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Manyam M, Biesheuvel M, Haenen A, van Asten L, van Werkhoven CHH, van de Kassteele J, van Gageldonk-Lafeber R, de Greeff S. Mortality Associated With Infectious Diseases in Dutch Nursing Homes. J Am Med Dir Assoc 2024:105198. [PMID: 39147369 DOI: 10.1016/j.jamda.2024.105198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Although older people in nursing homes have a larger susceptibility to infectious diseases, the extent to which infectious diseases contribute to their mortality is unknown. Therefore, we quantified the associations between seasonal infectious diseases and all-cause mortality in Dutch nursing homes. METHODS We analyzed time series (January 2009 to December 2021) of the weekly sentinel surveillance of infectious diseases in Dutch nursing homes. A generalized linear model with binomial distribution and identity link was used to associate the proportion of all-cause mortality with the incidence of infections: COVID-19 (2020-2021), gastroenteritis (GE), influenza-like illness (ILI), and lower respiratory tract infections (LRTIs) at 0- to 4-week time-lags (mortality incidence at 0 to 4 weeks after infections incidence). RESULTS Over 13 years, 81 nursing homes participated, with 20 to 35 homes each year (mean: 26). A total of 11,555 all-cause deaths occurred over 1,864,667 resident weeks, averaging a mortality incidence of 6.2 per 1000 resident weeks. All 4 tested infectious diseases exhibited a significant association with all-cause mortality in nursing homes (P ≤ .01). Collectively, these infectious diseases were associated with 18.6% (95% CI, 17.8%-19.3%) of all deaths. The association between mortality and ILI was significant in 7 of 12 ILI seasons. Yearly mortality associated with the specific infectious diseases was as follows: LRTI (10.2%; 95% CI, 9.6%-10.8%), ILI (8.2%; 95% CI, 7.5%-8.9%) (over the 7 of 12 significant seasons), COVID-19 (6.5%; 95% CI, 5.4%-7.7%) (over 2019-2021 as there was no previous SARS-CoV-2 circulation), and GE (2.3%; 95% CI, 2.0%-2.5%). CONCLUSION AND IMPLICATIONS In nursing homes, the occurrence of seasonal respiratory and gastrointestinal infections is associated with nearly one-fifth of all-cause deaths. Although infection prevention and surveillance may already be performed in some nursing homes, it is vital to implement, and enhance targeted strategies like (hand) hygiene protocols, environmental cleaning practices, reducing droplet and aerosol transmission, and vaccination to effectively address specific infections.
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Affiliation(s)
- Meghanadh Manyam
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), The Netherlands.
| | - Mirthe Biesheuvel
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), The Netherlands
| | - Anja Haenen
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), The Netherlands
| | - Liselotte van Asten
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), The Netherlands
| | - C H Henri van Werkhoven
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), The Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan van de Kassteele
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), The Netherlands
| | - Rianne van Gageldonk-Lafeber
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), The Netherlands
| | - Sabine de Greeff
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), The Netherlands
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Iversen AM, Hansen MB, Münster M, Kristensen B, Ellermann-Eriksen S. Hand hygiene compliance in nursing home wards: the effect of increased accessibility of alcohol-based hand rub. J Hosp Infect 2024; 147:206-212. [PMID: 38521416 DOI: 10.1016/j.jhin.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Elderly nursing home residents are vulnerable to infection from micro-organisms. Hand hygiene is considered one of the most important measures to prevent transmission. AIM To determine the effect of increased accessibility to alcohol-based hand rub (ABHR) in nursing home wards by monitoring hand hygiene compliance (HHC) among healthcare workers (HCWs). METHODS An 11-month intervention study was conducted in a Danish six-ward nursing home. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. Baseline HHC was compared with the HHC during an immediate intervention period and a long-term intervention period. FINDINGS A total of 159 HCWs were included. The AHHMS registered 341,078 hand hygiene opportunities. Overall baseline HHC was 31% (95% confidence interval: 30-32). A significant +18% absolute immediate effect (first five months) (95% CI: 17-19; P < 0.0001) and +13 percentage points (95% CI: 11-14; P < 0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean +27 percentage point difference (P < 0.0001). CONCLUSION Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, demonstrating a noteworthy effect. The study is the first to report the effect on nursing home dispenser accessibility as a single intervention and to show a significant unmet potential.
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Affiliation(s)
- A-M Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Denmark.
| | - M B Hansen
- Konduto ApS, Sani Nudge, Copenhagen, Denmark
| | | | - B Kristensen
- National Centre of Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - S Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Denmark
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Conlin M, Hamard M, Agrinier N, Birgand G. Assessment of implementation strategies adopted for antimicrobial stewardship interventions in long-term care facilities: a systematic review. Clin Microbiol Infect 2024; 30:431-444. [PMID: 38141820 DOI: 10.1016/j.cmi.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND The implementation of antimicrobial stewardship (AMS) interventions in long-term care facilities (LTCFs) is influenced by multi-level factors (resident, organizational, and external) making their effectiveness sensitive to the implementation context. OBJECTIVES This study assessed the strategies adopted for the implementation of AMS interventions in LTCFs, whether they considered organizational characteristics, and their effectiveness. DATA SOURCES Electronic databases until April 2022. STUDY ELIGIBILITY CRITERIA Articles covering implementation of AMS interventions in LTCFs. ASSESSMENT OF RISK OF BIAS Mixed Methods Appraisal Tool for empirical studies. METHODS OF DATA SYNTHESIS Data were collected on AMS interventions and context characteristics (e.g. type of facility, staffing, and residents). Implementation strategies and outcomes were mapped according to the Expert Recommendations for Implementing Change (ERIC) framework and validated taxonomy for implementation outcomes. Implementation and clinical effectiveness were assessed according to the primary and secondary outcomes results provided in each study. RESULTS Among 48 studies included in the analysis, 19 (40%) used implementation strategies corresponding to one to three ERIC domains, including education and training (n = 36/48, 75%), evaluative and iterative strategies (n = 24/48, 50%), and support clinicians (n = 23/48, 48%). Only 8/48 (17%) studies made use of implementation theories, frameworks, or models. Fidelity and sustainability were reported respectively in 21 (70%) and 3 (10%) of 27 studies providing implementation outcomes. Implementation strategy was considered effective in 11/27 (41%) studies, mainly including actions to improve use (n = 6/11, 54%) and education (n = 4/11, 36%). Of the 42 interventions, 18/42 (43%) were deemed clinically effective. Among 21 clinically effective studies, implementation was deemed effective in four and partially effective in five. Two studies were clinically effective despite having non-effective implementation. CONCLUSIONS The effectiveness of AMS interventions in LTCFs largely differed according to the interventions' content and implementation strategies adopted. Implementation frameworks should be considered to adapt and tailor interventions and strategies to the local context.
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Affiliation(s)
- Michèle Conlin
- Regional Center for Infection Prevention and Control Pays de la Loire, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marie Hamard
- Unité de gériatrie Aiguë, Hôpital Bichat-Claude Bernard, Paris, France
| | - Nelly Agrinier
- Université de Lorraine, Inserm, INSPIIRE, F-54000 Nancy, France; CHRU-Nancy, Inserm, Université de Lorraine, CIC, Epidémiologie clinique, Nancy, France.
| | - Gabriel Birgand
- Regional Center for Infection Prevention and Control Pays de la Loire, Centre Hospitalier Universitaire de Nantes, Nantes, France; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
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Alves PJ, Gryson L, Hajjar J, Lepelletier D, Reners M, Rodríguez Salazar J, Simon A. Role of antiseptics in the prevention and treatment of infections in nursing homes. J Hosp Infect 2023; 131:58-69. [PMID: 36216172 DOI: 10.1016/j.jhin.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
Inadequate infection control, wound care, and oral hygiene protocols in nursing homes pose challenges to residents' quality of life. Based on the outcomes from a focus group meeting and a literature search, this narrative review evaluates the current and potential roles of antiseptics within nursing home infection management procedures. We examine contemporary strategies and concerns within the management of meticillin-resistant Staphylococcus aureus (MRSA; including decolonization regimes), chronic wound care, and oral hygiene, and review the available data for the use of antiseptics, with a focus on povidone-iodine. Compared with chlorhexidine, polyhexanide, and silver, povidone-iodine has a broader spectrum of antimicrobial activity, with rapid and potent activity against MRSA and other microbes found in chronic wounds, including biofilms. As no reports of bacterial resistance or cross-resistance following exposure to povidone-iodine exist, it may be preferable for MRSA decolonization compared with mupirocin and chlorhexidine, which can lead to resistant MRSA strains. Povidone-iodine oral products have greater efficacy against oral pathogens compared with other antiseptics such as chlorhexidine mouthwash, highlighting the clinical benefit of povidone-iodine in oral care. Additionally, povidone-iodine-based products, including mouthwash, have demonstrated rapid in-vitro virucidal activity against SARS-CoV-2 and may help reduce its transmission if incorporated into nursing home coronavirus 2019 control protocols. Importantly, povidone-iodine activity is not adversely affected by organic material, such as that found in chronic wounds and the oral cavity. Povidone-iodine is a promising antiseptic agent for the management of infections in the nursing home setting, including MRSA decolonization procedures, chronic wound management, and oral care.
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Affiliation(s)
- P J Alves
- Wounds Research Laboratory, Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Portugal.
| | - L Gryson
- Belgian Defence Medical Component, Brussels, Belgium
| | - J Hajjar
- Infection Control Practitioner, Consultant, Pau, France
| | - D Lepelletier
- Hospital Hygiene Department, Nantes University Hospital, Nantes, France
| | - M Reners
- Private Dental Practice, Liège, Belgium
| | | | - A Simon
- Infection Control Team, Groupe Hospitalier Jolimont, Haine Saint-Paul, Belgium
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5
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Huang Y, Wei WI, Correia DF, Ma BHM, Tang A, Yeoh EK, Wong SYS, Ip M, Kwok KO. Antibiotic use for respiratory tract infections among older adults living in long-term care facilities: a systematic review and meta-analysis. J Hosp Infect 2023; 131:107-121. [PMID: 36202187 DOI: 10.1016/j.jhin.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Antibiotics are commonly prescribed for respiratory tract infections (RTIs) among older adults in long-term care facilities (LTCFs), and this contributes to the emergence of antimicrobial resistance. The objective of this study was to determine the antibiotic prescribing rate for RTIs among LTCF residents, and to analyse the antibiotic consumption patterns with the AwaRe monitoring tool, developed by the World Health Organization. METHODS MEDLINE, EMBASE and CINAHL were searched from inception to March 2022. Original articles reporting antibiotic use for RTIs in LTCFs were included in this review. Study quality was assessed using the Joanna Briggs Institute's Critical Appraisal Checklist for Prevalence Data. A random-effects meta-analysis was employed to calculate the pooled estimates. Subgroup analysis was conducted by type of RTI, country, and study start year. RESULTS In total, 47 articles consisting of 50 studies were included. The antibiotic prescribing rate ranged from 21.5% to 100% (pooled estimate 69.8%, 95% confidence interval 55.2-82.6%). The antibiotic prescribing rate for lower respiratory tract infections (LRTIs) was higher than the rates for viral and general RTIs. Compared with Italy, France and the USA, the Netherlands had lower antibiotic use for LRTIs. A proportion of viral RTIs were treated with antibiotics, and all the antibiotics were from the Watch group. Use of antibiotics in the Access group was higher in the Netherlands, Norway, Switzerland and Slovenia compared with the USA and Australia. CONCLUSION The antibiotic prescribing rate for RTIs in LTCFs was high, and AWaRe antibiotic use patterns varied by type of RTI and country. Improving antibiotic use may require coordination efforts.
