Incidence and impact of infection in a nursing home care unit

doi:10.1016/0196-6553(90)90180-Z

American Journal of Infection Control

Volume 18, Issue 3, June 1990, Pages 151-159

https://doi.org/10.1016/0196-6553(90)90180-Z Get rights and content

Abstract

In this study we examined the frequency of infection and its consequences in a Veterans Administration medical center nursing home care unit during its first 9 months of operation. A total of 231 patients were enrolled and were followed up for an average stay of 115 days. Sixty-nine infections occurred in 50 patients and yielded a period prevalence rate of 22% and an infection incidence rate of 2.6 infections per 1000 days of patient care. Symptomatic urinary tract infections, pneumonia, and skin and soft tissue infections accounted for 41%, 32%, and 17% of the infections, respectively. Staphylococci, streptococci, and aerobic gram-negative bacilli were the most common bacterial isolates. Thirty-four episodes of infection (49%) required administration of parenteral antibiotics in the nursing home care unit, and 21 episodes (30%) necessitated transfer to the acute care hospital for management. Infection caused one death and contributed to the death of 4 of the 55 other patients who died during the study period.

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The Nursing Home Pneumonia Risk Index: A Simple, Valid MDS-Based Method of Identifying 6-Month Risk for Pneumonia and Mortality
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Pneumonia is the leading infectious cause of hospitalization and death for nursing home (NH) residents; however, diagnosis is often delayed because classic signs of infection are not present. We sought to identify NH residents at high risk for pneumonia, to identify persons to target for more intensive surveillance and preventive measures.
Based on a literature review, we identified key risk factors for pneumonia and compiled them for use as prediction tool, limiting risk factors to those available on the Minimum Data Set (MDS). Next, we tested the tool's ability to predict 6-month pneumonia incidence and mortality rates in a sample of 674 residents from 7 NHs, evaluating it both as a continuous and a dichotomous variable, and applying both logistic regression and survival analysis to calculate estimates.
NH Pneumonia Risk Index scores ranged from −1 to 6, with a mean of 2.1, a median of 2, and a mode of 2. For the outcome of pneumonia, a 1-point increase in the index was associated with a risk odds ratio of 1.26 (P = .038) or a hazard ratio of 1.24 (P = .037); using it as a dichotomous variable (≤2 vs ≥3), the corresponding figures were a risk odds ratio of 1.78 (P = .045) and a hazard ratio of 1.82 (P = .025). For the outcome of mortality, a 1-point increase in the NH Pneumonia Risk Index was associated with a risk odds ratio of 1.58 (P = .002) and a hazard ratio of 1.45 (P = .013); using the index as a dichotomous variable, the corresponding figures were a risk odds ratio of 3.71 (P < .001) and a hazard ratio of 3.29 (P = .001).
The NH Pneumonia Risk Index can be used by NH staff to identify residents for whom to apply especially intensive preventive measures and surveillance. Because of its strong association with mortality, the index may also be valuable in care planning and discussion of advance directives.
Seasonal variations in acute hospitalization and mortality among nursing home residents: Results from LOVE (Long-term care of Old people Via KorEan Nursing Home Network) study
2013, European Geriatric Medicine
To analyze the seasonal variation (winter, spring, summer, and autumn) of causal diseases of acute hospitalization from nursing home.
We reviewed medical records of all 338 cases of acute hospitalization occurring among nursing home residents in the Korean Nursing Home Network, checking age, sex, admission day, final diagnosis, and clinical outcomes (admission to intensive care unit, mortality, duration of stay).
Admissions due to infectious diseases were more frequent in winter. Compared to patients without pneumonia, those with pneumonia had worse clinical outcomes. After adjustment of age, sex, and duration of hospital stay, pneumonia in winter season was associated with a higher mortality risk (Odd ratio = 2.40, 95% CI 1.01–5.67).
During winter especially, pneumonia poses a high mortality risk in nursing homes, and large-scale prospective studies of acute diseases in nursing homes are needed.
Antibiotic Use and Resistance in Long Term Care Facilities
2012, Journal of the American Medical Directors Association
The common occurrence of infectious diseases in nursing homes and residential care facilities may result in substantial antibiotic use, and consequently antibiotic resistance. Focusing on these settings, this article aims to provide a comprehensive overview of the literature available on antibiotic use, antibiotic resistance, and strategies to reduce antibiotic resistance.
Relevant literature was identified by conducting a systematic search in the MEDLINE and EMBASE databases. Additional articles were identified by reviewing the reference lists of included articles, by searching Google Scholar, and by searching Web sites of relevant organizations.
A total of 156 articles were included in the review. Antibiotic use in long term care facilities is common; reported annual prevalence rates range from 47% to 79%. Part of the prescribed antibiotics is potentially inappropriate.
The occurrence of antibiotic resistance is substantial in the long term care setting. Risk factors for the acquisition of resistant pathogens include prior antibiotic use, the presence of invasive devices, such as urinary catheters and feeding tubes, lower functional status, and a variety of other resident- and facility-related factors. Infection with antibiotic-resistant pathogens is associated with increased morbidity, mortality, and health care costs.
Two general strategies to reduce antibiotic resistance in long term care facilities are the implementation of infection control measures and antibiotic stewardship.
The findings of this review call for the conduction of research and the development of policies directed at reducing antibiotic resistance and its subsequent burden for long term care facilities and their residents.
