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Halonen K, van der Kooi T, Hertogh C, Haenen A, de Greeff SC. Prevalence of healthcare-associated infections in Dutch long-term care facilities from 2009 to 2019. J Hosp Infect 2024; 143:150-159. [PMID: 37321412 DOI: 10.1016/j.jhin.2023.06.008] [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: 02/24/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE We assessed trends in the prevalence of healthcare-associated infections (HCAIs) and associated resident and facility characteristics in a national network of long-term care facilities (LTCFs) in the Netherlands from 2009 to 2019. METHODS Participating LTCFs registered the prevalence of urinary tract infection (UTI), lower respiratory tract infection (LRTI), gastrointestinal infection (GI), bacterial conjunctivitis, sepsis and skin infection, using standardized definitions, in biannual point-prevalence surveys (PPSs). In addition, resident and LTCF characteristics were collected. Multi-level analyses were performed to study changes in the HCAI prevalence over time and to identify resident and LTCF-related risk factors. Analyses were performed for HCAIs overall and for UTI, LRTI and GI combined as these were recorded throughout the period. RESULTS Overall, 1353 HCAIs were registered in 44,551 residents with a prevalence of 3.0% (95% confidence interval: 2.8-3.1; range between years 2.3-5.1%). When including only UTI, LRTI and GI the prevalence decreased from 5.0% in 2009 to 2.1% in 2019. Multi-variable regression analyses for UTI, LRTI and GI combined indicated that both prolonged participation and calendar time were independently associated with HCAI prevalence; in LTCFs that participated ≥4 years, the HCAI risk was decreased (OR 0.72 (0.57-0.92)) compared with the first year, and the OR per calendar year was 0.93 (0.88-0.97). CONCLUSIONS Over 11 years of PPS in LTCFs the HCAI prevalence decreased over time. Prolonged participation further reduced the HCAI prevalence, in particular UTIs, despite the increasing age and associated frailty of the LTCF population, illustrating the potential value of surveillance.
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Affiliation(s)
- K Halonen
- National Institute for Public Health and the Environment, Centre for Infectious Disease Research, Epidemiology and Surveillance, Bilthoven, the Netherlands.
| | - T van der Kooi
- National Institute for Public Health and the Environment, Centre for Infectious Disease Research, Epidemiology and Surveillance, Bilthoven, the Netherlands
| | - C Hertogh
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands
| | - A Haenen
- National Institute for Public Health and the Environment, Centre for Infectious Disease Research, Epidemiology and Surveillance, Bilthoven, the Netherlands
| | - S C de Greeff
- National Institute for Public Health and the Environment, Centre for Infectious Disease Research, Epidemiology and Surveillance, Bilthoven, the Netherlands
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Falconer N, Paterson DL, Peel N, Welch A, Freeman C, Burkett E, Hubbard R, Comans T, Hanjani LS, Pascoe E, Hawley C, Gray L. A multimodal intervention to optimise antimicrobial use in residential aged care facilities (ENGAGEMENT): protocol for a stepped-wedge cluster randomised trial. Trials 2022; 23:427. [PMID: 35597993 PMCID: PMC9123829 DOI: 10.1186/s13063-022-06323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate antibiotic use can cause harm and promote antimicrobial resistance, which has been declared a major health challenge by the World Health Organization. In Australian residential aged care facilities (RACFs), the most common indications for antibiotic prescribing are for infections of the urinary tract, respiratory tract and skin and soft tissue. Studies indicate that a high proportion of these prescriptions are non-compliant with best prescribing guidelines. To date, a variety of interventions have been reported to address inappropriate prescribing and overuse of antibiotics but with mixed outcomes. This study aims to identify the impact of a set of sustainable, multimodal interventions in residential aged care targeting three common infection types. METHODS This protocol details a 20-month stepped-wedge cluster-randomised trial conducted across 18 RACFs (as 18 clusters). A multimodal multi-disciplinary set of interventions, the 'AMS ENGAGEMENT bundle', will be tailored to meet the identified needs of participating RACFs. The key elements of the intervention bundle include education for nurses and general practitioners, telehealth support and formation of an antimicrobial stewardship team in each facility. Prior to the randomised sequential introduction of the intervention, each site will act as its own control in relation to usual care processes for antibiotic use and stewardship. The primary outcome for this study will be antibiotic consumption measured using defined daily doses (DDDs). Cluster-level rates will be calculated using total occupied bed numbers within each RACF during the observation period as the denominator. Results will be expressed as rates per 1000 occupied bed days. An economic analysis will be conducted to compare the costs associated with the intervention to that of usual care. A comprehensive process evaluation will be conducted using the REAIM Framework, to enable learnings from the trial to inform sustainable improvements in this field. DISCUSSION A structured AMS model of care, incorporating targeted interventions to optimise antimicrobial use in the RACF setting, is urgently needed and will be delivered by our trial. The trial will aim to empower clinicians, residents and families by providing a robust AMS programme to improve antibiotic-related health outcomes. TRIAL REGISTRATION US National Library of Medicine Clinical Trials.gov ( NCT04705259 ). Prospectively registered in 12th of January 2021.
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Affiliation(s)
- Nazanin Falconer
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia.
- Department of Pharmacy, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, 4102, Australia.
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia.
| | - David L Paterson
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Metro North Health, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
| | - Nancye Peel
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Alyssa Welch
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Christopher Freeman
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Ellen Burkett
- Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - Ruth Hubbard
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
- Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - Tracy Comans
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Leila Shafiee Hanjani
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Elaine Pascoe
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Carmel Hawley
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
- Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - Leonard Gray
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
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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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Abstract
Background: Infection is the greatest cause of mortality in burn patients. As our population ages, the need to care for elderly burn patients will increase, and with it our understanding of how infection affects older patients with burn injuries. This article presents a review of the available literature on the effect of aging on the physiologic response to burns, of the known effects of infection in the elder population, and of the contribution of underlying medical comorbidities to the outcomes for the elderly burn patient. The potential for more serious outcomes from multi-drug resistance in the elder population is also discussed. Methods: This article is a review of the available literature on infection in elderly burn patients. A literature search was performed for key words: elderly; geriatric; burn; infection; comorbidity; multi-drug resistance; central line; urinary tract infection; and burn sepsis. Relevant findings were included in each section. Results: Pre-existing conditions are common in the elderly and contribute to a higher rate of development of pneumonia, cellulitis, urinary tract infection, central line infections, and burn wound infections. Specific data pertaining to infections in the elderly burn population are scarce or confined to single-center reports. Conclusions: Because of the inherent susceptibility of the elder population to infection because of pre-existing medical conditions, immunosenescence, and potential exposure via frequent interaction with the medical system, vigilance must be maintained for preventing and treating infection in elderly burn patients. More research is needed to define the risks and extent of this increasingly important issue.