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Affiliation(s)
- Y Huang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - W I Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - D F Correia
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - B H M Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - A Tang
- College of Computing and Informatics, Sungkyunkwan University, Seoul, Republic of Korea
| | - E K Yeoh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - S Y S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - M Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - K O Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China; Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Weinhandl ED, Liu J, Gilbertson DT, Wetmore JB, Johansen KL. Associations of COVID-19 Outcomes with Dialysis Modalities and Settings. Clin J Am Soc Nephrol 2022; 17:1526-1534. [PMID: 36400565 PMCID: PMC9528267 DOI: 10.2215/cjn.03400322] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
How maintenance dialysis modality, dialysis setting, and residence in a nursing facility have jointly associated with coronavirus disease 2019 (COVID-19)-related outcomes in the United States is relevant to future viral outbreaks. Using Medicare claims, we determined the incidence of COVID-19-related infection, hospitalization, and death between March 15, 2020 and June 5, 2021. The exposure was one of five combinations of dialysis modality and care setting: in-facility hemodialysis without a recent history of skilled nursing facility care, in-facility hemodialysis with a recent history of skilled nursing facility care, hemodialysis in a skilled nursing facility, home hemodialysis, and (home) peritoneal dialysis. Patient-weeks were pooled to estimate the adjusted associations of event incidence with each dialysis modality/setting during four intervals in 2020-2021. Relative to in-facility hemodialysis without a recent history of skilled nursing facility care, home dialysis was associated with 36%-60% lower odds of all events during weeks 12-23 of 2020; 24%-37% lower odds of all events during weeks 24-37 of 2020; 20%-33% lower odds of infection and hospitalization during the winter of 2020-2021; and similar odds of all events thereafter. In contrast, exposure to skilled nursing facilities was associated with 570%-1140% higher odds of all events during spring of 2020, although excess risk attenuated as the pandemic transpired, especially among patients who received hemodialysis in skilled nursing facilities. In conclusion, home dialysis was associated with lower risks of COVID-19 diagnosis, hospitalization, and death until vaccines were available, whereas care in skilled nursing facilities was associated with higher risks.
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Affiliation(s)
- Eric D. Weinhandl
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota
| | - Jiannong Liu
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - David T. Gilbertson
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - James B. Wetmore
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Division of Nephrology, Hennepin Healthcare and the University of Minnesota, Minneapolis, Minnesota
| | - Kirsten L. Johansen
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Division of Nephrology, Hennepin Healthcare and the University of Minnesota, Minneapolis, Minnesota
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Can alternative anatomical sites and environmental surveillance replace perianal screening for multidrug-resistant organisms in nursing homes? Infect Control Hosp Epidemiol 2022; 43:1063-1066. [PMID: 34016196 PMCID: PMC9190292 DOI: 10.1017/ice.2021.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Perianal screening can be intrusive. The sensitivities of multianatomical, nonperianal surveillance were 92.3% for methicillin-resistant Staphylococcus aureus (MRSA), 58.7% for vancomycin-resistant enterococci (VRE), and 54.9% for resistant Gram-negative bacilli (R-GNB). Sensitivities improved upon adding environmental surveillance (95.5%, 82.9%, and 67.9%, respectively). Multianatomical, nonperianal screening and room environment surveillance may replace perianal screening and reduce healthy participant bias in nursing homes.
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Harbin NJ, Lindbæk M, Romøren M. Barriers and facilitators of appropriate antibiotic use in primary care institutions after an antibiotic quality improvement program - a nested qualitative study. BMC Geriatr 2022; 22:458. [PMID: 35624423 PMCID: PMC9137170 DOI: 10.1186/s12877-022-03161-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antibiotic prescribing by physicians in primary care institutions is common and affected by several factors. Diagnosis and treatment of infections in a nursing home (NH) resident is challenging, with the risk of both under- and overtreatment. Identifying barriers and facilitators of appropriate antibiotic prescribing in NHs and municipal acute care units (MACUs) is essential to ensure the most adequate antibiotic treatment possible and develop future antibiotic stewardship programs. METHODS After implementing a one-year antibiotic quality improvement program, we conducted six semi-structured focus group interviews with physicians (n = 11) and nurses (n = 14) in 10 NHs and 3 MACUs located in the county of Østfold, Norway. We used a semi-structured interview guide covering multiple areas influencing antibiotic use to identify persistent barriers and facilitators of appropriate antibiotic prescribing after the intervention. The interviews were audio-recorded and transcribed verbatim. The content analysis was performed following the six phases of thematic analysis developed by Braun and Clarke. RESULTS We identified thirteen themes containing barriers and facilitators of the appropriateness of antibiotic use in primary care institutions. The themes were grouped into four main levels: Barriers and facilitators 1) at the clinical level, 2) at the resident level, 3) at the next of kin level, and 4) at the organisational level. Unclear clinical presentation of symptoms and lack of diagnostic possibilities were described as essential barriers to appropriate antibiotic use. At the same time, increased availability of the permanent nursing home physician and early and frequent dialogue with the residents' next of kin were emphasized as facilitators of appropriate antibiotic use. The influence of nurses in the decision-making process regarding infection diagnostics and treatment was by both professions described as profound. CONCLUSIONS Our qualitative study identified four main levels containing several barriers and facilitators of appropriate antibiotic prescribing in Norwegian NHs and MACUs. Diagnostic uncertainty, frequent dialogue with next of kin and organisational factors should be targeted in future antibiotic stewardship programs in primary care institutions. In addition, for such programs to be as effective as possible, nurses should be included on equal terms with physicians.
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Affiliation(s)
- Nicolay Jonassen Harbin
- Antibiotic Center for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0317, Oslo, Norway.
| | - Morten Lindbæk
- Antibiotic Center for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0317, Oslo, Norway
| | - Maria Romøren
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Sims S, Harris R, Hussein S, Rafferty AM, Desai A, Palmer S, Brearley S, Adams R, Rees L, Fitzpatrick JM. Social Distancing and Isolation Strategies to Prevent and Control the Transmission of COVID-19 and Other Infectious Diseases in Care Homes for Older People: An International Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3450. [PMID: 35329137 PMCID: PMC8955170 DOI: 10.3390/ijerph19063450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 12/18/2022]
Abstract
Older people living in care homes are at high risk of poor health outcomes and mortality if they contract COVID-19 or other infectious diseases. Measures used to protect residents include social distancing and isolation, although implementation is challenging. This review aimed to assess the social distancing and isolation strategies used by care homes to prevent and control the transmission of COVID-19 and other infectious diseases. Seven electronic databases were searched: Medline, CINAHL, Embase, PsycINFO, HMIC, Social Care Online, and Web of Science Core Collection. Grey literature was searched using MedRxiv, PDQ-Evidence, NICE Evidence Search, LTCCovid19.org and TRIP. Extracted data were synthesised using narrative synthesis and tabulation. 103 papers were included (10 empirical studies, seven literature reviews, and 86 policy documents). Strategies used to prevent and control the transmission of COVID-19 and other infectious diseases included social distancing and isolation of residents and staff, zoning and cohorting of residents, restriction of resident movement/activities, restriction of visitors and restriction of staff working patterns. This review demonstrates a lack of empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. Evaluative research on these interventions is needed urgently, focusing on the well-being of all residents, particularly those with hearing, vision or cognitive impairments.
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Affiliation(s)
- Sarah Sims
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Ruth Harris
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Shereen Hussein
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Anne Marie Rafferty
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Amit Desai
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Sinead Palmer
- Personal Social Services Research Unit, University of Kent, Canterbury CT2 7NZ, UK;
| | - Sally Brearley
- School of Nursing, Kingston University and St George’s University London, London SW17 0RE, UK;
| | | | - Lindsay Rees
- Encore Care Homes Management Ltd., Bournemouth BH8 9RL, UK;
| | - Joanne M. Fitzpatrick
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
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Cannon JL, Park GW, Anderson B, Leone C, Chao M, Vinjé J, Fraser AM. Hygienic monitoring in long-term care facilities using ATP, crAssphage, and human noroviruses to direct environmental surface cleaning. Am J Infect Control 2022; 50:289-294. [PMID: 35184878 PMCID: PMC8903150 DOI: 10.1016/j.ajic.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Norovirus and C. difficile are associated with diarrheal illnesses and deaths in long-term care (LTC) facilities and can be transmitted by contaminated environmental surfaces. Hygienic monitoring tools such as adenosine triphosphate (ATP) bioluminescence and indicators of fecal contamination can help to identify LTC facility surfaces with cleaning deficiencies. METHODS High-touch surfaces in 11 LTC facilities were swabbed and tested for contamination by norovirus, a fecal indicator virus, crAssphage, and ATP which detects organic debris. High levels of contamination were defined as log ATP relative light unit values or crAssphage log genomic copy values in the 75th percentile of values obtained from each facility. RESULTS Over 90% of surfaces tested positive for crAssphage or gave failing ATP scores. Norovirus contamination was not detected. Handrails, equipment controls, and patient beds were 4 times more likely than other surfaces or locations to have high levels of crAssphage. Patient bed handrails and tables and chairs in patient lounges had high levels of both ATP and crAssphage. CONCLUSIONS Surfaces with high levels of ATP and crAssphage were identified. Quantifying levels of contamination longitudinally and before and after cleaning might enhance infection prevention and control procedures for reducing diarrheal illnesses in LTC facilities.
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Affiliation(s)
- Jennifer L. Cannon
- National Foundation for the Centers for Disease Control and Prevention Inc., 600 Peachtree St. NE #1000, Atlanta, GA, 30308, USA,Center for Food Safety, University of Georgia, 1109 Experiment St, Griffin, GA, 30223, USA,Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA,Correspondence: Jennifer Cannon, 1600 Clifton Rd. NE, H18-7, Atlanta, GA, 30333, USA,
| | - Geun Woo Park
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Benjamin Anderson
- Center for Food Safety, University of Georgia, 1109 Experiment St, Griffin, GA, 30223, USA
| | - Cortney Leone
- Food, Nutrition, and Packaging Sciences Department, Clemson University, 206 Poole Agricultural Center, Clemson, SC, 29334, USA
| | - Morgan Chao
- Food, Nutrition, and Packaging Sciences Department, Clemson University, 206 Poole Agricultural Center, Clemson, SC, 29334, USA
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Angela M. Fraser
- Food, Nutrition, and Packaging Sciences Department, Clemson University, 206 Poole Agricultural Center, Clemson, SC, 29334, USA
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Cohen CC, Powell K, Dick AW, Deroche CB, Agarwal M, Stone PW, Alexander GL. Examining Nursing Home Information Technology Maturity and Antibiotic Use Among Long-Term Care Residents. J Am Med Dir Assoc 2022; 23:1019-1024.e2. [DOI: 10.1016/j.jamda.2022.01.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
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Gontjes KJ, Gibson KE, Lansing BJ, Mantey J, Jones KM, Cassone M, Wang J, Mills JP, Mody L, Patel PK. Association of Exposure to High-risk Antibiotics in Acute Care Hospitals With Multidrug-Resistant Organism Burden in Nursing Homes. JAMA Netw Open 2022; 5:e2144959. [PMID: 35103795 PMCID: PMC8808331 DOI: 10.1001/jamanetworkopen.2021.44959] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Little is known about the contribution of hospital antibiotic prescribing to multidrug-resistant organism (MDRO) burden in nursing homes (NHs). OBJECTIVES To characterize antibiotic exposures across the NH patient's health care continuum (preceding health care exposure and NH stay) and to investigate whether recent antibiotic exposure is associated with MDRO colonization and room environment contamination at NH study enrollment. DESIGN, SETTING, AND PARTICIPANTS This is a secondary analysis of a prospective cohort study (conducted from 2013-2016) that enrolled NH patients and followed them up for as long as 6 months. The study was conducted in 6 NHs in Michigan among NH patients who were enrolled within 14 days of admission. Clinical metadata abstraction, multi-anatomical site screening, and room environment surveillance for MDROs were conducted at each study visit. Data were analyzed between May 2019 and November 2021. EXPOSURES Antibiotic data were abstracted from NH electronic medical records by trained research staff and characterized by class, route, indication, location of therapy initiation, risk for Clostridioides difficile infection (C diffogenic agents), and 2019 World Health Organization Access, Watch, and Reserve (AWARE) antibiotic stewardship framework categories. MAIN OUTCOMES AND MEASURES The primary outcomes were MDRO colonization and MDRO room environment contamination at NH study enrollment, measured using standard microbiology methods. Multivariable logistic regression was used to identify whether antibiotic exposure within 60 days was associated with MDRO burden at NH study enrollment. Additionally, antibiotic exposure data were characterized using descriptive statistics. RESULTS A total of 642 patients were included (mean [SD] age, 74.7 [12.2] years; 369 [57.5%] women; 402 [62.6%] White; median [IQR] NH days to enrollment, 6.0 [3.0-7.0]). Of these, 422 (65.7%) received 1191 antibiotic exposures: 368 (57.3%) received 971 hospital-associated prescriptions, and 119 (18.5%) received 198 NH-associated prescriptions. Overall, 283 patients (44.1%) received at least 1 C diffogenic agent, and 322 (50.2%) received at least 1 high-risk WHO AWARE antibiotic (watch or reserve agent). More than half of NH patients (364 [56.7%]) and room environments (437 [68.1%]) had MDRO-positive results at enrollment. In multivariable analysis, recent antibiotic exposure was positively associated with baseline MDRO colonization (odds ratio [OR], 1.70; 95% CI, 1.22-2.38) and MDRO environmental contamination (OR, 1.67; 95% CI, 1.17-2.39). Exploratory stratification by C diffogenic agent exposure increased the effect size (MDRO colonization: OR, 1.99; 95% CI, 1.33-2.96; MDRO environmental contamination: OR, 1.86; 95% CI, 1.24-2.79). Likewise, exploratory stratification by exposure to high-risk WHO AWARE antibiotics increased the effect size (MDRO colonization: OR, 2.32; 95% CI, 1.61-3.36; MDRO environmental contamination: OR, 1.86; 95% CI, 1.26-2.75). CONCLUSIONS AND RELEVANCE The findings of this study suggest that high-risk, hospital-based antibiotics are a potentially high-value target to reduce MDROs in postacute care NHs. This study underscores the potential utility of integrated hospital and NH stewardship programming on regional MDRO epidemiology.
