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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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Behrens LL, Kitt-Lewis E, Boltz M, Calo WA, Lehman E, Whitaker J, Osevala N, Van Haitsma K, Van Scoy LJ, Kraschnewski JL. Leadership Perspectives on Nursing Home Operations From Crisis to Control: A Mixed Methods Study. J Am Med Dir Assoc 2024; 25:105145. [PMID: 38991652 DOI: 10.1016/j.jamda.2024.105145] [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: 02/27/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES Nursing home (NH) leaders remain challenged to deliver quality care, despite the COVID-19 transition to an endemic phase. This study describes NH leadership perspectives on preparing and maintaining quality care during times of diminishing resources as experienced through the COVID-19 pandemic to gain insight on how best to support NHs moving forward. DESIGN This was a cross-sectional, parallel convergent mixed methods study. SETTING AND PARTICIPANTS This study reports quantitative data from N = 5001 NHs across 12 states along with qualitative data from a subsample of NH leaders (N = 15). METHODS Publicly reported survey data were analyzed using descriptive statistics. Individual in-depth interviews with NH leaders conducted at 12-month follow-up were analyzed using inductive thematic coding organized by a guiding framework. Data were integrated using convergent analysis and a joint display. RESULTS NH leaders (licensed administrators, clinical directors, and managers) reported resident and staff infection rates, and access to resources (such as personal protective equipment and testing supplies) that aligned with national trends. Leaders described their NHs (n = 14; 43% rural; 71% not for profit) to be in varied states of operational readiness (standard, contingency, crisis) to support quality infection prevention and control (IPC) at the transition to the endemic COVID-19 phase. Leadership reported continued challenges in addressing resident and staff vaccinations, securing testing supplies, obtaining financial resources to maintain acceptable levels of personal protective equipment, continued staffing shortages, and issues in implementing isolation practices in current facilities. CONCLUSION AND IMPLICATIONS NH leaders continue to struggle delivering quality IPC care post-pandemic and require focused support in several areas. Clinical practice guidelines should include IPC practices to prevent the infection and spread of any COVID-19 variant in this endemic phase. Policies should support continued reporting of IPC-related metrics and adequate funding to account for the long-term financial burden NHs face.
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Affiliation(s)
- Liza L Behrens
- Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA.
| | - Erin Kitt-Lewis
- Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Marie Boltz
- Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - William A Calo
- College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Erik Lehman
- College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Janice Whitaker
- Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Nicole Osevala
- College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Kimberly Van Haitsma
- Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Lauren J Van Scoy
- College of Medicine, The Pennsylvania State University, Hershey, PA, USA
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Pardo-Garcia I, Martinez-Lacoba R, Moya-Martínez P, Amo-Saus E, del Pozo-Rubio R, Escribano-Sotos F. Mortality risk factors in the dependent population of Castilla-La Mancha (Spain) before and during the first COVID-19 wave. Heliyon 2024; 10:e28931. [PMID: 38617942 PMCID: PMC11015414 DOI: 10.1016/j.heliyon.2024.e28931] [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: 10/26/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
The coronavirus disease pandemic has had an important impact worldwide. The population aged over 65 years and aged dependent persons are the population groups which have suffered in a highest level the consequences of the pandemic in terms of cases and death. In Spain, the situation is similar to other countries, but regional studies are needed because competencies on long-term care depend on regional public administration. Thus, the aim of this work is to analyse social and individual factors associated with the risk of mortality of legally recognised dependent people during the pandemic compared to a non-pandemic period. The data were extracted from the administrative database on individuals included in Castilla-La Mancha's long-term care system and it was merged with the information from the Spanish National Death Index administered by the Ministry of Health, Consumption and Social Welfare. The results show that the risk of mortality between March and June 2020 was positively associated with being male; being older than 65, with an especially high impact in the group aged over 90; having a higher level of dependency; living in a nursing home; and living in a place with more population density. Intraregional differences related to health areas also exists in both pandemic and non-pandemic periods. These findings are critical with a view to enhancing protocols for the care of the most vulnerable population groups.