Hospital acquired infections (HAI) in the elderly: Comparison with the younger patients
2012, Archives of Gerontology and Geriatrics
Citation Excerpt :
In our study, 47.9% of all HAI episodes occurred in the elderly patients and the incidence of HAI per 1000 patient days was found to be 2.49. Although these results seem to correlate with some reports (Jacobson and Strausbaugh, 1990), our rates are lower than many other studies (Beaujean et al., 1997; Paillaud et al., 2005; Brusaferro et al., 2006; Eriksen et al., 2007). This may be due to the fact that many studies published in the literature were from geriatric or long-term-care facilities (LCFTs) and our hospital, like many other hospitals in Turkey, does not have a separate geriatric ward.
The aim of this retrospective study is to determine the frequency, type, microbiological characteristics and outcome of HAIs in the elderly (age ≥ 65) and to compare the data with younger patients in a Turkish Training and Research Hospital. From January 2008 to December 2009, the infection control team analyzed HAIs among 60,585 hospitalized patients (20,109 aged ≥ 65 and 40,747 aged between 18 and 64 years) with a total number of 419,017 patient days. A total of 825 HAIs episodes were detected in 607 patients, of which 395 episodes were in 301 elderly patients. The incidence of HAIs per 1000 patient days was 2.49 in the elderly and 1.64 in the younger patients’ group (p < 0.001). The most common site of infection in the elderly patients was the urinary tract, whereas in non-elderly group this was the lower respiratory tract. The incidence density of urinary tract infections, respiratory tract infections, surgical site, skin and soft tissue infections, primary bacteremia, and prosthesis infections were significantly higher in the elderly group (p < 0.05). Gram-negative species were the most frequently isolated agents in both groups. There were no significant differences between the groups in the frequency of isolated pathogens or antibiotic susceptibility patterns. Overall, the fatality rate was found 16.8%. The elderly patients were more likely to have crude mortality rates (22% vs. 12%; p < 0.01). The death was most often related to pneumonia, primary bacteremia or intravascular catheter infections in both groups.
Pneumonia in the long-term resident
2011, Clinics in Geriatric Medicine
Citation Excerpt :
Because there is an age-related decline in immune function, the response of the immune system to preventive vaccination is reduced, which increases the patient’s susceptibility to respiratory infections and pneumonia. Other studies indicate poor functional status, COPD, and tracheostomy as probable risk factors.52–56 Potentially modifiable risk factors may include large-volume aspiration and administration of sedating medications.21
Assessing the incidence of gastroenteritis among elderly people living in long term care facilities
2010, Journal of Hospital Infection
Citation Excerpt :
Surveillance studies published in the literature commonly use definitions for infectious conditions developed at a Canadian consensus conference in 1991 developed specifically for the long term care setting, known as ‘McGeer’s definitions’. Studies conducted prior to this time used definitions that may have been less sensitive.9–11 To meet McGeer’s definition for gastroenteritis, a resident must have two or more episodes of diarrhoea or vomiting in 24 hours, or have a stool specimen positive for a pathogen or toxin with at least one symptom consistent with the agent.
We conducted a systematic review and meta-analysis of the literature in order to estimate the incidence of gastroenteritis in long term care facility (LTCF) residents from published accounts of infection surveillance. PubMed, Web of Science and Google Scholar were searched using keywords ‘long-term care facility’, ‘nursing home’, ‘gastroenteritis’, ‘surveillance’, and ‘incidence’. We manually searched reference lists of all articles included. The number of cases of gastroenteritis and bed-days under surveillance was recorded so as to calculate incidence and assess the influence of the study country and case definition using random effects meta-analysis and regression. We included one trial and 14 surveillance studies in the analysis, with 47% (7/15) conducted after 1995. One study focused only on gastroenteritis in residents; the remainder considered a range of infections. There were 2 071 330 combined bed-days under surveillance and 717 cases of gastroenteritis. In all, 194 cases were associated with 10 outbreaks during these studies. We observed heterogeneity between studies, which may have been due to unreported clustering of gastroenteritis cases. The mean incidence of gastroenteritis in LTCF residents was 0.40 (95% confidence interval: 0.27–0.56) episodes per 1000 bed-days. Investigators conducting studies in the USA reported incidence three times lower than investigators in other countries. Use of a case definition developed specifically for LTCFs was not associated with a higher incidence of gastroenteritis. From our analysis, residents could expect to experience gastroenteritis once every 5–10 years, which is a lower rate than that estimated from point prevalence surveys. New studies are needed to better assess the incidence and causes of gastroenteritis in LTCF residents.

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ArticleIncidence and impact of infection in a nursing home care unit

Abstract

Am J Infect Control

J Chron Dis

Am J Infect Control

Am J Infect Control

Am J Infect Control

A prospective study of nosocomial in a chronic care facility

J Am Geriatr Soc

Prevalence survey of infections and their predisposing factors at a hospital-based nursing home care unit

J Am Geriatr Soc

A prevalence survey of infections in a combined acute and long-term care hospital

Infect Control

Infections among patients in nursing homes: policies, prevalence and problems

N Engl J Med

Infections and infection control among residents of eight rural Wisconsin nursing homes

Arch Intern Med

Article
Incidence and impact of infection in a nursing home care unit