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Affiliation(s)
- Kyle J. Gontjes
- Division of Geriatric & Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
- Department of Microbiology & Immunology, University of Michigan Medical School, Ann Arbor
| | - Kristen E. Gibson
- Division of Geriatric & Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Bonnie J. Lansing
- Division of Geriatric & Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Julia Mantey
- Division of Geriatric & Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Karen M. Jones
- Division of Geriatric & Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Marco Cassone
- Division of Geriatric & Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Joyce Wang
- Department of Microbiology & Immunology, University of Michigan Medical School, Ann Arbor
| | - John P. Mills
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Lona Mody
- Division of Geriatric & Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Payal K. Patel
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Division of Infectious Diseases, Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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13
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Park S, Yang Y, Song E. Factors influencing knowledge, awareness, and compliance with standard precautions among psychiatric nurses. Arch Psychiatr Nurs 2021; 35:625-630. [PMID: 34861955 PMCID: PMC8484232 DOI: 10.1016/j.apnu.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to assess the level of knowledge, awareness, and compliance with standard precautions and to examine individual factors related to compliance with standard precautions among psychiatric nurses. Data were collected from September 2020 to March 2021. A total of 160 questionnaires were distributed, and a total sample of 134 valid questionnaires was analyzed. Compliance with standard precautions was significantly correlated with knowledge and awareness. Awareness (β = 0.547, p < .001) was a significant factor of compliance with a total explanatory power of 35.0% (F = 7.27, p < .001). Thus, the current coronavirus disease pandemic has significantly influenced the mental health infection system. These findings highlighted that psychiatric nurse must continue their efforts to improve compliance with infection prevention to prepare for an uncertain future with potential pandemics.
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Affiliation(s)
- SookKyoung Park
- College of Nursing, Chonbuk National University, South Korea.
| | - YaKi Yang
- Department of Nursing, Wonkwang University, South Korea.
| | - EunJu Song
- Department of Nursing, Wonkwang University, South Korea.
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14
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Fiveash JM, Smith ML, Moore AK, Jandarov R, Sopirala MM. Build upon basics: An intervention utilizing safety huddles to achieve near-zero incidence of catheter associated urinary tract infection at a department of Veterans Affairs long-term care facility. Am J Infect Control 2021; 49:1419-1422. [PMID: 33798629 DOI: 10.1016/j.ajic.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND When traditional interventions are used in long term care for catheter associated urinary tract infection (CAUTI) prevention, residual rates are still high despite a decrease. We conducted a quality improvement study focusing our interventions on patient and staff behavioral patterns identified through a structured huddle process to improve upon the basics for CAUTI prevention. METHODS Baseline was from January 2016 to March 2017; the intervention period was from April 2017 to June 2020. We implemented a systematic huddle to determine root cause of each CAUTI and applied lessons throughout the facility. We measured the monthly CAUTI incidence per 1000 urinary catheter days and analyzed the reduction in CAUTI during the intervention period. RESULTS CAUTI decreased by 73% during the intervention period compared to the baseline period, with an IRR of 0.27 (95% confidence interval [CI]: 0.11-0.66; P = .004). The number of catheter days per month increased by 4% in the intervention period (17,407 in 39 months) compared to the baseline period (6,440 in 15 months) with IRR of 1.04 (95% confidence interval [CI]: 1.01-1.07; P = .008). No patterns were noted in organisms responsible for CAUTI. CONCLUSIONS Our findings stress the importance of looking beyond the traditional interventions for CAUTI prevention in long term care population. By doing this, interventions can be customized for this special population to achieve optimal outcomes.
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15
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Rubano MD, Kieffer EF, Larson EL. Infection prevention and control in nursing homes during COVID-19: An environmental scan. Geriatr Nurs 2021; 43:51-57. [PMID: 34808421 PMCID: PMC8810224 DOI: 10.1016/j.gerinurse.2021.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022]
Abstract
To examine processes and programmatic elements of infection prevention and control (IPC) efforts and identify themes and promising approaches in nursing homes (NHs), an environmental scan was conducted. Data sources included a literature search, relevant listservs and websites, and expert consensus based on a virtual summit of leaders in IPC in long-term care settings. Three thematic areas emerged which have the potential to improve overall IPC practices in the long-term care setting: staffing and resource availability, training and knowledge of IPC practices, and organizational culture. If improved IPC practices and reduced cross-transmission of infections in NHs are to be sustained, both short-term and long-term changes in these areas are essential to fully engage staff, build trust, and enhance a 'just' organizational culture.
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Affiliation(s)
- Mario D Rubano
- New York Academy of Medicine, 1216 5th Avenue - Office #441, New York, NY 10029, United States.
| | - Elana F Kieffer
- New York Academy of Medicine, 1216 5th Avenue - Office #441, New York, NY 10029, United States
| | - Elaine L Larson
- New York Academy of Medicine, 1216 5th Avenue - Office #441, New York, NY 10029, United States; Columbia University, New York, NY, United States
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16
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Gleich S, Turlik V, Schmidt S, Wohlrab D. [COVID-19 deaths among residents of inpatient nursing homes in Munich-causes and places of death]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1136-1145. [PMID: 34379132 PMCID: PMC8356210 DOI: 10.1007/s00103-021-03395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/01/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The new infectious disease COVID-19 first appeared in China in December 2019. So far, a systematic evaluation of death certificates of COVID-19-associated deaths of residents in inpatient nursing homes has not been presented. METHODS Death certificates of all deaths in Munich in the death period from 1 March to 31 July 2020 were analyzed. Inclusion criteria were the presence of "Corona, COVID-19, SARS-CoV-2" on the death certificates. Standardized, anonymized data entry was performed. The collected data were analyzed descriptively. RESULTS During the study period, a total of 5840 persons died, 281 (4.8%) of whom died of confirmed COVID-19 disease. Of those, 72 deaths involved residents of Munich nursing facilities. The most frequent causes of death were respiratory insufficiency (54 cases) and multiple organ failure (9 cases). On the death certificates, an average of two preexisting diseases had been reported; the average age at death was 88 years. All deaths of nursing home residents occurred in association with nosocomial COVID-19 outbreaks, which affected one-third of the facilities. The vast majority of these homes did not have a COVID-19 hygiene plan in place at the time. DISCUSSION One quarter of all COVID-19 deaths in Munich occurred in the context of nosocomial outbreaks in elderly, chronically ill residents of nursing facilities. Evidence of inadequate risk assessment and inadequate hygiene management emerged. In the opinion of the authors, the appropriate structures for adequate hygiene management must be created and a hygiene regulation must be issued in which the tasks and responsibilities of the facility operators are defined.
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Affiliation(s)
- Sabine Gleich
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland.
| | - Verena Turlik
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland
| | - Susann Schmidt
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland
| | - Doris Wohlrab
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland
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Fu CJ, Agarwal M, Estrada LV, Murali KP, Quigley DD, Dick AW, Stone PW. The Role of Regional and State Initiatives in Nursing Home Advance Care Planning Policies. Am J Hosp Palliat Care 2021; 38:1135-1141. [PMID: 33111537 PMCID: PMC8079519 DOI: 10.1177/1049909120970117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Antibiotic use at the end of life (EoL) may introduce physiological as well as psychological stress and be incongruent with patients' goals of care. Advance care planning (ACP) related to antibiotic use at the EoL helps improve goal-concordant care. Many nursing home (NH) residents are seriously ill. Therefore, we aimed to examine whether state and regional ACP initiatives play a role in the presence of "do not administer antibiotics" orders for NH residents at the EoL. METHODS We surveyed a random, representative national sample of 810 U.S. NHs (weighted n = 13,983). The NH survey included items on "do not administer antibiotics" orders in place and participation in infection prevention collaboratives. The survey was linked to state Physician Orders for Life-Sustaining Treatment (POLST) adoption status and resident, facility, and county characteristics data. We conducted multivariable regression models with state fixed effects, stratified by state POLST designation. RESULTS NHs in mature POLST states reported higher rates of "do not administer antibiotics" orders compared to developing POLST states (10.1% vs. 4.6%, respectively, p = 0.004). In mature POLST states, participation in regional collaboratives and smaller NH facilities (<100 beds) were associated with having "do not administer antibiotics" orders for seriously ill residents (β = 0.11, p = 0.006 and β = 0.12, p = 0.003, respectively). DISCUSSION NHs in states with mature POLST adoption that participated in infection control collaboratives were more likely to have "do not administer antibiotics" orders. State ACP initiatives combined with regional antibiotic stewardship initiatives may improve inappropriate antibiotic use at the EoL for NH residents.
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Affiliation(s)
- Caroline J. Fu
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, USA
| | - Mansi Agarwal
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, USA
| | - Leah V. Estrada
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, USA
| | - Komal P. Murali
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, USA
| | | | - Andrew W. Dick
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
| | - Patricia W. Stone
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, USA
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18
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Héquet D, Kessler S, Rettenmund G, Lemmenmeier E, Qalla-Widmer L, Gardiol C, Münzer T, Schlegel M, Petignat C, Kohler P. Healthcare-associated infections and antibiotic use in long-term care residents from two geographical regions in Switzerland. J Hosp Infect 2021; 117:172-178. [PMID: 34428504 DOI: 10.1016/j.jhin.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/21/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The burden of healthcare-associated infections (HAIs) and antimicrobial use in Swiss long-term care facilities (LTCFs) is currently unknown. This study assessed the prevalence of HAIs and antibiotic use among LTCF residents in Switzerland. METHODS A point-prevalence study was undertaken in LTCFs in eastern and western Switzerland from August to October 2019 according to the 'Healthcare-associated infections in long-term care facilities' (HALT) protocol. Characteristics of residents (age, sex, wounds, dementia, indwelling catheters) and institutions (specific factors, geographic region) were assessed. LTCF residents were screened for HAIs and current antibiotic treatment. Personal and institutional factors associated with HAIs were assessed. RESULTS In total, 1185 residents from 16 LTCFs (eight per geographic region) were screened for HAIs and antibiotic treatment. Median age was 87 years (interquartile range 79-91) and 71% were female. The prevalence of HAIs was 4.2% (west 4.3% vs east 4.2%; P=0.93), with mucocutaneous skin infections (36%) and respiratory tract infections (30%) being the most common. Independent risk factors for the presence of HAIs were presence of a chronic wound [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1-5.0; P=0.02] and being immobile (OR 1.8, 95% CI 1.0-3.3; P=0.04). Antibiotics were given to 2.9% of residents (west 3.9% vs east 1.8%; P=0.05) on the day of the survey. The most commonly prescribed antibiotics were amoxicillin-clavulanic acid and quinolones. CONCLUSIONS The prevalence of HAIs in Swiss LTCFs is similar to that in other European countries, whereas antibiotic consumption is lower. Further point-prevalence surveys on a broader scale are recommended to improve understanding of the burden of HAIs and antibiotic consumption in this setting.
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Affiliation(s)
- D Héquet
- Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland.
| | - S Kessler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - G Rettenmund
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - E Lemmenmeier
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - L Qalla-Widmer
- Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland
| | - C Gardiol
- Federal Office of Public Health, Bern, Switzerland
| | - T Münzer
- Geriatrische Klinik St. Gallen, St. Gallen, Switzerland
| | - M Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - C Petignat
- Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland
| | - P Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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19
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Ibrahim JE, Aitken G. A Proactive Nursing Home Risk Stratification Model for Disaster Response: Lessons Learned from COVID-19 to Optimize Resource Allocation. J Am Med Dir Assoc 2021; 22:1831-1839.e1. [PMID: 34390677 PMCID: PMC8292024 DOI: 10.1016/j.jamda.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/25/2021] [Accepted: 07/14/2021] [Indexed: 11/02/2022]
Abstract
A coordinated emergency management response to disaster management in nursing homes is desperately needed globally. During the most recent COVID-19 pandemic, aside from a few exemplary countries, most countries have struggled to protect their nursing home populations. Timely and appropriate allocation of resources to nursing homes during disaster response is a challenging yet crucial task to prevent morbidity and mortality of residents. The responsibility for the management of nursing homes during the pandemic was multifaceted, and responsibilities lay at the national, jurisdictional, and regional levels. Success in managing COVID-19 in nursing homes required all these levels to be aligned and supportive, ideally through management by an emergency response leadership team. However, globally there is a paucity of effective management strategies. This article uses the example of the COVID-19 pandemic to propose a risk stratification system to ensure timely and appropriate allocation of resources to nursing homes during disaster preparation and management. Nursing homes should be risk-stratified according to 4 domains: risk of intrusion, capability for outbreak containment, failure in organizational capability, and failure in the availability of community and health care supports. Risk stratification should also consider factors such as current levels of community transmission, if applicable, and geographic location of nursing homes and services. Early identification of nursing homes at risk for infectious disease, or disasters, and targeted allocation of resources might help reduce the number of outbreaks, lower the mortality, and preserve community supports such as acute hospital services. The next step is to debate this concept to validate the selected variables and then develop and pilot test a risk stratification tool for use.