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Affiliation(s)
- Alisa Savetamal
- Department of Surgery Connecticut Burn Center, Bridgeport Hospital, Bridgeport, Connecticut, USA
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Development of an information leaflet and diagnostic flow chart to improve the management of urinary tract infections in older adults: a qualitative study using the Theoretical Domains Framework. BJGP Open 2020; 4:bjgpopen20X101044. [PMID: 32576575 PMCID: PMC7465577 DOI: 10.3399/bjgpopen20x101044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 01/21/2023] Open
Abstract
Background Urinary tract infections (UTIs), older age, lack of access to health care, and recent antibiotic use are risk factors for Escherichia coli (E. coli) bloodstream infections. Aim To explore the diagnosis and management of UTIs in primary care to inform the development of an information leaflet, a diagnostic flow chart, and recommendations for other resources. Design & setting The study had a qualitative design and was undertaken in primary care settings and care homes. Method Interviews and focus groups were informed by the Theoretical Domains Framework (TDF) with 31 care home staff, three residents, six relatives, 57 GP staff, and 19 members of the public. An inductive thematic analysis was used and themes were placed in the Behaviour Change Wheel (BCW) to recommend interventions. Results Care home staff were pivotal for identifying suspected UTI, alerted clinicians to symptoms that influenced prescribing decisions, and reported confusion or behavioural changes as the most common diagnostic sign. Care home staff lacked knowledge about asymptomatic bacteriuria (ASB) and sepsis, and incorrectly diagnosed UTI using urine dipsticks. GP staff used urine dipsticks to rule out UTI and reported that stopping dipsticks would require a culture change, clear protocols, and education about ASB. Many prescribers believed that stopping urine dipstick use should help to reduce antibiotic use. Conclusion A consistent message about ASB and UTI diagnosis and management in older adults should be communicated across the care pathway. Resource development should increase capability, motivation, and opportunity to improve management of suspected UTIs. An educational leaflet for older adults and a diagnostic flow chart for clinicians have been developed, and recommendations for interventions are discussed.
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Perceived Patient Safety Culture in Nursing Homes Associated With "Nursing Home Compare" Performance Indicators. Med Care 2019; 57:641-647. [PMID: 31259786 DOI: 10.1097/mlr.0000000000001142] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The safety and quality of care provided to nursing home residents is a significant concern. Little is known whether fostering patient safety culture helps improve the safety and quality of nursing home care. METHODS This study determined the associations of nursing home patient safety culture performance, as reported by administrators, directors of nursing, and unit leaders in a large national sample of free-standing nursing homes, with several "Nursing Home Compare" performance indicators. We conducted the survey in 2017 using the Agency for Healthcare Research and Quality Survey on Patient Safety Culture for nursing homes to collect data on 12 core domains of safety culture scores. Survey data were linked to other nursing home files for multivariable regression analyses. RESULTS Overall, 818 of the 2254 sampled nursing homes had at least 1 completed survey returned for a response rate of 36%. After adjustment for nursing home, market, and state covariates, every 10 percentage points increase in overall positive response rate for safety culture was associated with 0.56 fewer health care deficiencies (P=0.001), 0.74 fewer substantiated complaints (P=0.004), reduced fines by $2285.20 (P=0.059), and 20% increased odds of being designated as 4-star or 5-star (vs. 1 to 3 star) facilities (odds ratio roughly=1.20, P<0.05). CONCLUSIONS Efforts to improve nursing home performance in patient safety culture have the potential to improve broad safety and quality of care measures encapsulated in the Nursing Home Compare publication.
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Surveillance of infections in long-term care facilities (LTCFs): The impact of participation during multiple years on health care-associated infection incidence. Epidemiol Infect 2019; 147:e266. [PMID: 31496454 PMCID: PMC6805744 DOI: 10.1017/s0950268819001328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We studied trends in the incidence of health care-associated infections (HAIs) in LTCFs between 2009 and 2015 and determined the effect of participation in our network. Elder-care physicians reported weekly the number of cases of influenza-like illness, gastroenteritis, (probable) pneumonia, urinary tract infections (UTIs) and all-cause mortality. Trends in the incidence of infection and mortality in relation to LTCF characteristics were calculated using multilevel univariate and multivariate logistic regression. Thirty LTCF participated for 3 years or more, 16 for 2 years and the remaining 12 LTCF for 1 year. During the study period, the median number of beds decreased from 158 to 139, whereas the percentage of residents with private bedrooms increased from 14% to 87%. UTIs were the most frequently reported infections, followed by (probable) pneumonia and gastroenteritis. Adjusted for calendar year and season, we observed a statistically significant decrease in the incidence of influenza-like illness (odds ratio (OR) = 0.8, P < 0.01) and (probable) pneumonia (OR = 0.8, P < 0.01) for each extra year an LTCF participated. Although there are other likely contributors, such as more private rooms and enhanced infection control measures, the decreasing trend of HAI in LTCFs participating in surveillance implies that surveillance is a valuable addition to current strategies to optimise infection control.
