne counts as much as ordinary brooms and remove more dust from surfaces.   However brooms and dust retaining mops should not be used in clinical areas where there is high risk of infection associated with dust (for example, burns units).
 
The procedure for routine surface cleaning is as follows:

• All cleaning solutions should be prepared immediately before use.
• Work surfaces should be cleaned (wiped over) with a neutral detergent and warm water solution, rinsed and dried before and after each session, or when visibly soiled.  Spills should be cleaned up as soon as practical.
• When a disinfectant is required for surface cleaning the manufacturer’s recommendations for use, and workplace health and safety instructions should be followed.
• Buckets should be emptied after use, washed with detergent and warm water, rinsed in hot water and stored dry (upside down).
• Mops should be laundered or cleaned in detergent and warm water, rinsed in hot water, then stored dry.  Mop heads should be detachable or stored with the mop head up.

 
Specialised areas
 
Isolation and treatment rooms and ensuite bathrooms should be cleaned at least twice daily.
 
Sterilising processing departments should be cleaned at least twice daily and when visibly soiled.
 
Wet areas
 
The following should be cleaned at least daily and more frequently as required:

• toilets, sinks, washbasins, baths and shower cubicles
• all fittings attached to showers, baths and handbasins
• surrounding floor and wall areas

Walls and fittings

• Walls and screens should be cleaned quarterly or if visibly soiled. 
• Blinds and curtains should be cleaned quarterly of if visibly soiled. 
• Carpets should be vacuumed daily, and other floor surfaces washed daily when soiled.
• Bed and examination screens should be changed weekly and when visibly soiled.

 
Cleaning other infection disease agents
 
Spills of blood and other body fluids and tissues should be cleaned using standard spills management procedures.  PPE used when cleaning contaminated surfaces should be incinerated after use. Reusable eye protection should be cleaned as above.
 
Maintenance of cleaning equipment
 
Cleaning items (including solutions, water, buckets, cleaning cloths and mop heads) should be changed after each use.  They should also be changed immediately following the cleaning of blood or body substance spills.
 
These items should be washed in detergent and warm water, rinsed and stored dry between uses.  Mops with detachable heads should be laundered between uses.
 
Waste disposal
 
All healthcare facilities should have policies and procedures in place for the correct management of all waste generated.  The Environmental Protection Authority New Zealand (EPANZ) has clear guidelines on how waste should be managed.  The National Health, and Medical Research Council (NHMRC) also has guidance on the management of waste generated in healthcare facilities.
 
Waste is classified into three main groups of waste:

• general
• clinical
• pharmaceutical

 
All waste should be stored in secure areas until collection.  Waste disposal companies licensed with the EPA will collect all clinical and pharmaceutical waste for disposal in specialised waste disposal facilities, which are also licensed by the EPA.
 
Waste should be removed from clinical areas at least three times each day, and more frequently as needed, such as from specialised areas.  Waste bags should be tied before removing from the area.
 
General waste disposal
 
Place in general waste bin for removal. 

​Walls and screens should be cleaned quarterly or if visibly soiled.
 
Blinds and curtains should be cleaned quarterly of if visibly soiled.
 
Carpets should be vacuumed daily, and other floor surfaces washed daily when soiled.

Bed and examination screens should be changed weekly and when visibly soiled.
 
Cleaning other infection disease agents
 
Spills of blood and other body fluids and tissues should be cleaned using standard spills management procedures.  PPE used when cleaning contaminated surfaces should be incinerated after use. Reusable eye protection should be cleaned as above.
 
Maintenance of cleaning equipment
 
Cleaning items (including solutions, water, buckets, cleaning cloths and mop heads) should be changed after each use.  They should also be changed immediately following the cleaning of blood or body substance spills.
 
These items should be washed in detergent and warm water, rinsed and stored dry between uses.  Mops with detachable heads should be laundered between uses.
 
Waste disposal
 
All healthcare facilities should have policies and procedures in place for the correct management of all waste generated.  The Environmental Protection Authority New Zealand (EPANZ) has clear guidelines on how waste should be managed.  The National Health, and Medical Research Council (NHMRC) also has guidance on the management of waste generated in healthcare facilities.
 
Waste is classified into three main groups of waste:

• general
• clinical
• pharmaceutical

 
All waste should be stored in secure areas until collection.  Waste disposal companies licensed with the EPA will collect all clinical and pharmaceutical waste for disposal in specialised waste disposal facilities, which are also licensed by the EPA.
 
Waste should be removed from clinical areas at least three times each day, and more frequently as needed, such as from specialised areas.  Waste bags should be tied before removing from the area.
 
General waste disposal
 
Place in general waste bin for removal.
 

​Clinical waste disposal
 
Place in biohazard bags as soon as possible.  Biohazard bags have a biohazard symbol and are currently coloured yellow.
 
Single use sharps should be placed (by the user) into a sharps container that meets the Australian and New Zealand Standards AS 4031:1992 and AS.NZS 4261:1994.
 
Pharmaceutical waste disposal
 
When uncertain about how to dispose of leftover pharmaceuticals they should be returned to             pharmacy for correct disposal.
 
Most disinfectants can be disposed of through the sewer system by running cold water into the sink before pouring the disinfectant into the sink.  Leaving the cold water running for a few moments after the disinfectant has been disposed of dilutes the disinfectant.
 
Impacts of infection control
 
One of the biggest and  most common challenges for aged care facilities is infection control.  The risk of healthcare associated infections occurs for many reasons, and while they can’t be completely eliminated they can be managed with the correct protocols.
 
Environmental services or frequent touchpoints  such as door handles, bathroom taps, and lift buttons can carry infections, which is why Community and Public Health recommends these areas be cleaned more frequently than the routinely recommended daily cleaning.
 
Other elements including productivity and time management are pivotal for success.  It is important aged care facilities continue to solve the challenges they are facing while striving for the best possible cleaning standard for residents.
 
 
 
Reference: Aged Care NZ Issue 02 2022