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Affiliation(s)
- Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.
| | - Georgia Aitken
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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20
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Cassone M, Mantey J, Gontjes KJ, Lansing BJ, Gibson KE, Wang J, Mody L. Seasonal Patterns in Incidence and Antimicrobial Resistance of Common Bacterial Pathogens in Nursing Home Patients and Their Rooms. Front Public Health 2021; 9:671428. [PMID: 34322470 PMCID: PMC8311345 DOI: 10.3389/fpubh.2021.671428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Colonization is the main precursor to infection, which may lead to adverse clinical outcomes among older adults in nursing homes (NHs). Understanding seasonal changes in the local burden of common bacterial pathogens is key to implementing appropriate and cost-effective infection prevention measures in this resource-constrained healthcare environment. It is thus surprising that seasonal trends in patient and environmental colonization with major bacterial pathogens are presently unknown in the expanding NH setting. Methods: We examined the seasonal incidence of four major pathogens among 640 nursing home patients and high-touch surfaces within their rooms over 2 years. In cases where a significant number of antimicrobial-resistant strains was found, incidence in antimicrobial-susceptible and antimicrobial-resistant isolates was compared, along with antibiotic use trends. Results: We observed spring peaks in the incidence of vancomycin-resistant enterococci (1.70 peak to trough ratio for both patient and environmental isolates) and methicillin-resistant Staphylococcus aureus (1.95 peak to trough ratio for patient isolates, 1.50 for environmental isolates). We also observed summer peaks in Klebsiella pneumoniae (1.83 and 1.82 peak to trough ratio for patient and environmental isolates, respectively), and ciprofloxacin-resistant Escherichia coli. Susceptible S. aureus and E. coli did not follow seasonal patterns. Conclusions: A meaningful seasonal pattern may be present in the NH setting for several significant pathogens, and especially antimicrobial-resistant ones. Whether such patterns are consistent across geographic areas and over longer periods of time should be a key focus of investigation, in order to better inform timing of surveillance and infection prevention efforts in this setting.
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Affiliation(s)
- Marco Cassone
- Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States
| | - Julia Mantey
- Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States
| | - Kyle J Gontjes
- Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States.,School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Bonnie J Lansing
- Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States
| | - Kristen E Gibson
- Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States
| | - Joyce Wang
- Department of Microbiology and Immunology, Michigan Medicine, Ann Arbor, MI, United States
| | - Lona Mody
- Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States.,Geriatric Research and Education Clinical Center, VA Ann Arbor, Ann Arbor, MI, United States
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21
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Aliyu S, Travers JL, Heimlich SL, Ifill J, Smaldone A. Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis. J Appl Gerontol 2021; 41:892-901. [PMID: 34075829 DOI: 10.1177/07334648211018299] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988-2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran's Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.
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Affiliation(s)
| | - Jasmine L Travers
- New York University Rory Meyers College of Nursing, New York City, USA
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22
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Epidemiology and Prevention of Healthcare-Associated Infections in Geriatric Patients: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105333. [PMID: 34067797 PMCID: PMC8156303 DOI: 10.3390/ijerph18105333] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/16/2022]
Abstract
Demographic studies show that life expectancy is increasing in developed countries; increased longevity has also increased the share of the older population with often concomitant chronic conditions. An ageing population and increased comorbidities lead to more complex pharmacological therapies (polypharmacy). The particular picture provided by chronic conditions and polypharmacy can lead to longer hospital stays and a greater need for healthcare. Elderly patients are identified as being in the high-risk group for the development of healthcare-associated infections (HAIs) due to the age-related decline of the immune system, known as immunosenescence. Comorbid conditions can often complicate infections, diminishing our ability to treat them effectively. Respiratory tract infections are the most common healthcare-associated infections, followed by urinary tract infections. HAIs in geriatric patients are responsible for longer hospital stays, extended antibiotic therapy, significant mortality, and higher healthcare costs. This is because the microorganisms involved are multidrug-resistant and, therefore, more difficult to eliminate. Moreover, geriatric patients are frequently transferred from one facility (nursing homes, skilled nursing facilities, home care, and other specialty clinics) to another or from one hospital ward to another; these transitions cause care fragmentation, which can undermine the effectiveness of treatment and allow pathogens to be transferred from one setting to another and from one person to another. Multifactorial efforts such as early recognition of infections, restricted use of invasive devices, and effective infection control measures (surveillance, isolation practices, hand hygiene, etc.) can contribute to significant reduction of HAIs in geriatric patients.
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Gracner T, Agarwal M, Murali KP, Stone PW, Larson EL, Furuya EY, Harrison JM, Dick AW. Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents. JAMA Netw Open 2021; 4:e217528. [PMID: 33890988 PMCID: PMC8065379 DOI: 10.1001/jamanetworkopen.2021.7528] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/03/2021] [Indexed: 12/28/2022] Open
Abstract
Importance Hospitalizations for infections among nursing home (NH) residents remain common despite national initiatives to reduce them. Cognitive impairment, which markedly affects quality of life and caregiving needs, has been associated with hospitalizations, but the association between infection-related hospitalizations and long-term cognitive function among NH residents is unknown. Objective To examine whether there are changes in cognitive function before vs after infection-related hospitalizations among NH residents. Design, Setting, and Participants This cohort study used data from the Minimum Data Set 3.0 linked to Medicare hospitalization data from 2011 to 2017 for US nursing home residents aged 65 years or older who had experienced an infection-related hospitalization and had at least 2 quarterly Minimum Data Set assessments before and 4 or more after the infection-related hospitalization. Analyses were performed from September 1, 2019, to December 21, 2020. Exposure Infection-related hospitalization lasting 1 to 14 days. Main Outcomes and Measures Using an event study approach, associations between infection-related hospitalizations and quarterly changes in cognitive function among NH residents were examined overall and by sex, age, Alzheimer disease and related dementias (ADRD) diagnosis, and sepsis vs other infection-related diagnoses. Resident-level cognitive function was measured using the Cognitive Function Scale (CFS), with scores ranging from 1 (intact) to 4 (severe cognitive impairment). Results Of the sample of 20 698 NH residents, 71.0% were women and 82.6% were non-Hispanic White individuals; the mean (SD) age at the time of transfer to the hospital was 82 (8.5) years. The mean CFS score was 2.17, and the prevalence of severe cognitive impairment (CFS score, 4) was 9.0%. During the first quarter after an infection-related hospitalization, residents experienced a mean increase of 0.06 points in CFS score (95% CI, 0.05-0.07 points; P < .001), or 3%. The increase in scores was greatest among residents aged 85 years or older vs younger residents by approximately 0.022 CFS points (95% CI, 0.004-0.040 points; P < .05). The prevalence of severe cognitive impairment increased by 1.6 percentage points (95% CI, 1.2-2.0 percentage points; P < .001), or 18%; the increases were observed among individuals with ADRD but not among those without it. After an infection-related hospitalization, cognition among residents who had experienced sepsis declined more than for residents who had not by about 0.02 CFS points (95% CI, 0.00-0.04 points; P < .05). All observed differences persisted without an accelerated rate of decline for at least 6 quarters after infection-related hospitalization. No differences were observed by sex. Conclusions and Relevance In this cohort study, infection-related hospitalization was associated with immediate and persistent cognitive decline among nursing home residents, with the largest increase in CFS scores among older residents, those with ADRD, and those who had experienced sepsis. Identification of NH residents at risk of worsened cognition after an infection-related hospitalization may help to ensure that their care needs are addressed to prevent further cognitive decline.
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Affiliation(s)
- Tadeja Gracner
- RAND Corporation, Arlington, Virginia
- Now with RAND Corporation, Santa Monica, California
| | - Mansi Agarwal
- Center for Health Policy, Columbia University School of Nursing, New York, New York
- Now with Washington University School of Medicine, St Louis, Missouri
| | - Komal P. Murali
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Patricia W. Stone
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Elaine L. Larson
- Columbia University School of Nursing, New York, New York
- Columbia University Mailman School of Public Health, New York, New York
| | - E. Yoko Furuya
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Kim NE, Lee JH, Chang JH, Lee SH, Ryu YJ. Clinical characteristics and outcomes among older nursing home residents hospitalized with pneumonia. Arch Gerontol Geriatr 2021; 95:104394. [PMID: 33765657 DOI: 10.1016/j.archger.2021.104394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to population aging, the number of cases of pneumonia in nursing homes in South Korea has been increasing. This study investigated the characteristics and clinical outcomes in nursing home residents with pneumonia admitted to a tertiary hospital. METHODS A retrospective cohort study was conducted of patients transferred to the tertiary hospital from nursing homes between August 2009 and October 2016. The in-hospital mortality, Pneumonia Severity Index, bacterial pathogens in sputum cultures, and antibiotic sensitivity profile were assessed. RESULTS The analysis included a total of 174 patients hospitalized with pneumonia. Their median age was 78 years, and 109 patients (62.6%) were male. 108 patients (62.1%) were admitted to the intensive care unit. The in-hospital mortality rate was 12.6% (22/174). Culture of a multidrug-resistant (MDR) pathogen was an independent risk factor for mortality (odds ratio [OR]: 3.72, 95% confidence interval [CI]: 1.16-11.89). Male sex and a history of antibiotic use within the previous 3 months were independent risk factors for MDR pathogen isolation (OR: 3.32, 95% CI, 1.38-7.98 and OR: 3.93, 95% CI: 1.82-8.49, respectively). CONCLUSIONS Detection of an MDR pathogen, rather than host factors such as old age, bedridden status, and comorbidities, was the most important risk factor for in-hospital mortality in patients with nursing home pneumonia. Patients with a history of antibiotic use within the previous 3 months had a higher probability of MDR pathogen identification. Identifying MDR pathogens is important in treating older nursing home residents with pneumonia.
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Affiliation(s)
- Nam Eun Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Womans Seoul Hospital, Seoul, Republic of Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Womans Seoul Hospital, Seoul, Republic of Korea
| | - Jung Hyun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Womans Mokdong Hospital, Seoul, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Womans Seoul Hospital, Seoul, Republic of Korea.
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Risk adjustment for benchmarking nursing home infection surveillance data: A narrative review. Am J Infect Control 2021; 49:366-374. [PMID: 32791257 DOI: 10.1016/j.ajic.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/20/2022]
Abstract
Until recently, there was no national surveillance system for monitoring infection occurrence in long-term care facilities (LTCF) in the United States. As a result, there are no national benchmarks for LTCF infection rates that can be utilized for quality improvement at the facility level. One of the major challenges in the reporting of health care-related infection data is accounting for nonmodifiable facility and patient characteristics that influence benchmarks for infection. The objectives of this paper are to review: (a) published infection rates in LTCF in the United States to assess the level of variability; (b) studies describing facility- and resident-level risk factors for infection that can be used in risk adjustment models; (c) published attempts to risk-adjust LTCF infection rates; and (d) efforts to develop models specifically for risk adjustment of infection rates in LTCF for benchmarking. It is anticipated that this review will stimulate further study of methods to risk-adjust LTCF infection rates for benchmarking that will facilitate research and public reporting.
