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CMAJ • April 18, 2000; 162 (8)
© 2000 Canadian Medical Association or its licensors

Research
Recherche

Surveillance for outbreaks of respiratory tract infections in nursing homes

Mark Loeb*, Allison McGeer{dagger}, Margaret McArthur{dagger}, Rosanna W. Peeling, Martin Petric{ddagger} and Andrew E. Simor§

From *the Hamilton Regional Laboratory Medicine Program and the Departments of Pathology and Molecular Medicine, McMaster University, Hamilton, Ont.; the Departments of Microbiology at {dagger}Mount Sinai Hospital, {ddagger}the Hospital for Sick Children, and §Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Toronto, Ont.; and ¶the Bureau of Microbiology, Laboratory Centre for Disease Control, Health Canada, Ottawa, Ont.

Background: Outbreaks of respiratory tract infections are common in long-term care facilities for older people. The objective of our study was to determine both the frequency of such outbreaks and their clinical and epidemiological features.

Methods: Prospective surveillance for outbreaks of respiratory tract infections and a retrospective audit of surveillance records were conducted in 5 nursing homes in metropolitan Toronto over 3 years. The clinical manifestations of infected residents were identified and microbiological investigations for causal agents were conducted.

Results: Sixteen outbreaks, involving 480 of 1313 residents, were identified prospectively during 1 144 208 resident-days of surveillance, for an overall rate of 0.42 infections per 1000 resident-days. Another 30 outbreaks, involving 388 residents, were identified retrospectively. Outbreaks occurred year-round, with no seasonal pattern. Pathogens included influenza virus, parainfluenza virus, respiratory syncytial virus, Legionella sainthelensi and Chlamydia pneumoniae. Multiple pathogens were detected in 38% (6/16) of the prospectively identified outbreaks. Of the 480 residents in the prospectively identified outbreaks 398 (83%) had a cough, 194 (40%) had fever and 215 (45%) had coryza. Clinical findings were nonspecific and could not be used to distinguish between causal agents. Pneumonia developed in 72 (15%) of the 480 residents, and 58 (12%) required transfer to hospital. The case-fatality rate was 8% (37/480).

Interpretation: Our findings emphasize the importance of adequate surveillance for outbreaks of respiratory tract infections in nursing homes and of early diagnosis so that appropriate interventions can be promptly instituted.




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