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Affiliation(s)
- Isabel Pardo-Garcia
- Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha, Spain
- Departamento de Economía Aplicada I, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
| | - Roberto Martinez-Lacoba
- Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha, Spain
- Departamento de Análisis Económico y Finanzas, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
| | - Pablo Moya-Martínez
- Facultad de Ciencias Sociales, Universidad de Castilla-La Mancha, Spain
- Departamento de Análisis Económico y Finanzas, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
| | - Elisa Amo-Saus
- Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha, Spain
- Departamento de Análisis Económico y Finanzas, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
| | - Raúl del Pozo-Rubio
- Facultad de Ciencias Sociales, Universidad de Castilla-La Mancha, Spain
- Departamento de Análisis Económico y Finanzas, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
| | - Francisco Escribano-Sotos
- Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha, Spain
- Departamento de Análisis Económico y Finanzas, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
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Wright JR, Ly TT, Brislawn CJ, Chen See JR, Anderson SLC, Pellegrino JT, Peachey L, Walls CY, Bess JA, Bailey AL, Braun KE, Shope AJ, Lamendella R. cleanSURFACES® intervention reduces microbial activity on surfaces in a senior care facility. Front Cell Infect Microbiol 2022; 12:1040047. [PMID: 36439229 PMCID: PMC9682068 DOI: 10.3389/fcimb.2022.1040047] [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: 09/08/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
As one of the top public health challenges outlined by the Centers for Disease Control (CDC), estimates report that hospital acquired infections (HAIs) claim the lives of 99,000 Americans and cost healthcare providers over $28 billion each year. In addition to underlying conditions related to age, elderly patients in long-term care facilities are at an elevated risk of acquiring HAIs. A large percentage of HAIs is attributable to contaminated surfaces and medical devices. To that end, this study utilized a metatranscriptomic sequencing workflow (CSI-Dx™) to profile active microbial communities from surfaces in the HJ Heinz Community Living Center, a long-term care facility in the Veterans Affairs Pittsburgh Health Care System. Swabs were collected from high-touch surfaces (Keyboard, Ledge, Workstation on Wheels, Worksurfaces) before (Baseline) and after cleanSURFACES® were installed at 4 timepoints (Day 1, Day 7, Day 14, and Day 30). Microbial richness was significantly reduced after cleanSURFACES® intervention (Wilcoxon test with Holm correction, p=0.000179). Beta diversity results revealed distinct clustering between Baseline and Post-intervention samples (Adonis, p<0.001). Reduction in bacterial (Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis) and fungal (Malassezia restricta, Candida albicans, Candida glabrata, and Candida orthopsilosis) expression of opportunistic pathogens was observed. Additionally, a subset of taxa (Corynebacterium, Cutibacterium acnes, and Ralstonia pickettii) was present in specific Post-intervention timepoints and surface types. This study revealed decreased microbial activity, highlighting the potential for the combinatorial application of cleanSURFACES® and regular decontamination practices to reduce the prevalence of microbes causing HAIs.
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Sarro A, Di Nardo F, Andreoletti M, Airoldi C, Scotti L, Panella M. Prevalence of Antimicrobial Prescribing in Long-Term Care Facilities in a Local Health Authority of Northern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13412. [PMID: 36293992 PMCID: PMC9603076 DOI: 10.3390/ijerph192013412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Almost half of antimicrobial prescriptions in long-term care facilities (LTCFs) is inappropriate. This broad use might represent a strong contributor to antimicrobial resistance in these facilities. This study aimed to assess antibiotic use patterns and potential associated factors with a survey of LTCFs in the local health authority (LHA) of Novara. METHODS A cross-sectional study was conducted in 25 LTCFs in the LHA of Novara following the healthcare-associated infection in LCTFs (HALT) protocol. Information on residents and facilities was assessed. Antibiotic usage and potential determinants were also estimated. RESULTS In total, 1137 patients were screened for antibiotic usage. Mean age was 84.58 years (SD 9.77), and the majority were female (76.52%). Twenty-six were antibiotic users (prevalence rate 2.29%, 95%CI 1.50-3.33). Antimicrobials were mainly prescribed orally (84.62%). Potential risk factors for antibiotic prescription were catheter use (central and peripheral venous, p-values 0.0475 and 0.0034, respectively, and urinary, p-value 0.0008), immobilization (p-value < 0.0001), and sex (p-value 0.0486). CONCLUSIONS This study identified a low prevalence of antimicrobic consumption in LTCFs. Further surveillance studies are warranted to identify trends and changes in pathogen incidence and antimicrobial resistance and to inform public health authorities on the necessity of prudent use of antimicrobials in LCTFs.