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Harbin NJ, Haug JB, Romøren M, Lindbæk M. Oral and parenteral antibiotic use in Norwegian nursing homes: are primary care institutions becoming our new local hospitals? JAC Antimicrob Resist 2020; 2:dlaa093. [PMID: 34223046 PMCID: PMC8209996 DOI: 10.1093/jacamr/dlaa093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background Norwegian nursing homes (NHs) have over the last 10 years increasingly applied the use of parenteral treatment, which in turn allows more broad-spectrum use of antibiotics. Previous studies from Norwegian NHs have for the most part not described parenteral formulations. Objectives To describe systemic antibiotic use in Norwegian NHs. Methods Thirty-seven NHs in the county of Østfold, Norway, were invited to participate in this retrospective cross-sectional study. Associated pharmacies provided sales data for systemic antibiotic use for the participating NHs for 1 year (October 2015 to October 2016). General institutional characteristics were collected through a questionnaire. Results Thirty-four NHs participated in the study. Mean use of antibiotics was 9.5 DDD/100 bed days (range 0.6–30.9 DDD/100 bed days). Oral antibiotics accounted for 83% and parenteral antibiotics for 17% of the total antibiotic use. Of parenteral antibiotics, ampicillin was most used (31.1%) followed by cefotaxime (17.7%) and penicillin G (16.6%). The proportion of antibiotics compliant with guideline recommendations was 60%. Being a short-term NH was associated with increased antibiotic use, with an unstandardized coefficient of 13.1 (95% CI 4.2–21.9; P = 0.005). Conclusions We found a high level of total and parenteral antibiotic use compared with previous studies from Norwegian NHs. Data showed wide variations in total antibiotic use and that only a moderate proportion of the antibiotic use was considered guideline compliant. This highlights the necessity of further implementation strategies regarding the national guidelines for antibiotic use in NHs.
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Affiliation(s)
| | - Jon Birger Haug
- Department of Infection Control, Østfold Health Trust, Kalnes, Norway
| | - Maria Romøren
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Morten Lindbæk
- Antibiotic Center for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Montoya A, Jenq G, Mills JP, Beal J, Diviney Chun E, Newton D, Gibson K, Mantey J, Hurst K, Jones K, Mody L. Partnering with Local Hospitals and Public Health to Manage COVID-19 Outbreaks in Nursing Homes. J Am Geriatr Soc 2020; 69:30-36. [PMID: 33034039 PMCID: PMC7675453 DOI: 10.1111/jgs.16869] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/04/2020] [Accepted: 09/12/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES Almost half of deaths related to COVID‐19 in the United States are linked to nursing homes (NHs). We describe among short‐term and long‐term residents at three NHs in Michigan the outbreak identification process, universal testing, point prevalence of COVID‐19, and subsequent containment efforts, outcomes, and challenges. DESIGN Outbreak investigation. SETTING Three NHs in southeast Michigan. PARTICIPANTS All residents (N = 215) at three NHs (total beds = 356) affiliated with a large academic healthcare system. METHODS Upon detection of confirmed cases within the facility, each NH in collaboration and consultation with local hospital, public health officials, and parent corporation implemented immediate facility‐wide testing and the following intervention measures: cohorting of COVID‐19 positive residents; communication regarding testing and results with residents, healthcare professionals, and families; personal protective equipment reeducation and use throughout facilities; and dedicated staffing for infected patients cohorted in a dedicated COVID‐19 wing. We collected patient data regarding demographics, symptoms, comorbidities, hospitalization, and 14‐day outcomes. RESULTS A total of 29 cases of COVID‐19 were identified at three participating NHs. Nineteen cases of COVID‐19 were identified through symptom‐triggered testing from March 23 to April 23, 2020; 10 (4.7%) additional cases were identified through universal testing of 215 residents conducted from April 7 to 15, 2020. The hospitalization rate was 37.9%. The case fatality rate was 20.7% (6/29); these patients had multiple comorbidities. No residents who tested positive through the point‐prevalence survey required hospitalization, and five were discharged home within 14 days. CONCLUSION Proactive and coordinated steps between NH medical directors and administrators, referral hospitals including their laboratories, and local public health officials are necessary to rapidly respond to an outbreak and limit the transmission of COVID‐19. This coordinated public health approach may save lives, minimize the burden to the healthcare system, and reduce healthcare costs. See related editorial by Kathleen Unroe
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Affiliation(s)
- Ana Montoya
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Post-Acute Care Services, University of Michigan Medical Group, Ann Arbor, Michigan
| | - Grace Jenq
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Post-Acute Care Services, University of Michigan Medical Group, Ann Arbor, Michigan
| | - John P Mills
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer Beal
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Erin Diviney Chun
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Duane Newton
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kristen Gibson
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Julia Mantey
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kristen Hurst
- Post-Acute Care Services, University of Michigan Medical Group, Ann Arbor, Michigan
| | - Karen Jones
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Geriatrics Research Education and Clinical Center (GRECC), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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Hooshmand E, Moa A, Trent M, Kunasekaran M, Poulos CJ, Chughtai AA, MacIntyre CR. Epidemiology of 2017 influenza outbreaks in nine Australian Aged care facilities. Influenza Other Respir Viruses 2020; 15:278-283. [PMID: 33026149 PMCID: PMC7902252 DOI: 10.1111/irv.12811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 01/07/2023] Open
Abstract
Background The 2017 A/H3N2 influenza season was the most severe season since the 2009 influenza pandemic. There were over 591 influenza outbreaks in institutions across the state of New South Wales (NSW) in Australia. Aim To describe the epidemiology of influenza outbreaks in nine Sydney aged care facilities in 2017. Methods Study data were collected from nine Sydney aged care facilities for 2017 influenza season. Descriptive epidemiological analysis was conducted. Results From the nine sites included, with a total of 716 residents, four sites reported laboratory‐confirmed influenza outbreaks during the study period, with an attack rate in residents ranging from 6% to 29%. The outbreaks resulted in lockdowns in two facilities and hospitalisation of seven residents. No deaths were reported as a result of influenza infection. Influenza A was the most common influenza type reported across the facilities. The duration of outbreak lasted for 1‐4 weeks varied by site. Conclusion The 2017 season was a severe influenza season recorded in Australia. About half of the facilities studied experienced outbreaks of influenza, with a high attack rate among residents. Infection prevention and control measures and outbreak management plans are crucial for aged care facilities, including vaccination of staff and visitors to prevent outbreaks among the vulnerable residents.
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Affiliation(s)
- Elmira Hooshmand
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Aye Moa
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mallory Trent
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Bouza E, Brenes FJ, Díez Domingo J, Eiros Bouza JM, González J, Gracia D, Juárez González R, Muñoz P, Petidier Torregrossa R, Ribera Casado JM, Ramos Cordero P, Rodríguez Rovira E, Sáez Torralba ME, Serra Rexach JA, Tovar García J, Verdejo Bravo C, Palomo E. The situation of infection in the elderly in Spain: a multidisciplinary opinion document. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2020; 33:327-349. [PMID: 32896115 PMCID: PMC7528417 DOI: 10.37201/req/057.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 11/10/2022]
Abstract
Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.
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Affiliation(s)
- E Bouza
- Emilio Bouza, Instituto de Investigación Sanitaria Gregorio Marañón. C/ Dr. Esquerdo, 46 28007 Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Palomo
- Esteban Palomo, Director. Health Sciences Foundation. C/ Severo Ochoa 2 - 28760 Tres Cantos. Madrid. Phone +34 91 3530150
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Vena A, Berruti M, Adessi A, Blumetti P, Brignole M, Colognato R, Gaggioli G, Giacobbe DR, Bracci-Laudiero L, Magnasco L, Signori A, Taramasso L, Varelli M, Vendola N, Ball L, Robba C, Battaglini D, Brunetti I, Pelosi P, Bassetti M. Prevalence of Antibodies to SARS-CoV-2 in Italian Adults and Associated Risk Factors. J Clin Med 2020; 9:jcm9092780. [PMID: 32867328 PMCID: PMC7563864 DOI: 10.3390/jcm9092780] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/08/2020] [Accepted: 08/18/2020] [Indexed: 01/25/2023] Open
Abstract
We aimed to assess the prevalence of and factors associated with anti- severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positivity in a large population of adult volunteers from five administrative departments of the Liguria and Lombardia regions. A total of 3609 individuals were included in this analysis. Participants were tested for anti-SARS-CoV-2 antibodies [Immunoglobulin G (IgG) and M (IgM) class antibodies] at three private laboratories (Istituto Diganostico Varelli, Medical Center, and Casa della Salute di Genova). Demographic data, occupational or private exposure to SARS-CoV-2-infected patients, and prior medical history consistent with SARS-CoV-2 infection were collected according to a preplanned analysis. The overall seroprevalence of anti-SARS-CoV-2 antibodies (IgG and/or IgM) was 11.0% [398/3609; confidence interval (CI) 10.0%–12.1%]. Seroprevalence was higher in female inmates than in male inmates (12.5% vs. 9.2%, respectively, p = 0.002), with the highest rate observed among adults aged >55 years (13.2%). A generalized estimating equations model showed that the main risk factors associated with SARS-CoV-2 seroprevalence were the following: an occupational exposure to the virus [Odd ratio (OR) = 2.36; 95% CI 1.59–3.50, p = 0.001], being a long-term care facility resident (OR = 4.53; 95% CI 3.19–6.45, p = 0.001), and reporting previous symptoms of influenza-like illness (OR = 4.86; 95% CI 3.75–6.30, p = 0.001) or loss of sense of smell or taste (OR = 41.00; 95% CI 18.94–88.71, p = 0.001). In conclusion, we found a high prevalence (11.0%) of SARS-CoV-2 infection that is significantly associated with residing in long-term care facilities or occupational exposure to the virus. These findings warrant further investigation into SARS-CoV-2 antibody prevalence among the Italian population.
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Affiliation(s)
- Antonio Vena
- Infectious Diseases Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (A.V.); (M.B.); (D.R.G.); (L.M.); (L.T.)
| | - Marco Berruti
- Infectious Diseases Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (A.V.); (M.B.); (D.R.G.); (L.M.); (L.T.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | | | - Pietro Blumetti
- Medical Center srl, Sesto Calende, 21018 Varese, Italy; (P.B.); (R.C.)
| | - Michele Brignole
- Department of Cardiology, Arrhytmology Centre and Syncope Unit, Ospedale del Tigullio, 16033 Lavagna, Italy;
- IRCCS Istituto Auxologico Italiano, Faint and Fall Programme, Ospedale San Luca, 20149 Milano, Italy
| | - Renato Colognato
- Medical Center srl, Sesto Calende, 21018 Varese, Italy; (P.B.); (R.C.)
| | - Germano Gaggioli
- Division of Cardiology, Ospedale Villa Scassi, 16149 Genova, Italy;
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (A.V.); (M.B.); (D.R.G.); (L.M.); (L.T.)
| | - Luisa Bracci-Laudiero
- Institute of Translational Pharmacology, Consiglio Nazionale Delle Ricerche (CNR), 00185 Rome, Italy;
- Division of Rheumatology and Immuno-Rheumatology Research Laboratories, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Laura Magnasco
- Infectious Diseases Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (A.V.); (M.B.); (D.R.G.); (L.M.); (L.T.)
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences, University of Genova, 16132 Genova, Italy;
| | - Lucia Taramasso
- Infectious Diseases Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (A.V.); (M.B.); (D.R.G.); (L.M.); (L.T.)
| | - Marco Varelli
- Diagnostic Institute Varelli, Clinical Analysis, 80126 Napoli, Italy;
| | - Nicoletta Vendola
- Division of Obstetrics and Gynecology, Sant’Andrea Hospital, 13100 Vercelli, Italy;
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy; (L.B.); (P.P.)
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (C.R.); (D.B.); (I.B.)
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (C.R.); (D.B.); (I.B.)
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (C.R.); (D.B.); (I.B.)
| | - Iole Brunetti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (C.R.); (D.B.); (I.B.)
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy; (L.B.); (P.P.)