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Song YJ, Cheong HK, Ki M, Shin JY, Hwang SS, Park M, Ki M, Lim J. The Epidemiological Influence of Climatic Factors on Shigellosis Incidence Rates in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102209. [PMID: 30309010 PMCID: PMC6210993 DOI: 10.3390/ijerph15102209] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/06/2018] [Accepted: 10/06/2018] [Indexed: 12/03/2022]
Abstract
Research has shown the effects of climatic factors on shigellosis; however, no previous study has evaluated climatic effects in regions with a winter seasonality of shigellosis incidence. We examined the effects of temperature and precipitation on shigellosis incidence in Korea from 2002–2010. The incidence of shigellosis was calculated based on data from the Korean Center for Disease Control and Prevention (KCDC, Cheongju, Korea), and a generalized additive model (GAM) was used to analyze the associations between the incidence and climatic factors. The annual incidence rate of shigellosis was 7.9 cases/million persons from 2002–2010. During 2007–2010, high incidence rates and winter seasonality were observed among those aged ≥65 years, but not among lower age groups. Based on the GAM model, the incidence of shigellosis is expected to increase by 13.6% and 2.9% with a temperature increase of 1 °C and a lag of two weeks and with a mean precipitation increase of 1 mm and a lag of five weeks after adjustment for seasonality, respectively. This study suggests that the incidence of shigellosis will increase with global climate change despite the winter seasonality of shigellosis in Korea. Public health action is needed to prevent the increase of shigellosis incidence associated with climate variations.
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Affiliation(s)
- Yeong-Jun Song
- Department of Preventive Medicine College of Medicine, Eulji University, Daejeon 34824, Korea.
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea.
| | - Myung Ki
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul 02841, Korea.
| | - Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea.
| | - Seung-Sik Hwang
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea.
| | - Mira Park
- Department of Preventive Medicine College of Medicine, Eulji University, Daejeon 34824, Korea.
| | - Moran Ki
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea.
| | - Jiseun Lim
- Department of Preventive Medicine College of Medicine, Eulji University, Daejeon 34824, Korea.
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Murray MT, Johnson CL, Cohen B, Jackson O, Jones LK, Saiman L, Larson EL, Neu N. Use of antibiotics in paediatric long-term care facilities. J Hosp Infect 2017; 99:139-144. [PMID: 29111352 DOI: 10.1016/j.jhin.2017.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adult long-term care (LTC) facilities have high rates of antibiotic use, raising concerns about antimicrobial resistance. Few studies have examined antibiotic use in paediatric LTC facilities. AIM To describe antibiotic use in three paediatric LTC facilities and to describe the factors associated with use. METHODS A retrospective cohort study was conducted from September 2012 to December 2015 in three paediatric LTC facilities. Medical records were reviewed for demographics, healthcare-associated infections (HAIs), antimicrobial use and diagnostic testing. Logistic regression was used to identify predictors for antibiotic use. The association between susceptibility testing results and appropriate antibiotic coverage was determined using Chi-squared test. FINDINGS Fifty-eight percent (413/717) of residents had at least one HAI, and 79% (325/413) of these residents were treated with at least one antibiotic course, totalling 2.75 antibiotic courses per 1000 resident-days. Length of enrolment greater than one year, having a neurological disorder, having a tracheostomy, and being hospitalized at least once during the study period were significantly associated with receiving antibiotics when controlling for facility (all P < 0.001). Diagnostic testing was performed for 40% of antibiotic-treated HAIs. Eighty-six percent of antibiotic courses for identified bacterial pathogens (201/233) provided appropriate coverage. Access to susceptibility testing was not associated with appropriate antibiotic choice (P = 0.26). CONCLUSION Use of antibiotics in paediatric LTC facilities is widespread. There is further need to assess antibiotic use in paediatric LTC facilities. Evaluation of the adverse outcomes associated with inappropriate antibiotic use, including the prevalence of resistant organisms in paediatric LTC facilities, is critical.
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Affiliation(s)
- M T Murray
- School of Nursing, Columbia University Medical Center, New York, NY, USA.
| | - C L Johnson
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - B Cohen
- School of Nursing, Columbia University Medical Center, New York, NY, USA
| | - O Jackson
- Elizabeth Seton Paediatric Center, Yonkers, NY, USA
| | | | - L Saiman
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA; Department of Infection Prevention and Control, New York Presbyterian Hospital, New York, NY, USA
| | - E L Larson
- School of Nursing, Columbia University Medical Center, New York, NY, USA
| | - N Neu
- School of Nursing, Columbia University Medical Center, New York, NY, USA; Elizabeth Seton Paediatric Center, Yonkers, NY, USA
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Burdsall DP, Gardner SE, Cox T, Schweizer M, Culp KR, Steelman VM, Herwaldt LA. Exploring inappropriate certified nursing assistant glove use in long-term care. Am J Infect Control 2017; 45:940-945. [PMID: 28863810 DOI: 10.1016/j.ajic.2017.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Certified Nursing Assistants (CNAs) frequently wear gloves when they care for patients in standard precautions. If CNAs use gloves inappropriately, they may spread pathogens to patients and the environment, potentially leading to health care-associated infections (HAIs). METHODS Using a descriptive structured observational design, we examined the degree of inappropriate health care personnel glove use in a random sample of 74 CNAs performing toileting and perineal care at 1 long-term care facility. RESULTS During the 74 patient care events, CNAs wore gloves for 80.2% (1,774/2,213) of the touch points, failing to change gloves at 66.4% (225/339) of glove change points. CNAs changed gloves a median of 2.0 times per patient care event. A median of 1.0 change occurred at a change point. CNAs failed to change their gloves at a glove change point a median of 2.5 times per patient care event. Most (61/74; 82.4%) patient care events had >1 contaminated touch point. Over 44% (782/1,774) of the gloved touch points were defined as contaminated for a median of 8.0 contaminated glove touch points per patient care event. All contaminated touches were with gloved hands (P <.001). CONCLUSIONS Inappropriate glove use was frequently observed in this study. Contaminated gloves may be a significant cause of cross-contamination of pathogens in health care environments. Future research studies should evaluate strategies to improve glove use to reduce HAIs.