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Affiliation(s)
- Andrea Sarro
- Department of Translational Medicine, Università Degli Studi del Piemonte Orientale, 28100 Novara, Italy
| | | | | | - Chiara Airoldi
- Department of Translational Medicine, Università Degli Studi del Piemonte Orientale, 28100 Novara, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università Degli Studi del Piemonte Orientale, 28100 Novara, Italy
| | - Massimiliano Panella
- Department of Translational Medicine, Università Degli Studi del Piemonte Orientale, 28100 Novara, Italy
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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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Wojkowska-Mach J, Brudło M, Topolski M, Bochenek T, Jachowicz E, Siewierska M, Różańska A. Antibiotic consumption in long-term care facilities in Poland and other European countries in 2017. Antimicrob Resist Infect Control 2021; 10:154. [PMID: 34702342 PMCID: PMC8549207 DOI: 10.1186/s13756-021-01019-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The aim of this research study was to compare the situation concerning the use of microbiology testing, the epidemiology of healthcare-associated infection (HAI) and antimicrobial consumption (AMC) in Polish long-term care facilities (LTCFs) with other European countries, using the most recent findings available in the European databases. Furthermore, this study aimed to highlight several basic factors that contribute to the observable differences in AMC between countries participating in the HALT-3 study, especially the relationship with demographic indicators, as well as the health care resources utilization rates. Patients and methods The most recent HAIs in Long-Term care facilities Point Prevalence Survey (HALT PPS) was carried out in EU/EEA countries in 2016–2017, and in Poland it was carried out in April–June 2017 in 24 LTCFs. AMC data was collected with use of methodology of the Anatomical Therapeutic Chemical (ATC) classification system of the WHO. Results In total total in HALT-3 study on the day of the PPS, 5035 out of the 102,301 eligible residents received at least one antimicrobial agent, with prevalence of 4.9%, and in Poland 3.2%. The most common HAIs in the countries included into the study was urinary tract infection with relative frequency of 32%, in Poland it was skin infection, 30.4%. The respiratory tract infections, excluding pneumonia (PNU) were observed in 29.5% of residents in total, in Poland 17.4%, the prevalence rate of PNU were 1.4% and 5.4%, respectively. The lack of microbiological results of HAIs testing concerned the vast majority of all HAIs, 75.8% in total and 81.5% in Poland. The most frequently used antibacterial for systemic use were beta-lactams and the most frequently prescribed antimicrobial agent was ‘amoxicillin and enzyme inhibitor’. AMC was closely correlated with the age of the general population (65 years of age and more) and the availability of doctors in general population. Conclusions A significant problem observed in LTCFs was the empirical use of antibiotics and the scarcity of microbiological testing. In the studied Polish LTCFs, where the age of residents was low, also the AMC was found to be lower. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-01019-1.
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Affiliation(s)
- Jadwiga Wojkowska-Mach
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Krakow, Poland.
| | - Michał Brudło
- Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Mariusz Topolski
- Department of Systems and Computer Networks, Faculty of Electronics, Wrocław University of Science and Technology, Wrocław, Poland
| | - Tomasz Bochenek
- Department of Nutrition and Drug Research, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Estera Jachowicz
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Krakow, Poland
| | | | - Anna Różańska
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Krakow, Poland
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Mahmoud E, Abanamy R, Binawad E, Alhatmi H, Alzammam A, Habib A, Alturaifi D, Alharbi A, Alqahtani H, Aldohayan M. Infections and patterns of antibiotic utilization in support and comfort care patients: A tertiary care center experience. J Infect Public Health 2021; 14:839-844. [PMID: 34118733 DOI: 10.1016/j.jiph.2021.05.002] [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: 04/12/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Little is known regarding the burden of infections and clinical practice towards hospitalized patients with limits on life-sustaining measures. We aim to describe the infectious syndromes, clinical care, the emergence of multi-drug resistant organisms and outcomes in this population. PATIENTS AND METHODS Retrospective cohort of patients labeled as support or comfort care in a tertiary care center between 2016-2019. RESULTS A total of 347 patients were included with a mean age of 68.5 years, who were predominantly males (59.94%), bedbound (69.74%), on tube feeding (66.86%), and required indwelling urinary catheters (61.96%). The total number of admissions during the first year was 498, with the mean length of stay being 30 days. The number of infectious syndromes identified during that period was 821episodes, with a mean of 2 infectious syndromes per admission. The most common infection identified was pneumonia (41.66%) followed by urinary tract infections (27.16%). A total of 3891 microbiological cultures were taken with a mean of 5 cultures per infectious syndrome. The most commonly identified pathogens were Gram-negative bacteria (61.03%), with a high rate of multidrug-resistant organisms (MDROs) (48.53%). The one-year mortality was 86.4%. Using carbapenem antibiotic and pneumonia were the independent predictors used for the MDROs. CONCLUSION Our study reflects the high burden of infections, antimicrobial resistance, and hospital admissions among a population with limited life expectancy. A consensus regarding investigating and managing of infectious syndromes, and antimicrobial prescription is needed to reduce the harms associated with overuse of antimicrobials.