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (C.R.); (D.B.); (I.B.)
| | - Matteo Bassetti
- Infectious Diseases Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (A.V.); (M.B.); (D.R.G.); (L.M.); (L.T.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-010-555-4658; Fax: +39-010-555-6712
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Time to Strategically Position Nursing Homes to Effectively Manage Emerging Infections. J Am Med Dir Assoc 2020; 21:1578-1579. [PMID: 32807656 PMCID: PMC7428431 DOI: 10.1016/j.jamda.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
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Durham SH, Hohmann NS, Ragan AH. Implementation of a Urinary Tract Infection Treatment Protocol to Improve Prescribing Practices in the Long-Term Care Facility of a Veteran’s Healthcare System. PHARMACY 2020; 8:pharmacy8030129. [PMID: 32722253 PMCID: PMC7558276 DOI: 10.3390/pharmacy8030129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 11/21/2022] Open
Abstract
Urinary tract infections (UTIs) are a commonly diagnosed problem in long-term care facilities (LTCFs), but antimicrobial treatment is often incorrectly prescribed. Although bacterial resistance to antimicrobials commonly used for UTIs, such as trimethoprim/sulfamethoxazole and fluoroquinolones, has been dramatically increasing, they are still commonly prescribed. The purpose of this project was to determine if implementation of a standard treatment protocol for UTIs, which emphasized correct UTI diagnosis and use of nitrofurantoin and cefpodoxime/ceftriaxone as empiric therapy per the institutional antibiogram, changed clinician prescribing practices. This quasi-experimental model utilized two years of pre-intervention and two years of post-intervention data. Three hundred patient encounters were included. Antibiotics prescribed in the pre-intervention period included: trimethoprim/sulfamethoxazole (32%), ciprofloxacin (14%), amoxicillin (13%), levofloxacin (9%), cefpodoxime (9%), ceftriaxone (8%), amoxicillin/clavulanate (5%), nitrofurantoin (4%), and other (6%). By contrast, antibiotics prescribed in the post-intervention period included: cefpodoxime (46%), nitrofurantoin (30%), ceftriaxone (10%), trimethoprim/sulfamethoxazole (8%), amoxicillin/clavulanate (1%), and other (5%). These differences in prescribed drug between the pre-intervention and post-intervention encounters were statistically significant (p < 0.001). Overall, appropriate empiric treatment was prescribed in only 48/217 encounters (22%) during the pre-intervention period, but this increased to 73/83 encounters (88%) in the post-intervention period (p < 0.001). The results indicate that the treatment protocol was successful in changing prescribing practices and decreasing the use of inappropriate antimicrobials at the LTCF.
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Affiliation(s)
- Spencer H. Durham
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849-5341, USA;
- Correspondence: ; Tel.: +334-844-7138
| | - Natalie S. Hohmann
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849-5341, USA;
| | - Addison H. Ragan
- Department of Pharmacy, Central Alabama Veterans Health Care System, Montgomery, AL 36109, USA;
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Shi C, Zhang Y, Li C, Li P, Zhu H. Using the Delphi Method to Identify Risk Factors Contributing to Adverse Events in Residential Aged Care Facilities. Risk Manag Healthc Policy 2020; 13:523-537. [PMID: 32581615 PMCID: PMC7281847 DOI: 10.2147/rmhp.s243929] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/13/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to identify risk factors associated with adverse events in residential aged care facilities in China. Patients and Methods After compiling a list of risk factors for adverse events generated from in-depth interviews with managers of residential aged care facilities, a three-round Delphi method was used to reach consensus. The synthesized risk factors were presented on a Likert scale to the expert panelists three times to validate their responses. Results The list identified 67 items as risk factors for adverse events, attached to four first-level indexes (ie, environmental facility, nursing staff, older adults' characteristics, and management factors). The experts' authority coefficient was 0.87. The positive coefficients were 82.76%, 91.67%, and 100%, and the coordination coefficients were 0.154, 0.297, and 0.313 in the first, second, and third rounds, respectively. Conclusion Using a Delphi method, this study established a consensus on risk factors contributing to adverse events and developed a risk assessment grade for use in future aged care practice and research. The resulting list is useful in prioritizing risk-reduction activities and assessing intervention or education strategies for preventing adverse events in residential aged care facilities. Impact This study fills the gap in risk identification in the Chinese residential aged care system to ensure provision of best-practice care to this vulnerable population. Nursing staff and management factors at the top of the list are not only the most common causes of adverse events but also the core elements in creating a secure and error-free environment. This list was intended to support predictive and prevention-oriented decision-making by managers and nursing supervisors to reduce preventable adverse events.
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Affiliation(s)
- Chunhong Shi
- Nursing Department, XiangNan University, Chenzhou 423000, People's Republic of China
| | - Yinhua Zhang
- Nursing Department, Hunan University of Chinese Medicine, Changsha 410208, People's Republic of China
| | - Chunyan Li
- Nursing Department, XiangNan University, Chenzhou 423000, People's Republic of China
| | - Pan Li
- Nursing Department, XiangNan University, Chenzhou 423000, People's Republic of China
| | - Haili Zhu
- Nursing Department, Hunan Academy of Traditional Chinese Medicine Affiliated Hospital, Changsha, 410006, People's Republic of China
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Dorritie R, Quigley DD, Agarwal M, Tark A, Dick A, Stone PW. Support of nursing homes in infection management varies by US State Departments of Health. J Hosp Infect 2020; 105:258-264. [PMID: 32068013 DOI: 10.1016/j.jhin.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In many countries, healthcare-associated infections (HAIs) are problematic in long-term aged care living facilities. In the United States (US), HAIs occur frequently in nursing homes (NHs). Identifying effective practices for state Departments of Health (DOHs) to help NHs improve infection prevention and control and reduce HAIs is necessary. AIM As a first step, the objective was to systematically examine and catalogue the variations in state intentions and activities related to HAI prevention in NHs. METHODS An environmental scan of state DOH websites, HAI plans, and HAI state infographics was conducted. Data were collected on 16 items across three domains: (1) intentions to reduce HAIs in NHs, (2) actions to reduce HAIs in NHs, and (3) website usability. FINDINGS State infection control support for NHs varied widely. Most states (92%) mentioned NHs in their HAI plans and 76% included NHs in their infographic. Half has an HAI prevention advisory council, while one-third had a state HAI prevention collaborative. Only 57% of HAI plans that mentioned NHs included training materials on HAI reduction. The most common training available was on antibiotic stewardship. CONCLUSION Many US states have room for improvement in the support they provide NHs regarding infection prevention and control. Specific areas of improvement include: (1) increased provision of training materials on HAI reduction, (2) focusing training materials on common HAIs, and (3) NH engagement in collaboratives aimed at HAI reduction. More research is needed linking DOH activities to resident outcomes.
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Affiliation(s)
- R Dorritie
- Helene Fuld College of Nursing, New York, NY, USA
| | | | - M Agarwal
- Helene Fuld College of Nursing, New York, NY, USA
| | - A Tark
- Helene Fuld College of Nursing, New York, NY, USA
| | - A Dick
- RAND Corporation, Boston, MA, USA
| | - P W Stone
- Helene Fuld College of Nursing, New York, NY, USA
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Hoffman GJ, Min LC, Liu H, Marciniak DJ, Mody L. Role of Post-Acute Care in Readmissions for Preexisting Healthcare-Associated Infections. J Am Geriatr Soc 2020; 68:370-378. [PMID: 31644835 PMCID: PMC9045555 DOI: 10.1111/jgs.16208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/27/2019] [Accepted: 09/02/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Although preventable, healthcare-associated infections (HAIs) are commonly observed in post-acute care settings for at-risk older adults and are a leading cause of hospital readmissions. However, whether HAIs resulting in avoidable readmissions for preexisting HAIs (the same HAI as at the index admission) are more common for patients discharged to post-acute care as opposed to home is unknown. We examined the risk of preexisting HAI readmissions according to patient discharge disposition and comorbidity level. DESIGN We used 2013-2014 national hospital discharge data to estimate the likelihood of readmissions for preexisting HAIs according to patients' discharge disposition and whether the likelihood varies according to patient comorbidity level, across four common types of HAIs (not including respiratory infections). PARTICIPANTS A total of 702 304 hospital discharges for Medicare beneficiaries 65 years or older. MEASUREMENTS Our outcome was a 30-day preexisting, or "linked," HAI readmission (readmission involving the same HAI diagnosis as at the index admission). Patient discharge disposition was skilled nursing facility (SNF), home health care, and home care without home health care ("home"). RESULTS Of 702 304 index admissions involving HAI treatment, 353 073 (50%) were discharged to a SNF, 179 490 (26%) to home health care, and 169 872 (24%) to home. Overall, 17 523 (2.5%) of preexisting HAIs resulted in linked HAI readmissions, which were more common for Clostridioides difficile infections (4.0%) and urinary tract infections (2.4%) than surgical site infections (1.1%; P < .001). Being discharged to a SNF compared to home or to home health care was associated with a 1.15 percentage point (95% confidence interval = -1.29 to -1.00), or 38%, lower risk of a linked HAI readmission. This risk difference was observed to increase with greater patient comorbidity. CONCLUSIONS SNF discharges were associated with fewer avoidable readmissions for preexisting HAIs compared with home discharges. Further research to identify modifiable mechanisms that improve posthospital infection care at home is needed. J Am Geriatr Soc 68:370-378, 2020.
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Affiliation(s)
- Geoffrey J Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Lillian C Min
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Department of Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management and Research (CCMR), VA Medical Center, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
- Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Haiyin Liu
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Dan J Marciniak
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lona Mody
- Department of Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan
- Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Agarwal M, Dick AW, Sorbero M, Mody L, Stone PW. Changes in US Nursing Home Infection Prevention and Control Programs From 2014 to 2018. J Am Med Dir Assoc 2020; 21:97-103. [PMID: 31888867 PMCID: PMC6948108 DOI: 10.1016/j.jamda.2019.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/22/2019] [Accepted: 10/27/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Burgeoning rates of antibiotic resistance have resulted in a shift in national focus to improve infection prevention and control programs in US nursing homes (NHs). We sought to evaluate the changes in nursing home infection prevention and control programs over time. DESIGN Retrospective comparative analysis of national nursing home survey data from 2014 and 2018. SETTING AND PARTICIPANTS We used survey data from 2 nationally representative samples of US nursing homes (945 NHs in 2014 and 888 in 2018). METHODS Three indices measuring antibiotic stewardship, outbreak control, and urinary tract infection prevention (ranging from 0 to 100) were developed to measure the change in infection prevention and control programs. Multivariable linear regression models were used to identify facility and infection preventionist characteristics associated with each index. Decomposition models were used to identify contributions of factors on the differences in each index over time. RESULTS From 2014 to 2018, we saw strengthening of antibiotic stewardship practices by 33 percentage points, outbreak control practices by 13 percentage points, and urinary tract infection prevention practices by 6 percentage points. Although we found several predictors of these improvements, much of the improvement was due to the difference in time. CONCLUSIONS AND IMPLICATIONS Policy mandates and greater national attention are likely important factors in improving nursing home infection prevention and control practices. Further work is needed to evaluate the effect of these programs on resident outcomes.
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Affiliation(s)
- Mansi Agarwal
- Columbia University School of Nursing, New York, NY.
| | | | | | - Lona Mody
- University of Michigan, Ann Arbor, MI
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Gontjes KJ, Gibson KE, Lansing B, Cassone M, Mody L. Contamination of Common Area and Rehabilitation Gym Environment with Multidrug‐Resistant Organisms. J Am Geriatr Soc 2019; 68:478-485. [DOI: 10.1111/jgs.16284] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Kyle J. Gontjes
- Division of Geriatric and Palliative MedicineUniversity of Michigan Medical School Ann Arbor Michigan
- Department of EpidemiologyUniversity of Michigan School of Public Health Ann Arbor Michigan
| | - Kristen E. Gibson
- Division of Geriatric and Palliative MedicineUniversity of Michigan Medical School Ann Arbor Michigan
| | - Bonnie Lansing
- Division of Geriatric and Palliative MedicineUniversity of Michigan Medical School Ann Arbor Michigan
| | - Marco Cassone
- Division of Geriatric and Palliative MedicineUniversity of Michigan Medical School Ann Arbor Michigan
| | - Lona Mody
- Division of Geriatric and Palliative MedicineUniversity of Michigan Medical School Ann Arbor Michigan
- Geriatrics Research, Education and Clinical CenterVeterans Affairs Ann Arbor Healthcare System Ann Arbor Michigan
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Cassone M, Mantey J, Perri MB, Gibson K, Lansing B, McNamara S, Patel PK, Cheng VCC, Walters MS, Stone ND, Zervos MJ, Mody L. Environmental Panels as a Proxy for Nursing Facility Patients With Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus Colonization. Clin Infect Dis 2019; 67:861-868. [PMID: 29726892 DOI: 10.1093/cid/ciy115] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/08/2018] [Indexed: 01/09/2023] Open
Abstract
Background Most nursing facilities (NFs) lack methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) surveillance programs due to limited resources and high costs. We investigated the utility of environmental screening of high-touch surfaces in patient rooms as a way to circumvent these challenges. Methods We compared MRSA and VRE culture data from high-touch surfaces in patients' rooms (14450 samples from 6 NFs) and ranked each site's performance in predicting patient colonization (7413 samples). The best-performing sites were included in a MRSA- and a VRE-specific panel that functioned as a proxy for patient colonization. Molecular typing was performed to confirm available concordant patient-environment pairs. Results We identified and validated a MRSA panel that consisted of the bed controls, nurse call button, bed rail, and TV remote control. The VRE panel included the toilet seat, bed controls, bed rail, TV remote control, and top of the side table. Panel colonization data tracked patient colonization. Negative predictive values were 89%-92% for MRSA and 82%-84% for VRE. Molecular typing confirmed a strong clonal type relationship in available concordant patient-environment pairs (98% for MRSA, 91% for VRE), pointing to common epidemiological patterns for environmental and patient isolates. Conclusions Environmental panels used as a proxy for patient colonization and incorporated into facility surveillance protocols can guide decolonization strategies, improve awareness of MRSA and VRE burden, and inform efforts to reduce transmission. Targeted environmental screening may be a viable surveillance strategy for MRSA and VRE detection in NFs.