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Uršič T, Miksić NG, Lusa L, Strle F, Petrovec M. Viral respiratory infections in a nursing home: a six-month prospective study. BMC Infect Dis 2016; 16:637. [PMID: 27814689 PMCID: PMC5097393 DOI: 10.1186/s12879-016-1962-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/25/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The knowledge on viral respiratory infections in nursing home (NH) residents and their caregivers is limited. The purpose of the present study was to assess and compare the incidence of acute respiratory infections (ARI) in nursing home (NH) residents and staff, to identify viruses involved in ARI and to correlate viral etiology with clinical manifestations of ARI. METHODS The prospective surveillance study was accomplished in a medium-sized NH in Slovenia (central Europe). Ninety NH residents and 42 NH staff were included. Nasopharyngeal swabs were collected from all participants at enrollment (December 5th, 2011) and at the end of the study (May 31st, 2012), and from each participant that developed ARI within this timeframe. Molecular detection of 15 respiratory viruses in nasopharyngeal swab samples was performed. RESULTS The weekly incidence rate of ARI in NH residents and NH staff correlated; however, it was higher in staff members than in residents (5.9 versus 3.8/1,000 person-days, P = 0.03), and was 2.5 (95 % CI: 1.36-4.72) times greater in residents without dementia than in residents with dementia. Staff members typically presented with upper respiratory tract involvement, whereas in residents lower respiratory tract infections predominated. Respiratory viruses were detected in 55/100 ARI episodes. In residents, influenza A virus, respiratory syncytial virus, and human metapneumovirus were detected most commonly, whereas in NH staff rhinovirus and influenza A virus prevailed. 38/100 ARI episodes (30/56 in residents, 8/44 in staff) belonged to one of three outbreaks (caused by human metapneumovirus, influenza A virus and respiratory syncytial virus, respectively). NH residents had higher chances for virus positivity within outbreak than HN staff (OR = 7.4, 95 % CI: 1.73-31.48, P < 0.01). CONCLUSIONS ARI are common among NH residents and staff, and viruses were detected in a majority of the episodes of ARI. Many ARI episodes among NH residents were outbreak cases and could be considered preventable. TRIAL REGISTRATION The study was registered on the 1th of December 2011 at ClinicalTrials ( NCT01486160 ).
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Affiliation(s)
- Tina Uršič
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia.
| | - Nina Gorišek Miksić
- Department of Infectious Diseases, Maribor University Medical Center, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Lara Lusa
- Faculty of Medicine, Institute for Biostatistics and Medical Informatics, Vrazov trg 2, 1104, Ljubljana, Slovenia
| | - Franc Strle
- Department of Infectious Diseases, University Medical Center Ljubljana, Japljeva 2, 1525, Ljubljana, Slovenia
| | - Miroslav Petrovec
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia
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Chang SC, Shiu MN, Chen HT, Ng YY, Lin LC, Wu SC. Evaluation of care quality for disabled older patients living at home and in institutions. J Clin Nurs 2015; 24:3469-80. [DOI: 10.1111/jocn.12946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Huey-Tzy Chen
- Department of Nursing; Fu Jen Catholic University; Taipei Taiwan
| | - Yee-Yung Ng
- Division of Nephrology; Department of Medicine; Veterans General Hospital-Taipei; Taipei Taiwan
| | - Li-Chan Lin
- Institute of Clinical and Community Health Nursing; National Yang-Ming University; Taipei Taiwan
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy; National Yang-Ming University; Taipei Taiwan
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13
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McNulty C, Verlander NQ, Turner K, Fry C. Point prevalence survey of urinary catheterisation in care homes and where they were inserted, 2012. J Infect Prev 2014; 15:122-126. [PMID: 28989371 DOI: 10.1177/1757177414532507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 11/15/2022] Open
Abstract
The extent to which the use of catheter care bundles and other interventions has led to a reduction in urinary catheterisation rates is unknown. We aimed to determine current urinary catheterisation rates in care homes with residents over 65 years old, and determine the extent to which residents are discharged from the hospital setting with urinary catheters. A point prevalence questionnaire survey was used in care homes that looked after residents over 65 years in six UK health boards or primary care trusts, to determine urinary catheterisation rates, and where these catheters were inserted. Questionnaires for 445 of 461 care homes (96.5%) were completed, 425 of 445 care homes cared for residents over 65 years; 888 (6.9%) of 12,827 residents had a urethral (82.5%) or supra-pubic (17.5%) urinary catheter. Over half of all catheters (both urethral and suprapubic, 57.4%, 509 of 888 catheters), and 3.1% of all residents had a catheter inserted while the residents were hospital inpatients, and then discharged back to the care home still catheterised. There was a significant variation in urinary catheterisation rates in the care homes surveyed, and rates remain similar to previous English surveys in 2003 and 2009. More still needs to be done to understand the variation in urinary catheterisation rates in care homes and reduce these rates, including the numbers of residents that are discharged from hospital with a urinary catheter.
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Affiliation(s)
- Cam McNulty
- Public Health England Primary Care Unit, and Cardiff University, UK
| | | | - K Turner
- Public Health England Primary Care Unit, UK
| | - C Fry
- Department of Health, London, UK
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Lim CJ, Kong DCM, Stuart RL. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives. Clin Interv Aging 2014; 9:165-77. [PMID: 24477218 PMCID: PMC3894957 DOI: 10.2147/cia.s46058] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of particular concern is the recent emergence of multidrug-resistant organisms among this vulnerable population. Accordingly, antimicrobial stewardship (AMS) programs have started to be introduced into the residential aged care facilities setting to promote judicious antimicrobial use. However, to successfully implement AMS programs, there are unique challenges pertaining to this resource-limited setting that need to be addressed. In this review, we summarize the epidemiology of infections in this population and review studies that explore antibiotic use and prescribing patterns. Specific attention is paid to issues relating to inappropriate or suboptimal antibiotic prescribing to guide future AMS interventions.