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Affiliation(s)
- Ebrahim Mahmoud
- Division of Infectious Diseases, Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
| | - Reem Abanamy
- Division of Infectious Diseases, Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Eman Binawad
- Division of Infectious Diseases, Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hind Alhatmi
- Division of Infectious Diseases, Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ali Alzammam
- Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Abdulrahman Habib
- Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Dana Alturaifi
- Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alharbi
- Division of Infectious Diseases, Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hajar Alqahtani
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Aldohayan
- Department of Health Informatics, CPHHI, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Data and Business Intelligence Management Department, ISID, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Lescure D, Haenen A, de Greeff S, Voss A, Huis A, Hulscher M. Exploring determinants of hand hygiene compliance in LTCFs: a qualitative study using Flottorps' integrated checklist of determinants of practice. Antimicrob Resist Infect Control 2021; 10:14. [PMID: 33446248 PMCID: PMC7809817 DOI: 10.1186/s13756-021-00882-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elderly residents in long-term care facilities (LTCFs) are vulnerable to healthcare-associated infections. Although hand hygiene is a leading measure for preventing infection, the compliance of healthcare workers is low. The aim of this study is to identify determinants that influence hand hygiene compliance of nursing staff in LTCFs. This information on determinants can eventually be used to develop a tailored implementation strategy for LTCFs. METHODS This is an explorative, descriptive study using qualitative methods. We performed semi-structured focus group discussions with 31 nurses and nurse assistants from five Dutch LTCFs. Our focus group discussions continued until no new information could be identified from the data. We used Flottorps' comprehensive checklist for identifying determinants of practice (the TICD checklist) to guide data collection and analysis. The audiotapes were transcribed verbatim and two authors independently analysed the transcripts with Atlas.ti software. RESULTS LTCFs for the elderly have setting specific determinants that are decisive in explaining hand hygiene compliance. Most of these determinants are related to the residents with whom nurses build close relationships and for whom they want to create a homelike atmosphere. Residents can complicate the provision of care with unpredictable behaviour, being unwilling to receive care or use shared facilities. Our study also discovered setting-transcending determinants related to knowledge, professional interactions, guidelines, and incentives/resources. CONCLUSIONS Nurses in LTCFs are constantly pursuing a balance between working hygienically, responding adequately to acute care needs, and maintaining a homelike environment for their residents. As a result, setting-specific determinants affect hand hygiene compliance, as do the known determinants that are important in other care settings. To improve compliance in LTCFs, interventions should be selected on a theoretical base while linking these determinants to change interventions. TRIAL REGISTRATION Registration number 50-53000-98-113, Compliance With Hand Hygiene in Nursing Homes: Go for a Sustainable Effect (CHANGE) on ClinicalTrials.gov. Date of registration 28-6-2016.
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Affiliation(s)
- Dominique Lescure
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Present Address: Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Anja Haenen
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Centre for Infectious Disease Control/Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment (RIVM), P.O. Box 9101, 6500 HB Nijmegen, Bilthoven, The Netherlands
| | - Sabine de Greeff
- Department Antimicrobial Resistance and Healthcare Associated Infections, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, Canisius-Wilhelmina Hospital, P.O. Box 9015, 6500 GS Nijmegen, The Netherlands
| | - Anita Huis
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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10
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Baxter R, Jemberie WB, Li X, Naseer M, Pauelsen M, Shebehe J, Viklund EWE, Xia X, Zulka LE, Badache A. COVID-19: Opportunities for interdisciplinary research to improve care for older people in Sweden. Scand J Public Health 2020; 49:29-32. [PMID: 33161880 PMCID: PMC7859561 DOI: 10.1177/1403494820969544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The emergence of COVID-19 has changed the world as we know it, arguably none more so than for older people. In Sweden, the majority of COVID-19-related fatalities have been among people aged ⩾70 years, many of whom were receiving health and social care services. The pandemic has illuminated aspects within the care continuum requiring evaluative research, such as decision-making processes, the structure and organisation of care, and interventions within the complex public-health system. This short communication highlights several key areas for future interdisciplinary and multi-sectorial collaboration to improve health and social care services in Sweden. It also underlines that a valid, reliable and experiential evidence base is the sine qua non for evaluative research and effective public-health systems.