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Affiliation(s)
- Marco Cassone
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor
| | - Julia Mantey
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor
| | | | - Kristen Gibson
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor
| | - Bonnie Lansing
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor
| | - Sara McNamara
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor
| | - Payal K Patel
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor.,Department of Internal Medicine, Division of Infectious Diseases, Veterans Affairs Ann Arbor Healthcare System, Michigan
| | - Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.,Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Maroya S Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marcus J Zervos
- Henry Ford Health System, Detroit.,Wayne State University School of Medicine, Detroit
| | - Lona Mody
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor.,Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Michigan
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Tandan M, Burns K, Murphy H, Hennessy S, Cormican M, Vellinga A. Antimicrobial prescribing and infections in long-term care facilities (LTCF): a multilevel analysis of the HALT 2016 study, Ireland, 2017. ACTA ACUST UNITED AC 2019; 23. [PMID: 30458910 PMCID: PMC6247462 DOI: 10.2807/1560-7917.es.2018.23.46.1800278] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background The 2016 point prevalence survey (PPS) of healthcare-associated infections (HAI) and antimicrobial use (AMU) in Irish long-term care facilities (LTCF) (HALT) showed a 9.8% AMU and 4.4% HAI prevalence, based on aggregated data analysis. Aim Our aim was to identify institutional and resident risk factors of AMU and HAI. Methods HALT 2016 gathered information using institutional and resident questionnaires, for residents who met the surveillance definition of active HAI and/or AMU, limiting analysis to the aggregated institutional level. In January 2017, we requested additional data on age, sex, urinary catheter use and disorientation of current residents from HALT 2016 LTCF and matched to 2016 HALT data. Results Of 224 HALT 2016 LTCF, 80 provided additional information on 3,816 residents; prevalence of AMU was 10.6% and HAI was 4.7%. Presence of a coordinating physician (Odds ratio (OR): 0.3; 95% confidence interval (CI): 0.2–0.6), antimicrobial stewardship committee (OR: 0.2; 95%; CI: 0.1–0.6), healthcare assistants (OR: 0.9; 95% CI: 0.9–1.0), antimicrobial consumption feedback (OR: 0.3; 95% CI: 0.1–0.6) and medical care by personal general practitioner (OR: 0.6; 95% CI: 0.7–1.0) were associated with less AMU and feedback on surveillance of infection prevention and control (IPC) practices (OR: 0.6; 95% CI: 0.3–1.0) with less HAI. AMU and HAI varied significantly between LTCF. Conclusions Multilevel modelling identified significant inter-facility variation, as well as institutional factors associated with AMU and HAI. An antimicrobial stewardship committee linked with feedback on IPC and prescribing was associated with reduced AMU and HAI.
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Affiliation(s)
- M Tandan
- Discipline of General Practice, School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland
| | - K Burns
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - H Murphy
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - S Hennessy
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - M Cormican
- Discipline of Bacteriology, School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland
| | - A Vellinga
- Discipline of Bacteriology, School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland.,Discipline of General Practice, School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland
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Who Comes to the Emergency Room with an Infection from a Long-term Care Hospital? A Retrospective Study Based on a Medical Record Review. Asian Nurs Res (Korean Soc Nurs Sci) 2018; 12:293-298. [PMID: 30448263 DOI: 10.1016/j.anr.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Health care-associated infections increase disease prevalence and mortality and are the main reason for the hospitalization of the elderly. However, the management of underlying infections in patients hospitalized in long-term care hospitals (LTCHs) is insufficient, and the transfer of these poorly managed patients to the emergency room (ER) of an acute care hospital can lead to rapid spread of infection. This study investigated the risk factors associated with an ER visit due to infections that developed in LTCHs. METHODS The electronic medical records of patients who were transferred to the ER of a university hospital in South Korea were used. Infection prevalence, causative infectious agent, and antibiotic sensitivity were assessed. The associations between patient characteristics and hospital-associated infections were examined using multiple logistic regression analyses. RESULTS Among the 483 patients transferred to the ER during the study period, the number of infection cases was 197, and 171 individuals (35.4%) had one or more infections, with pneumonia being the most common (52.8%), followed by urinary tract (21.3%) and bloodstream (17.8%) infections. Patients with bedsores, fever, an indwelling catheter, and a higher nursing need were more likely to be seen in the ER because of infectious disease from an LTCH. CONCLUSION Both an intensive care system and surveillance support should be established to prevent infections, particularly in high-risk patients at LTCHs.
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Lee SH, Kim SJ, Choi YH, Lee JH, Chang JH, Ryu YJ. Clinical outcomes and prognostic factors in patients directly transferred to the intensive care unit from long-term care beds in institutions and hospitals: a retrospective clinical study. BMC Geriatr 2018; 18:259. [PMID: 30367604 PMCID: PMC6203994 DOI: 10.1186/s12877-018-0950-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/16/2018] [Indexed: 12/29/2022] Open
Abstract
Background There has been a steady increase in the aging population and an increase in the need for long-term care beds in institutions and hospitals (LTCHs) in Korea. The aim of this study was to investigate prognosis and to identify factors contributing to mortality of critically ill patients with respiratory problems who were directly transferred to intensive care units (ICU) from LTCHs. Methods Following a retrospective review of clinical data and radiographic findings between July 2009 and September 2016, we included 111 patients with respiratory problems who had visited the emergency room (ER) transferred from LTCHs due to respiratory symptoms and who were then admitted to the ICU. Results The mean age of the 111 patients was 79 years, and 71 patients (64%) were male. Pneumonia developed in 98 patients (88.3%), pulmonary thromboembolism in 4 (3.6%) and pulmonary tuberculosis in 3 (2.7%). Overall mortality was 19.8% (22/111). Multiple-drug-resistant (MDR) pathogens (odds ratio [OR], 17.43; 95% confidence interval [CI], 1.96–155.40) and serum albumin levels < 2.15 g/dL, which were derived through ROC (sensitivity, 72.7%; specificity, 85.4%) (OR, 28.05; 95% CI, 5.47–143.75), were independent predictors for mortality. The need for invasive ventilation (OR, 2.74; 95% CI, 1.02–7.32) and history of antibiotic use within the 3 months (OR, 3.23; 95% CI, 1.32–7.90) were risk factors for harboring MDR pathogens. Conclusions The presence of MDR pathogens and having low serum albumin levels may be poor prognostic factors in patients with respiratory problems who are admitted to the ICU from LTCHs. A history of antibiotic use within the 3 months and the need for invasive ventilation can be helpful in choosing the appropriate antibiotics to combat MDR pathogens at the time of admission.
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Affiliation(s)
- Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea
| | - Soo Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea
| | - Yoon Hee Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea
| | - Jung Hyun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
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Implementation of a national quality improvement program to enhance hand hygiene in nursing homes in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:345-351. [PMID: 30316727 DOI: 10.1016/j.jmii.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/09/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE This study investigated the cause of hand hygiene deficit, and further implemented a quality improvement program using WHO's hand-hygiene strategy to enhance the compliance of hand hygiene in the nursing home in Taiwan. METHODS This prospective study was conducted in eleven nursing homes in Taiwan from January 2015 to December 2016. After intervention, we monitor the compliance, and accuracy of hand hygiene. In addition, we also calculated the number of episodes of infection per 1000 resident-days in each nursing home in the intervention period (July-December 2015) and post-intervention period (January-October 2016). RESULTS Overall, the consumption of alcohol-based handrubs increased from 10.1 ml per resident-day in intervention period to 12.2 ml per resident-day in post intervention period. The compliance of hand hygiene increased from 74% in intervention period to 79% in post-intervention period and the rate of correct hand hygiene increased from 81% in intervention period to 87% in post-intervention period. Most importantly, the infection density decreased from 2.39 per 1000 resident-day in intervention period to 1.89 per 1000 resident-day. CONCLUSIONS A national quality-improvement program using WHO's hand-hygiene strategy to enhance hand hygiene and reduce healthcare associated infection is effective in nursing homes in Taiwan.
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Marra F, McCabe M, Sharma P, Zhao B, Mill C, Leung V, Chong M, Patrick DM. Utilization of Antibiotics in Long-Term Care Facilities in British Columbia, Canada. J Am Med Dir Assoc 2018; 18:1098.e1-1098.e11. [PMID: 29169741 DOI: 10.1016/j.jamda.2017.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antibiotic use is highly prevalent in long-term care facilities (LTCFs); a resident's annual exposure to at least 1 course of antibiotic is approximately 50% to 80%. The objective of this study was to understand the extent of antibiotic use in the population of residents in British Columbia's (BC) LTCFs from 2007 to 2014. METHODS Antibiotic prescription data for LTCF residents was extracted from the central prescription database and linked to the physician billing plan to obtain antibiotic indication. Total defined daily dose (DDD) per 1000 residents per day was calculated. RESULTS Our database had 381 LTCFs with an average of nearly 24,694 residents annually and 419,036 antibiotic prescriptions. Antibiotic utilization did not change dramatically between 2007 and 2014, ranging from 39.2 in 2007 to 35.2 DDD per 1000 residents per day in 2014. Although usage of most antibiotics declined, use of moxifloxacin, amoxicillin-clavulanate, doxycycline, and amoxicillin increased significantly. The indication most frequently linked to prescription was urinary tract infection (6.58 DDD per 1000 residents per day), with nitrofurantoin, ciprofloxacin, and trimethoprim/sulfamethoxazole being the most commonly prescribed agents. This was followed closely by prescriptions for respiratory infections (5.34 DDD per 1000 residents per day), with moxifloxacin being the most commonly prescribed antibiotic, primarily for upper respiratory tract infection (URTI), whereas doxycycline is used commonly for lower respiratory tract infection. Duration of antibiotic therapy in LTCF residents has decreased significantly from 9.29 days to 7.3 days per prescription in 2014. CONCLUSION Antibiotic use in LTCFs is high relative to the general population. Our study underscores that stewardship in LTCFs should continue to focus on length of treatment, appropriate detection of urinary tract infections, and avoidance of treating URTIs with antibiotics.
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Affiliation(s)
- Fawziah Marra
- University of British Columbia, Vancouver, BC, Canada.
| | - Mark McCabe
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | | | - Bin Zhao
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Christopher Mill
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Victor Leung
- University of British Columbia, Vancouver, BC, Canada; St. Paul's Hospital, Vancouver, BC, Canada
| | - Mei Chong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - David M Patrick
- University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada
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44
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Abstract
At least one-third of patients at the end of life (EOL) receive interventions that are without benefit, and a similar proportion of patients die in the intensive care unit. Here, the authors discuss the role of antimicrobials in patients at the EOL, including the patient populations and scenarios in which antimicrobials may or may not have benefit. They also review adverse outcomes associated with antimicrobial use at the EOL, including societal harms. Finally, an algorithm to aid management of suspected infections at the EOL is proposed.
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Affiliation(s)
- Adam Baghban
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, PO Box 208022, New Haven, CT 06520, USA
| | - Manisha Juthani-Mehta
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, PO Box 208022, New Haven, CT 06520, USA.
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45
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Cairns S, Gibbons C, Milne A, King H, Llano M, MacDonald L, Malcolm W, Robertson C, Sneddon J, Weir J, Reilly J. Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections? J Hosp Infect 2018; 99:312-317. [PMID: 29621601 DOI: 10.1016/j.jhin.2018.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Healthcare-associated infections (HCAIs) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HCAI and contain antimicrobial resistance. AIM To measure the prevalence of HCAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection. METHODS A national rolling point-prevalence survey (PPS) in National Health Service (NHS) acute, NHS non-acute, NHS paediatric, and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. FINDINGS The prevalence of HCAI was 4.6%, 2.7%, and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most frequent HCAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3%, and 13.8% in acute adults, paediatric, and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal, and urinary tract infections were the most common infections being treated at the time of survey. CONCLUSION HCAI continues to be a public health concern in Scotland. Urinary tract infection and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings.