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Affiliation(s)
- Ching Jou Lim
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - David C M Kong
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Rhonda L Stuart
- Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia ; Department of Medicine, Monash University, Clayton, VIC, Australia
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15
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Van Gaal BG, Schoonhoven L, Mintjes-de Groot JA, Defloor T, Habets H, Voss A, van Achterberg T, Koopmans RT. Concurrent Incidence of Adverse Events in Hospitals and Nursing Homes. J Nurs Scholarsh 2013; 46:187-98. [DOI: 10.1111/jnu.12063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Betsie G.I. Van Gaal
- Senior researcher, Scientific Institute for Quality of Healthcare; Radboud university medical center; Nijmegen the Netherlands
| | - Lisette Schoonhoven
- Senior Research Fellow Nursing Science, Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, the Netherlands and Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Joke A.J. Mintjes-de Groot
- Emeritus Professor Critical Care, Faculty of Health and Social Studies; HAN University of Applied Sciences; Nijmegen the Netherlands
| | - Tom Defloor
- Was Professor of Nursing Science, Department of Public Health, Faculty of Medicine and Health Science; Ghent University; Gent Belgium
| | - Herbert Habets
- Geriatric Clinical Nurse Specialist, Orbis Medical Centre, Sittard-Geleen, Senior Lecturer; Zuyd University of Applied Sciences; Heerlen The Netherlands
| | - Andreas Voss
- Professor of Clinical Microbiology and Infection Control, Department of Medical Microbiology, Radboud university medical center, Nijmegen, the Netherlands and Consultant Clinical Microbiologist; Canisius-Wilhelmina Hospital; Nijmegen the Netherlands
| | - Theo van Achterberg
- Professor of Nursing Science, Scientific Institute for Quality of Healthcare, Radboud university medical center; Nijmegen, the Netherlands and Center for Health Services and Nursing Research; KU Leuven Leuven Belgium
| | - Raymond T.C.M. Koopmans
- Professor of Elderly Care Medicine, Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health; Radboud university medical center; Nijmegen the Netherlands
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16
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Pobiega M, Wojkowska-Mach J, Chmielarczyk A, Romaniszyn D, Adamski P, Heczko PB, Gryglewska B, Grodzicki T. Molecular characterization and drug resistance of Escherichia coli strains isolated from urine from long-term care facility residents in Cracow, Poland. Med Sci Monit 2013; 19:317-26. [PMID: 23632427 PMCID: PMC3659068 DOI: 10.12659/msm.883898] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 12/18/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the prevalence of multidrug-resistant Escherichia coli and extended-spectrum â-lactamases (ESBL) pathogens isolated from asymptomatic bacteriuria and urinary tract infections (UTIs), and the relationship between the phylogeny, antimicrobial resistance, and virulence among isolates in residents of 3 long-term care facilities (LTCF) in Krakow, Poland. MATERIAL AND METHODS This was point prevalence study and prospective infection control in a group of 217 people. Urine samples were examined with standard microbiological methods and screened for the presence of blaCTX-M, blaSHV, and blaTEM. E. coli isolates were screened for 6 common virulence factors (VFs) and classified according to the rapid phylogenetic grouping technique. RESULTS Among all the strains tested, 14 isolates (13.9%) expressed ESBL activity. A significant proportion of isolates were resistant to ciprofloxacin (32.7%, n=33). Resistance to trimethoprim/sulfamethoxazole was identified among 45 isolates (44.5%). Independent risk factors for the presence of an ESBL-producing strain were: UTI, urinary and/or fecal incontinence, bedridden, and low values of the Barthel and Katz Indexes. Gene sequencing identified 8 blaCTX-M-15, 1 blaCTX-M-3, 9 blaTEM-1, and 1 blaSHV-12. Among E. coli, no relationship between number of VF genes and phylogeny was found. The most prevalent virulence factor was fimH (82.1%). CONCLUSIONS The findings of this study emphasize the need for further research on the epidemiology of multi-drug resistant organisms (MDRO) and ESBL in LTCF, including transmission patterns, rates of infection, and factors associated with infections. It may be necessary to extend the requirements and precautions to MDRO and ESBL-producers.
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Affiliation(s)
- Monika Pobiega
- Jagiellonian University Medical College, Cracow, Poland.
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17
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18
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Age and other risk factors of pneumonia among residents of Polish long-term care facilities. Int J Infect Dis 2013; 17:e37-43. [DOI: 10.1016/j.ijid.2012.07.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/24/2012] [Accepted: 07/04/2012] [Indexed: 11/20/2022] Open
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19
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Infection control: point prevalence study versus incidence study in Polish long-term care facilities in 2009-2010 in the Małopolska Region. Infection 2012; 41:1-8. [PMID: 23086684 PMCID: PMC3566398 DOI: 10.1007/s15010-012-0351-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 10/03/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the epidemiology of infection in Polish long-term care facilities (LTCFs) and to analyse the capabilities and legitimacy of implementing continuous targeted surveillance. METHODS The study investigated the relationship between the presence of infection and health status, tested using a point prevalence study (PPS) and incidence study. A 1-day PPS was carried out in October 2009, with prospective continuous surveillance between December 2009 and November 2010. Infections were defined according to McGeer's criteria. RESULTS The surveillance encompassed 193 people. The prevalence was 14.0 % in residential homes (RHs) and 18.7 % in the nursing home (NH). Various types of infections (in the PPS) were observed significantly more frequently in patients with asthma, wounds, atherosclerosis of lower extremities, tracheotomy tubes and conditions in patients hospitalised in intensive care units (ICUs) up to 1 year before the PPS day. The incidence rate was 2.7/1,000 patient days (pds). CONCLUSIONS The factors determined to be important for the risk of infection (in the continuous study) include the general status of patients, expressed using Barthel, abbreviated mental and Katz scales, as well as limited physical activity, stool incontinence and urinary catheterisation. In the PPS study, only a slight relationship was shown between the general status of residents and the risk of infection. None of the general status scales used clinically were shown to be helpful in estimating that risk, similarly to the five-point physical activity scale. Prospective continuous surveillance shows a possibility of limiting the range of infection control in the LTCFs within targeted surveillance in a population of patients that requires intensive nursing procedures. As a marker, one could point to the low score in the Barthel or Katz scales or low physical activity/bedridden persons.