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Affiliation(s)
| | - Wossenseged Birhane Jemberie
- Department of Social Work, Umeå University, Sweden.,Centre for Demographic and Ageing Research (CEDAR), Umeå University, Sweden
| | - Xia Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Mahwish Naseer
- School of Education, Health and Social Studies, Dalarna University, Sweden.,Ageing Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Mascha Pauelsen
- Department of Health Sciences, Luleå University of Technology, Sweden
| | - Jacques Shebehe
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Sweden
| | - Emilia W E Viklund
- Department of Health Sciences, Faculty of Education and Welfare Studies, Åbo Akademi University, Finland
| | - Xin Xia
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Sweden
| | - Linn Elena Zulka
- Department of Psychology, Centre for Ageing and Health (AgeCap), University of Gothenburg, Sweden
| | - Andreea Badache
- Department of Disability Sciences, School of Health Sciences, Örebro University, Sweden.,Swedish Institute of Disability Research, Örebro University, Sweden
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11
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Danis K, Fonteneau L, Georges S, Daniau C, Bernard-Stoecklin S, Domegan L, O'Donnell J, Hauge SH, Dequeker S, Vandael E, Van der Heyden J, Renard F, Sierra NB, Ricchizzi E, Schweickert B, Schmidt N, Abu Sin M, Eckmanns T, Paiva JA, Schneider E. High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32524949 PMCID: PMC7336111 DOI: 10.2807/1560-7917.es.2020.25.22.2000956] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Residents in long-term care facilities (LTCF) are a vulnerable population group. Coronavirus disease (COVID-19)-related deaths in LTCF residents represent 30–60% of all COVID-19 deaths in many European countries. This situation demands that countries implement local and national testing, infection prevention and control, and monitoring programmes for COVID-19 in LTCF in order to identify clusters early, decrease the spread within and between facilities and reduce the size and severity of outbreaks.
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Affiliation(s)
| | - Kostas Danis
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Laure Fonteneau
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Scarlett Georges
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Côme Daniau
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | | | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | | | | | | | | | - Enrico Ricchizzi
- Regional Health and Social Agency - Emilia Romagna, Bologna, Italy
| | | | | | | | | | | | - Elke Schneider
- European Agency for Safety and Health at Work, Bilbao, Spain
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12
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Danis K, Fonteneau L, Georges S, Daniau C, Bernard-Stoecklin S, Domegan L, O'Donnell J, Hauge SH, Dequeker S, Vandael E, Van der Heyden J, Renard F, Sierra NB, Ricchizzi E, Schweickert B, Schmidt N, Abu Sin M, Eckmanns T, Paiva JA, Schneider E. High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020. Euro Surveill 2020. [PMID: 32524949 DOI: 10.2807/1560-7917.es.2020.25.22.200095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Residents in long-term care facilities (LTCF) are a vulnerable population group. Coronavirus disease (COVID-19)-related deaths in LTCF residents represent 30-60% of all COVID-19 deaths in many European countries. This situation demands that countries implement local and national testing, infection prevention and control, and monitoring programmes for COVID-19 in LTCF in order to identify clusters early, decrease the spread within and between facilities and reduce the size and severity of outbreaks.
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Affiliation(s)
- Kostas Danis
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Laure Fonteneau
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Scarlett Georges
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Côme Daniau
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | | | - Lisa Domegan
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | | | | | | | | | - Enrico Ricchizzi
- Regional Health and Social Agency - Emilia Romagna, Bologna, Italy
| | | | | | | | | | | | - Elke Schneider
- European Agency for Safety and Health at Work, Bilbao, Spain
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13
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Non-ventilator health care-associated pneumonia (NV-HAP): Long-term care. Am J Infect Control 2020; 48:A14-A16. [PMID: 32331558 DOI: 10.1016/j.ajic.2020.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/14/2022]
Abstract
Nonventilator health care-associated pneumonia (NV-HAP) is costly and preventable with significant impact on patient morbidity and mortality. This chapter outlines the increased risk of NV-HAP among individuals residing in long-term care facilities and the incidence of pneumonia in this health care setting which accounts for up to 18% of all persons admitted to acute care hospital for pneumonia. A description of prevention strategies with detail on modifiable and Nonmodifiable risk factors for acquiring pneumonia are presented along with the need for a robust interdisciplinary team and approach for this vulnerable population. In addition, the lack of active surveillance and infection prevention expertise may result in the spread of pathogens that can cause NVHAP outbreaks.
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