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Affiliation(s)
- S Cairns
- National Services Scotland, Health Protection Scotland, Glasgow, UK.
| | - C Gibbons
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - A Milne
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - H King
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - M Llano
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - L MacDonald
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - W Malcolm
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - C Robertson
- National Services Scotland, Health Protection Scotland, Glasgow, UK; University of Strathclyde, Glasgow, UK
| | - J Sneddon
- Healthcare Improvement Scotland, Glasgow, UK
| | - J Weir
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - J Reilly
- National Services Scotland, Health Protection Scotland, Glasgow, UK; Glasgow Caledonian University, Glasgow, UK
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46
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Temime L, Cohen N, Ait-Bouziad K, Denormandie P, Dab W, Hocine MN. Impact of a multicomponent hand hygiene-related intervention on the infectious risk in nursing homes: A cluster randomized trial. Am J Infect Control 2018; 46:173-179. [PMID: 28987524 DOI: 10.1016/j.ajic.2017.08.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of this study was to assess the impact of a multifaceted hand hygiene (HH) program on the infectious risk in nursing homes (NHs). METHODS This was a 2-arm cluster randomized trial; French NHs were allocated randomly to the intervention (13 NHs) or control (13 NHs) groups. The intervention consisted of implementing a bundle of HH-related measures over 1 year, including increased availability of alcohol-based handrub, HH promotion, staff education, and local work groups. The primary end point was the incidence rate of acute respiratory infections and gastroenteritis reported in the context of clustered cases episodes. Secondary end points were mortality, hospitalization, and antibiotic prescription rates. RESULTS Baseline characteristics did not differ between groups. The overall handrub consumption was higher in the intervention group over the 1-year intervention period. Because of underreporting, data on the primary end points were of insufficient quality for analysis. Hospitalizations did not differ between the 2 groups. However, the intervention group showed significantly lower mortality (2.10 vs 2.65 per 100 residents per month, respectively; P = .003) and antibiotic prescriptions (5.0 vs 5.8 defined daily doses per 100 resident days, respectively; P < .001). These results were confirmed by the longitudinal multivariate analysis adjusted for NH and resident characteristics and for seasonality (mortality rate ratio, 0.76). CONCLUSIONS A multifaceted HH intervention may have a short-term impact on mortality in NHs. Nevertheless, other strategies may remain necessary to reduce morbidity.
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47
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Naf A, Decalonne M, Santos SD, Mereghetti L, van der Mee-Marquet NL. Evaluation of the Swabbing of Disposable Absorbent Incontinence Products for Assessing the Carriage of Multiresistant Enterobacteriaceae in Nursing Home Residents. Front Microbiol 2017; 8:1858. [PMID: 29033915 PMCID: PMC5627303 DOI: 10.3389/fmicb.2017.01858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/12/2017] [Indexed: 11/23/2022] Open
Abstract
We compared the performance of incontinence product (IP) and rectal swabbing for the detection of multidrug-resistant Enterobacteriaceae (MDRE) carriage in a large multicenter study conducted in February 2017 among the residents of 23 French nursing homes. The study included 547 residents who habitually wore IP, 88 of whom were MDRE carriers (16.1%). Positive results were obtained for both rectal and IP swabs for 64 of these residents, for rectal swabs only for 22 and for IP swabs only for two of these patients. The estimated prevalence of MDRE carriage depended on the type of sample: 15.7% for rectal swabs and 12.1% for IP swabs (p < 0.001). The positive percent agreement was 84.2% and the negative percent agreement was 97.4%. Rectal swabbing remains the best method for detecting MDRE carriage in elderly residents, but our findings provide support for the use of swabs from IP used overnight to increase response rates in MDRE surveys in elderly residents that habitually wear IP, when rectal swabbing is not feasible.
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Affiliation(s)
- Alexis Naf
- Cellule Régionale d'Epidémiologie Nosocomiale, Hôpital Trousseau, Service de Bactériologie, Virologie, Hygiène, Centre Hospitalier Régional Universitaire, Tours, France.,Centre d'Appui pour la Prévention des Infections Associées aux Soins pour la région Centre Val de Loire, Hôpital Bretonneau, Service de Bactériologie, Virologie, Hygiène, Centre Hospitalier Régional Universitaire, Tours, France
| | - Marie Decalonne
- Centre d'Appui pour la Prévention des Infections Associées aux Soins pour la région Centre Val de Loire, Hôpital Bretonneau, Service de Bactériologie, Virologie, Hygiène, Centre Hospitalier Régional Universitaire, Tours, France
| | - Sandra Dos Santos
- Cellule Régionale d'Epidémiologie Nosocomiale, Hôpital Trousseau, Service de Bactériologie, Virologie, Hygiène, Centre Hospitalier Régional Universitaire, Tours, France.,Unité de bactériologie, Hôpital Bretonneau, Service de Bactériologie, Virologie, Hygiène, Centre Hospitalier Régional Universitaire, Tours, France
| | - Laurent Mereghetti
- Unité de bactériologie, Hôpital Bretonneau, Service de Bactériologie, Virologie, Hygiène, Centre Hospitalier Régional Universitaire, Tours, France
| | - Nathalie L van der Mee-Marquet
- Cellule Régionale d'Epidémiologie Nosocomiale, Hôpital Trousseau, Service de Bactériologie, Virologie, Hygiène, Centre Hospitalier Régional Universitaire, Tours, France.,Centre d'Appui pour la Prévention des Infections Associées aux Soins pour la région Centre Val de Loire, Hôpital Bretonneau, Service de Bactériologie, Virologie, Hygiène, Centre Hospitalier Régional Universitaire, Tours, France.,Unité de bactériologie, Hôpital Bretonneau, Service de Bactériologie, Virologie, Hygiène, Centre Hospitalier Régional Universitaire, Tours, France
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48
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Feldstein D, Sloane PD, Feltner C. Antibiotic Stewardship Programs in Nursing Homes: A Systematic Review. J Am Med Dir Assoc 2017; 19:110-116. [PMID: 28797590 DOI: 10.1016/j.jamda.2017.06.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/22/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Antibiotic stewardship programs (ASPs) are coordinated interventions promoting the appropriate use of antibiotics to improve patient outcomes and reduce microbial resistance. These programs are now mandated in nursing homes (NHs) but it is unclear if these programs improve resident outcomes. This systematic review evaluated the current evidence regarding outcomes of ASPs in the NH. METHODS PubMed, CINAHL, EMBASE, and the Cochrane Library were systematically searched for intervention trials of ASPs performed in NHs that evaluated final health outcomes (mortality and Clostridium difficile infections), healthcare utilization outcomes (emergency department visits and hospital admissions) and intermediate health outcomes (number of antibiotics prescribed, adherence to recommended guidelines). RESULTS A total of 14 studies rated good or fair quality were included. Eight studies reported a reduction in antibiotic prescriptions. Ten found an increase in adherence to guidelines proposed by the studied ASP. None reported a statistically significant change in NH mortality rates, C. difficile infection rates, or hospitalizations. DISCUSSION The limited research to date suggests that NH ASPs can affect intermediate health outcomes, but not key health outcomes or health care utilization. CONCLUSION Larger trials evaluating more intensive interventions over longer durations may be needed to determine whether ASPs in NHs improve health outcomes as they have in hospitals.
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Affiliation(s)
- Diana Feldstein
- Division of Geriatric Medicine, Center for Aging and Health, University of North Carolina, Chapel Hill, NC.
| | - Philip D Sloane
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
| | - Cynthia Feltner
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; Department of Medicine, University of North Carolina, Chapel Hill, NC
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49
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Mody L, Greene MT, Meddings J, Krein SL, McNamara SE, Trautner BW, Ratz D, Stone ND, Min L, Schweon SJ, Rolle AJ, Olmsted RN, Burwen DR, Battles J, Edson B, Saint S. A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents. JAMA Intern Med 2017; 177:1154-1162. [PMID: 28525923 PMCID: PMC5710434 DOI: 10.1001/jamainternmed.2017.1689] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Catheter-associated urinary tract infection (UTI) in nursing home residents is a common cause of sepsis, hospital admission, and antimicrobial use leading to colonization with multidrug-resistant organisms. OBJECTIVE To develop, implement, and evaluate an intervention to reduce catheter-associated UTI. DESIGN, SETTING, AND PARTICIPANTS A large-scale prospective implementation project was conducted in community-based nursing homes participating in the Agency for Healthcare Research and Quality Safety Program for Long-Term Care. Nursing homes across 48 states, Washington DC, and Puerto Rico participated. Implementation of the project was conducted between March 1, 2014, and August 31, 2016. INTERVENTIONS The project was implemented over 12-month cohorts and included a technical bundle: catheter removal, aseptic insertion, using regular assessments, training for catheter care, and incontinence care planning, as well as a socioadaptive bundle emphasizing leadership, resident and family engagement, and effective communication. MAIN OUTCOMES AND MEASURES Urinary catheter use and catheter-associated UTI rates using National Healthcare Safety Network definitions were collected. Facility-level urine culture order rates were also obtained. Random-effects negative binomial regression models were used to examine changes in catheter-associated UTI, catheter utilization, and urine cultures and adjusted for covariates including ownership, bed size, provision of subacute care, 5-star rating, presence of an infection control committee, and an infection preventionist. RESULTS In 4 cohorts over 30 months, 568 community-based nursing homes were recruited; 404 met inclusion criteria for analysis. The unadjusted catheter-associated UTI rates decreased from 6.78 to 2.63 infections per 1000 catheter-days. With use of the regression model and adjustment for facility characteristics, the rates decreased from 6.42 to 3.33 (incidence rate ratio [IRR], 0.46; 95% CI, 0.36-0.58; P < .001). Catheter utilization was 4.5% at baseline and 4.9% at the end of the project. Catheter utilization remained unchanged (4.50 at baseline, 4.45 at conclusion of project; IRR, 0.95; 95% CI, 0.88-1.03; P = .26) in adjusted analyses. The number of urine cultures ordered for all residents decreased from 3.49 per 1000 resident-days to 3.08 per 1000 resident-days. Similarly, after adjustment, the rates were shown to decrease from 3.52 to 3.09 (IRR, 0.85; 95% CI, 0.77-0.94; P = .001). CONCLUSIONS AND RELEVANCE In a large-scale, national implementation project involving community-based nursing homes, combined technical and socioadaptive catheter-associated UTI prevention interventions successfully reduced the incidence of catheter-associated UTIs.
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Affiliation(s)
- Lona Mody
- Geriatric Research Education and Clinical Center, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan.,Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - M Todd Greene
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.,Center for Clinical Management Research, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan
| | - Jennifer Meddings
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.,Medicine Service, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan.,Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor
| | - Sarah L Krein
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.,Center for Clinical Management Research, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan
| | - Sara E McNamara
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Barbara W Trautner
- The Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas.,Section of Infectious Diseases, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas
| | - David Ratz
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.,Center for Clinical Management Research, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan
| | - Nimalie D Stone
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lillian Min
- Geriatric Research Education and Clinical Center, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan.,Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | | | - Andrew J Rolle
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois
| | | | - Dale R Burwen
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - James Battles
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Barbara Edson
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois
| | - Sanjay Saint
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.,Center for Clinical Management Research, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan.,Medicine Service, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan
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50
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Alberg T, Holen Ø, Blix HS, Lindbæk M, Bentele H, Eriksen HM. Antibiotic use and infections in nursing homes. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:357-361. [PMID: 28272565 DOI: 10.4045/tidsskr.16.0621] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Residents in nursing homes have a higher risk of developing infections that require antibiotic treatment than elderly people living at home. Use of antibiotics may cause adverse effects and result in the development of antimicrobial resistance. MATERIAL AND METHOD Data on healthcare-associated infections and antibiotic use in 540 Norwegian nursing homes were retrieved from the Norwegian Institute of Public Health’s point prevalence survey in the spring of 2016. Based on information on drug, dosage and indication, we assessed whether the use of antibiotics for the treatment of UTIs was in accordance with the National Guidelines for the Use of Antibiotics in Primary Care. RESULTS UTI was the most commonly occurring type of infection, with a prevalence of 2.7 %. Prescription of first-line antibiotics accounted for approximately 60 % of the prescriptions for treatment of this illness. Choice of drug, dosage and microbiological testing when treating lower UTIs was not always in accordance with the national guidelines. The study showed widespread use of methenamine in Norwegian nursing homes. INTERPRETATION The survey indicates that compliance with the national guidelines when treating lower UTIs could be improved with regard to the choice of drug, dosage and microbiological testing. Norwegian nursing home doctors should also consider whether their use of methenamine is in accordance with national and international recommendations.
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Affiliation(s)
- Torunn Alberg
- Avdeling for resistens- og infeksjonsforebygging Avdeling for smittevernregistre Folkehelseinstituttet
| | - Øyunn Holen
- Avdeling for resistens- og infeksjonsforebygging Folkehelseinstituttet
| | | | | | - Horst Bentele
- Avdeling for resistens- og infeksjonsforebygging Folkehelseinstituttet
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