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20
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Laurent M, Bories PN, Le Thuaut A, Liuu E, Ledudal K, Bastuji-Garin S, Paillaud E. Impact of Comorbidities on Hospital-Acquired Infections in a Geriatric Rehabilitation Unit: Prospective Study of 252 Patients. J Am Med Dir Assoc 2012; 13:760.e7-12. [DOI: 10.1016/j.jamda.2012.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 07/01/2012] [Accepted: 07/02/2012] [Indexed: 11/29/2022]
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de Figueiredo RMD, Maroldi MAC. [Home care: health professionals at risk for biological exposure]. Rev Esc Enferm USP 2012; 46:145-50. [PMID: 22441278 DOI: 10.1590/s0080-62342012000100020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 05/12/2011] [Indexed: 11/22/2022] Open
Abstract
This prospective, exploratory study was performed using a quantitative approach with the objective of characterizing the healthcare tasks that involved biological risk for professionals working with the Home Care Service of the São Carlos Municipal Hospital (São Carlos, SP, Brazil). We followed 159 visits from June 2008 to January 2009. A total of 347 procedures were considered to present risks for biological exposure, categorized as follows: dressings (31.1%), capillary blood glucose monitoring (14.4%); and vascular access (3.1%). Of all subjects, 21.5% complied with hand cleansing prior to performing a procedure, 66.3% wore gloves and 83.5% disposed of sharps appropriately. In conclusion, these professionals are subject to biological risks similar to those found in the hospital environment, because they are also exposed to blood and sharps often and have a poor adherence to the standard preventive measures. Further studies to evaluate the influence of the features of the household on the referred risk should be encouraged.
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22
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Lim CJ, McLellan SC, Cheng AC, Culton JM, Parikh SN, Peleg* AY, Kong* DCM. Surveillance of infection burden in residential aged care facilities. Med J Aust 2012; 196:327-31. [DOI: 10.5694/mja12.10085] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ching Jou Lim
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
| | - Susan C McLellan
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
| | - Joanne M Culton
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC
| | - Sneha N Parikh
- Infectious Diseases Unit, Alfred Hospital, Melbourne, VIC
| | - Anton Y Peleg*
- Infectious Diseases Unit, Alfred Hospital, Melbourne, VIC
- Microbiology Department, Monash University, Melbourne, VIC
| | - David C M Kong*
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
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23
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Avci M, Ozgenc O, Coskuner SA, Olut AI. Hospital acquired infections (HAI) in the elderly: Comparison with the younger patients. Arch Gerontol Geriatr 2012; 54:247-50. [DOI: 10.1016/j.archger.2011.03.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 03/14/2011] [Accepted: 03/15/2011] [Indexed: 10/18/2022]
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24
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Cheung WK, Tsang YM. Emphysematous infections of the prostate and scrotum in an older adult in a nursing home. J Am Geriatr Soc 2011; 59:2378-9. [PMID: 22188085 DOI: 10.1111/j.1532-5415.2011.03710.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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25
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Chami K, Gavazzi G, Carrat F, de Wazières B, Lejeune B, Piette F, Rothan-Tondeur M. Burden of infections among 44,869 elderly in nursing homes: a cross-sectional cluster nationwide survey. J Hosp Infect 2011; 79:254-9. [DOI: 10.1016/j.jhin.2011.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 08/02/2011] [Indexed: 10/17/2022]
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26
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MRSA: A Challenge to Norwegian Nursing Home Personnel. Interdiscip Perspect Infect Dis 2011; 2011:197683. [PMID: 21941537 PMCID: PMC3175413 DOI: 10.1155/2011/197683] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/15/2011] [Accepted: 07/17/2011] [Indexed: 11/18/2022] Open
Abstract
In Norway, methicillin-resistant Staphylococcus aureus (MRSA) is increasing in primary healthcare, associated with imported cases and outbreaks in long-term care. According to Norwegian national guidelines, MRSA-exposed healthcare workers (HCWs) and patients are tested. Carriage of MRSA leads to exclusion from work in healthcare institutions. In this study, 388 staff members in 42 nursing homes in Oslo County responded to questions about personal experience with MRSA and of own attitudes to challenges associated with the control and treatment of MRSA patients. Half (52%) of the nursing staff were concerned of becoming infected with MRSA and the consequences of this would be for own social life, family, economy, and work restriction. The concern was associated with risk factors like old buildings not suitable for modern infection control work, low staffing rate (70% without specific training in healthcare and 32% without formal healthcare education), defective cleaning and decolonization, and lack of formal routines and capacity for isolation of MRSA patients. Since the Norwegian MRSA guideline permits patients with persistent MRSA infections to move freely around in nursing homes, the anxiety of the staff to become infected and excluded from job was real.
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27
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Forrest J, Tucker A, Brnabic AJ. A 9-year infection-control surveillance program in Sydney-based residential aged-care facilities. ACTA ACUST UNITED AC 2011. [DOI: 10.1071/hi11014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Smith M, Bull AL, Richards M, Woodburn P, Bennett NJ. Infection rates in residential aged care facilities, Grampians region, Victoria, Australia. ACTA ACUST UNITED AC 2011. [DOI: 10.1071/hi11017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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29
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Beobide Telleria I, Alaba Trueba J, Genua Goena MI, Arriola Manchola E, Iturrioz Arrechea I, Alvarez De Arcaya Vitoria M, Miró Isasi B. [Infection epidemiology in gerontology centres]. Rev Esp Geriatr Gerontol 2011; 46:63-7. [PMID: 21388711 DOI: 10.1016/j.regg.2010.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 11/11/2010] [Accepted: 11/13/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Infection processes in gerontology centres (GC) are one of the main causes of mortality and aggravation of concomitant chronic diseases. An epidemiological surveillance system was set up to find out their magnitude and distribution. MATERIAL AND METHODS A prevalence study was conducted during the years 2006-2009 in 4 GCs of the Matia Foundation. Prevalence was measured by making an annual cut-off, recording: infection type, demographic data, risk factors and antibiotic use. The incidence was measured for two years in one GC as a pilot centre, recording: infection type and antibiotic use. RESULTS The prevalence in the GCs varied between 4.8% and 6.44%. The infection incidence density in the pilot study was between 3.45-5.77 infections per 1,000 resident days. The most common infection location and in this order were, respiratory, urinary and cutaneous. The incidence of respiratory infection is more statistically significant in the presence of dysphagia, malnutrition and COPD. However, no significant relationship was seen in the incidence of urinary infection with the different risk factors analysed. CONCLUSIONS The frequency and repercussions of nosocomial infections in GCs demonstrate the need for intervention plans and the development of adequate prevention measures.
