When it comes to preventing infection in aged care facilities, some measures are more impactful than others. Just as in many cause and effect relationships, a few vital actions can reduce the likelihood of an infection in your facility by up to 80%. The good news? We have already figured out what those few critical actions are.

What is the Pareto Principle?

More than a century ago (1896), the Italian economist Vilfredo Pareto noticed that most income and wealth went to the minority of the people. In particular, he identified that 20% of the population owned 80% of the land. Pareto discovered that this strong imbalance of land ownership (80/20) was repeated consistently whenever he looked at data referring to different periods or different countries.

The inbuilt imbalance between causes and results can still be seen in a variety of areas today [1]:

  • 20% of companies’ products usually account for 80% of revenue
  • 20% of criminals typically account for 80% of all crime
  • 20% of motorists cause 80% of accidents
  • 20% of your clothes are worn 80% of the time

The importance of Pareto’s Principle in aged care facilities

The reason that Pareto’s 80/20 Principle is so valuable is that it is counterintuitive. We tend to expect that all causes will have roughly the same significance. That all residents will require an equal amount of care, all staff members deliver similar levels of value, and all resident family members desire equal frequencies of contact. Yet, whether you realise it or not, the 80/20 principle applies to all of these examples too. A few residents will demand most of the care, a few team members get most of the work done, a few members of the team cause all the drama, and a few family members drive most of the time spent on communication.

How can Pareto’s Principle help control and reduce infection?

The imbalance between cause and effect also holds for the efforts you undertake to prevent infection in your facility: not every action aimed against spreading of infection is as valuable as another. In fact, in Bug Control’s experience, the consistent and correct execution of two high priority activities can decrease the chance of infection by 80%.

High-priority activity 1: Handwashing

When it comes to infection control, handwashing is the number one activity that you need to undertake to improve your IPC outcomes. As soon as a facility starts taking handwashing more seriously, we see an immediate drop in the number of infections. In the example below, you can see the effects handwashing program implementation in one of the facilities we have audited. Since the program commenced in August 2017, you see a dramatic reduction in urinary tract infections and new respiratory infections. When we compare the 12 months prior to implementing the program (Sep 16–Aug 17) with the 12 months afterwards (Sep 17 – Aug 18) the total number of infections has dropped significantly by 66%.

Residents with new urinary tract infections graphs

After introducing a handwashing program in 2017, this facility was able to reduce the number of new UTIs dramatically.

New Respiratory Infecions - Residents Infected graph

With the handwashing program, the facility also managed to reduce the number of new respiratory infections.

Total infection by month - 3 monthly trend graph

As a result of the decreasing numbers of UTIs and respiratory infections, the total number of infections in the facility has dropped to an all-time low.

As a facility manager, you have to ensure that all your team members and visitors to your facility wash their hands thoroughly and frequently in-line with the infection prevention and control guidelines.

You have probably experienced that just asking your staff to change their handwashing habits doesn’t always improve their behaviour. In fact, many organisations have gone through the most creative attempts to convince people to follow the right routines.

Example of a creative attempt to change people’s handwashing behaviour.

Although we would love to see you make a movie like this, our best advice is to talk to your staff individually. Try to have deeper conversations about the impact of the decision to wash their hands on their personal life. Try to make them visualise that their decision to skip vital handwashing steps not only affects residents, but can result in them taking the germs and bacteria into their cars and homes. Consequently, infections from the aged care facility can potentially reach their loved ones and even their children. At Bug Control we’ve often received feedback that this strategy has been highly effective for staff in many facilities.

High-priority activity 2: Cleaning

The second most significant action to dramatically decrease the likelihood of transmission of infection is making sure that staff thoroughly clean and disinfect all surfaces in your facility. Their focus should be on the critical spots for transmission, such as doorknobs, handles, light switches and other frequently touched surfaces [2]. Earlier this year, we found that 95% of facilities that not pass their Infection Prevention and Control audits don’t clean their facility adequately.

One of the most common mistakes that staff are unaware of is that it’s the friction of the actual rubbing that cleans the bacteria off. The cleaning solution only helps a little bit. Too often, people think a little spray and wipe will make things clean. As a facility manager, it is vital to show leadership and change that perspective.

Conclusions and recommendations

Pareto’s Principle shows that 80% of outcomes are often driven by 20% of efforts. This surprising unbalance has been found in many areas and industries, including aged care. In fact, aged care facilities have been able to drop the infections by 66% by increasing the focus on handwashing only. Facilities that improve their cleaning efforts at the same time can easily accomplish an 80% reduction. Therefore, facility managers should prioritise the two activities that have proven to contribute most to an infection-free facility: handwashing and cleaning. This strategy will dramatically decrease the likelihood of infection in your facility.


[1]  The 80/20 Principle, Richard Koch (2011)

[2]  Tuladhar E et al., Appl Environ Microbiol, Residual Viral and Bacterial Contamination of Surfaces after Cleaning and Disinfection (2012)

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