Thank you for your interest in the Hepatic Encephalopathy (HE) In-service Toolkit. The materials in the kit are for your utilization in your facilities or other LTC treatment settings that you work to provide education to your staff on (HE).
The kit includes two (HE) in-service decks; Part 1: Change in Mental Status Hepatic Encephalopathy (HE) Management Overview and Part 2: Change in Mental Status Hepatic Encephalopathy (HE) Treatment & IDT Process that you can use to deliver two separate in-service presentations approximately 15-20 minutes In length. There is also a version of each in-service presentation with facilitator notes to help you prepare for your in-service presentations.
We have also included two links to recorded versions of each in-service presentation for easy on-demand utilization or for you to send out to your staff as you see fit to support their education and development.
Finally, we have included an article that was recently published in the Annals of Long Term Care titled “Hepatic Encephalopathy in LTC Residents: Missing a Potential Cause of Change in Mental Status in Patients With Cirrhosis”. This article can be utilized as another preparation piece or can be distributed to your staff as an enduring reference.
We hope you find these materials helpful and we thank you for the support you provide to your staff and the care you provide to you residents.
Part 1: Change in Mental Status Hepatic Encephalopathy (HE) Management Video (password if needed: paradigm)
Part 2: Change in Mental Status Hepatic Encephalopathy (HE) Treatment & IDT Process Video (password if needed: paradigm)
Long-term care infection prevention
If you or a loved one is staying in a long-term care facility, there are some important things you need to know to prevent infections.
Why is infection prevention important for long-term care residents?
When people are living closely together, they are more likely to become sick with infections that are transmitted from person to person.
Because residents in long-term facilities may have open wounds, devices such as urinary catheters or intravenous catheters, or be incontinent of urine or stool, it is especially important for the staff, visitors, and other patients to practice good infection prevention and control techniques.
Good infection prevention and control techniques include cleaning hands before and after touching another resident, cleaning and disinfecting environmental surfaces, removing soiled items (like used tissues or adult diapers from the environment), or wearing personal protective equipment (such as gloves, a gown, or a mask).
Bacteria and viruses that can be transmitted to others in long-term care facilities include methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C. diff), norovirus, and other bacteria, fungi, or viruses.
Infections, like influenza or the common cold, can spread when the sick person talks, coughs, or sneezes and releases droplets of saliva and mucus. These droplets can travel through the air and can be inhaled through the nose and mouth of another person or contaminate their hands.
What residents can do:
Wash your hands before you eat and after using the bathroom. It should take at least 20 seconds to thoroughly wash your hands. Using an alcohol-based hand sanitizer is a good option if your hands are not visibly dirty.
If you have open sores, cover them with a bandage. Do not pick at your sores or remove your bandage.
Cover your mouth with the inside of your elbow when you cough or sneeze. Throw away any used tissues and wash your hands afterwards.
Don’t share your personal items with other residents.
Remind your care providers to wash their hands frequently. It’s OK to ask if a care provider has cleaned their hands before caring for you.
If your doctor prescribes an antibiotic for an infection, take the medication exactly how it is prescribed.
Follow directions if you are asked to stay in your room.
Don’t touch any food that will be eaten by someone else.
What residents can observe/ask:
If your healthcare provider has prescribed you antibiotics, be sure to ask the following questions:
“Do I really need an antibiotic?”
“Can I get better without this antibiotic?”
“What side effects or drug interactions can I expect?”
“What side effects should I report to you?”
“How do you know what kind of infection I have? I understand that antibiotics won’t work for viral infections.”
If you have an infection, your caregivers may be wearing protective equipment, like gowns, gloves or face mask. Make sure they take them off before they leave the room.
Make sure that everyone (residents, care providers, and visitors) wash their hands when they enter the room and when they leave the room.
Make sure your care provider is wearing gloves if they are removing a dressing. A gown might be necessary if the wound is large.
Ask staff how they are cleaning items used by many residents (e.g., recreational therapy objects).
What family members or other visitors can do:
Wash hands before and after each visit.
Wear a surgical mask if visiting someone that has an infection with germs that can be spread to others through the air (for example, the flu).
Wear a gown and gloves if visiting someone who has a virus or type of bacteria that can be transmitted through direct contact.
Learn more and share:
How to be a good visitor at a nursing home—APIC consumer alert
Ask questions about your medications—Infection Prevention and You
Nursing Homes and Assisted Living (Long-term Care Facilities)—The Centers for Disease Control and Prevention
FAQ: Standard Precautions, FAQ: Droplet Precautions, and FAQ: Contact Precautions—Virginia Department of Health
Seniors at risk for the flu—Flu.gov