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30
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Kirk M, Hall G, Veitch M, Becker N. Assessing the incidence of gastroenteritis among elderly people living in long term care facilities. J Hosp Infect 2010; 76:12-7. [DOI: 10.1016/j.jhin.2010.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 04/02/2010] [Indexed: 10/19/2022]
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31
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Roberts C, Roberts J, Roberts RJ. Survey of healthcare-associated infection rates in a nursing home resident population. J Infect Prev 2010. [DOI: 10.1177/1757177410364867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this study we assessed the incidence and types of healthcare-associated infection (HCAI) in a nursing home resident population. The influences of home size, resident category, gender and age were also examined. Fifteen homes were recruited and infection rates recorded from 1 October 2006 to 2 December 2006. A rate of 6.04 infections/1000 bed days was recorded for the complete study. Infection rates for the four main categories of infection (number of infections/ 1000 bed days) were respiratory (2.52), urinary (1.87), skin and soft tissue (1.57) and gastrointestinal (0.41). Infection rates for small, medium and large homes were 4.64 (range 1.95—6.51), 5.9 (range 0.49—10.76) and 7.79 (range 5.79—9.39), respectively; however, statistical significance was not achieved ( p = 0.335). Results indicate that respiratory infection rates are higher in larger homes (4.08) than in small (1.88) or medium size homes (2.22). Urinary infection rates were similar in small (1.89), medium (1.88) and large (1.82) homes and skin and soft tissue infections were lower in small homes (0.87) but similar in medium (1.69) and large (1.90) homes. We found a statistically significant relationship between the type of infection acquired and both resident category ( p = 0.017) and gender ( p = 0.005); the relationship between type of infection and age did not reach statistical significance ( p = 0.346).
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Affiliation(s)
- C. Roberts
- HNorth Wales Health Protection Team, Public Health Wales, UK,
| | - J. Roberts
- Psychology, School of Health and Social Care, Glyndwr University, Wrexham, UK
| | - RJ Roberts
- Vaccine Preventable Disease Programme, Public Health Wales, UK
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32
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Roberts C, Roberts J, Roberts RJ. Investigation into the effect of an alcohol-based hand product on infection rate in a nursing home setting. J Infect Prev 2009. [DOI: 10.1177/1757177409106073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The study assessed the impact on nursing home (NH) resident infection rates of providing staff with a personal alcohol-based hand product (ABHP) with and without training on its use. Fifteen North Wales NHs were recruited and randomly allocated into one of three groups. All monitored infection rates throughout the study period of 18 weeks (Phase I [weeks 1—9], Phase II [weeks 11—19]). NHs used liquid soap and water for hand washing throughout the study. Groups B and C introduced interventions during week ten: Group B were provided with personal ABHPs without training on use; Group C personal ABHPs with standard training from the sponsoring hand hygiene company. Infection rates between groups and pre- and post-intervention were compared. Infection rates (per 1,000 bed days) for Phase I vs. Phase II of the study were: Group A: 6.99 vs. 7.16; Group B: 6.08 vs. 3.46; and Group C: 5.04 vs. 6.78 respectively. Change in infection rates in Groups B and C pre- and post-intervention did not reach statistical significance, p = 0.097 and p = 0.072 respectively. Comparison of rates in non-intervention Group A with the intervention groups indicated a significantly lower rate after the intervention in Group B ( p = 0.035) but not Group C ( p = 0.765). Findings are limited due to sample size; introduction of personal ABHPs with training did not reduce infection rates. This conflicts with other studies examining education and improvement of hand hygiene compliance. However, infection rates fell in NHs not receiving training, possibly mediated through a sense of `ownership' of the intervention.
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Affiliation(s)
- C. Roberts
- North Wales Health Protection Team, National Public Health Service for Wales,
| | - J. Roberts
- Psychology, School of Health and Social Care, Glyndwr University, Wrexham
| | - RJ Roberts
- National Public Health Service for Wales
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33
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McNulty CAM. Reducing urinary catheter related infections in care homes: a review of the literature. J Infect Prev 2009. [DOI: 10.1177/1757177408098180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although much guidance indicates that indwelling urinary catheters should only be used for the management of urinary retention and incontinence as a last resort, approximately 10% of care home residents have them, leading to increased risks of catheter associated infections and mortality. Catheterisation rates and subsequent infections can be reduced through more proactive management of incontinence and toileting, and removal of urinary catheters from residents discharged from hospital. Staffing in care homes should match residents' nursing and continence needs to allow this proactive approach. Audit of care home should and hospital discharge catheterisation rates, combined with feedback and staff training will raise awareness of the benefits of reducing catheterisation rates. Use of the Department of Health's Essential Steps to Safe, Clean Urinary Catheter Care (2006a) will also help to reduce catheter associated infections.
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Affiliation(s)
- Cliodna AM McNulty
- Health Protection Agency Primary Care Unit, and Consultant Medical Microbiologist, Microbiology Laboratory, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN,
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34
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Lomas GM, Howell-Jones R, McNulty CAM. Identifying key factors that affect care home catheterisation rates: changing practice through audit. J Infect Prev 2009. [DOI: 10.1177/1757177408098142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Urinary catheterisation in care homes is associated with increased morbidity and mortality. Catheterisation rates in English care homes can vary significantly, yet the cause of these variations remains unclear. The authors approached 114 randomly selected care homes (3,190 residents) in the health district of Gloucestershire, England. A postal questionnaire survey was used to determine the number of catheters per care home and where residents' catheters were first acquired. There was a wide range of urinary catheterisation prevalence between homes, with some homes having no catheterised residents and one home with a prevalence of 47%. The majority of care home residents acquired catheters as hospital in-patients (57%), prior to care home admission. The authors suggest that patients discharged from hospital with a urinary catheter need a catheter care plan stating the reason for catheter insertion, and plans for review and removal. There is a need for ongoing local audits in primary and secondary care to determine how many patients are being discharged with unnecessary urinary catheters.
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Affiliation(s)
- GM Lomas
- Health Protection Agency, Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road Gloucester Gl1 3NN, UK,
| | - R. Howell-Jones
- Health Protection Agency, Centre For Infections, HIV & STI Department, Colindale, London, UK
| | - CAM McNulty
- Health Protection Agency, Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital
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35
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Koch AM, Eriksen HM, Elstrøm P, Aavitsland P, Harthug S. Severe consequences of healthcare-associated infections among residents of nursing homes: a cohort study. J Hosp Infect 2009; 71:269-74. [PMID: 19147254 DOI: 10.1016/j.jhin.2008.10.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 10/03/2008] [Indexed: 10/21/2022]
Abstract
The aim of this study was to identify the consequences of healthcare-associated infections in Norwegian nursing homes, to include debilitation, hospital transfer and mortality. We followed the residents of six nursing homes in two major cities in Norway during the period October 2004 to March 2005. For each resident with infection we randomly selected two controls among residents who did not have an infection. Cases and the controls were followed for 30 days as a cohort in order to measure the incidence of complications and risk ratio (RR) in the two groups. The incidence of infection was 5.2 per 1000 resident-days. After 30 days follow-up 10.9% of residents who had acquired infection demonstrated a reduction in overall physical condition compared with 4.8% in the unexposed group (RR: 2.3). Altogether 13.0% of residents with infections were admitted to hospital compared with 1.4% in the unexposed group (RR 9.2), and 16.1% residents with infections died in the nursing home during follow-up compared with 2.4% in the unexposed group (RR: 6.6). Residents with lower respiratory tract infections demonstrated higher morbidity and mortality. In conclusion, healthcare-associated infections cause severe consequences for people living in nursing homes, including debilitation, hospital admission and death.
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Affiliation(s)
- A M Koch
- Department of Infection Control, Haukeland University Hospital, Bergen, Norway.
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McNulty C, Bowen J, Howell-Jones R, Walker M, Freeman E. Exploring reasons for variation in urinary catheterisation prevalence in care homes: a qualitative study. Age Ageing 2008; 37:706-10. [PMID: 18703520 DOI: 10.1093/ageing/afn140] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cliodna McNulty
- Department of Microbiology, Health Protection Agency Primary Care Unit, Gloucestershire Royal Hospital, Gloucester GL1 3 NN, UK.
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Sie I, Thorstad M, Andersen BM. Infection control and meticillin-resistant Staphylococcus aureus in nursing homes in Oslo. J Hosp Infect 2008; 70:235-40. [PMID: 18786745 DOI: 10.1016/j.jhin.2008.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
Abstract
Healthcare workers (HCWs) might be important in reducing healthcare-associated infections but infected or colonised HCWs may still spread pathogenic microbes to others. Norwegian policies for infection control in healthcare environments emphasise infection control programmes for both patients and HCWs. In this study, HCWs from 42 of 55 nursing homes in Oslo participated in an investigation concerning the implementation of infection control programmes during 2006-2007. Three separate questionnaires were used: the first aimed at nursing staff (enrolled nurses and assisting staff); the second for ward sisters; and the third for institution managers. Nearly 70% of the nursing homes had policies for controlling infection and transmission of meticillin-resistant Staphylococcus aureus (MRSA). About 60% of the institutions had policies for tracing MRSA infections. Four of five ward sisters tested patients for MRSA when wounds were not healing, when admitted from hospitals overseas, when patients shared a room with an MRSA-infected patient, or if patients had ever been MRSA positive. Two of five sisters would test patients with chronic urinary tract infection or patients admitted from another hospital. Among nursing staff, one out of five had cared for MRSA-positive patients. Only 4% of the staff had worked in healthcare institutions abroad, and only a few of them had been tested for MRSA. Almost 20% of the responding nursing staff worked at several institutions at the same time.
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Affiliation(s)
- I Sie
- Nursing College, Diakonova University College, Oslo, Norway.
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Educational interventions for prevention of healthcare-associated infection: a systematic review. Crit Care Med 2008; 36:933-40. [PMID: 18431283 DOI: 10.1097/ccm.0b013e318165faf3] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Healthcare-associated infections (HCAIs) are associated with considerable morbidity and mortality. Education of healthcare providers is a fundamental measure to prevent HCAI. OBJECTIVE To perform a systematic review to determine the effect of educational strategies of healthcare providers for reducing HCAI. DATA SOURCE Multiple computerized databases for the years 1966 to November 1, 2006, supplemented by manual searches for relevant articles. STUDY SELECTION English-language controlled studies and randomized trials that included an educational intervention and provided data on the incidence of one or more kinds of HCAIs were included. DATA EXTRACTION Data were extracted on study design, patient population, type of intensive care unit, details of the educational intervention, target group for intervention, incidence of HCAI, duration of follow-up, and costs of intervention. Both investigators abstracted data using a standard data abstraction form; study quality was also assessed. DATA SYNTHESIS A total of 26 studies used a number of different educational programs targeting varied study populations of healthcare providers to determine their effect on HCAI rates. Most were pre-post intervention studies and were implemented in the intensive care setting. There was a statistically significant decrease in infection rates after intervention in 21 studies, with risk ratios ranging from 0 to 0.79. The beneficial effect of education was apparent in teaching and nonteaching institutions and in lesser-developed countries and developed nations. LIMITATIONS Only English language studies were included. Because of the study designs and limitations of the individual studies, a causal association between educational interventions and reduced HCAI rates cannot be made. CONCLUSIONS The implementation of educational interventions may reduce HCAI considerably. Cluster randomized trials using validated educational interventions and costing methods are recommended to determine the independent effect of education on reducing HCAI and the cost-savings that may be realized with this approach.
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Chami K, Bertin-Hugault F, Gavazzi G, Rothan-Tondeur M. Le risque infectieux en maisons de retraite : plus de questions que de réponses. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.antib.2008.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Current World Literature. Curr Opin Pulm Med 2008; 14:266-73. [DOI: 10.1097/mcp.0b013e3282ff8c19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Andrea Gruneir
- Department of Community Health, Brown University, Providence, Rhode Island 02912; ,
| | - Vincent Mor
- Department of Community Health, Brown University, Providence, Rhode Island 02912; ,
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