Associations Between Intrinsic Capacity and Adverse Events Among Nursing Home Residents: The INCUR Study

OBJECTIVES

The predictive ability of the novel intrinsic capacity (IC) construct has been scarcely investigated in the nursing home setting. The objective of this study was to investigate the associations of IC and its individual domains with mortality, hospitalization, pneumonia onset, and functional status decline in a population of nursing home residents (NHRs).

DESIGN

We undertook an analysis using data from the INCUR study, a prospective observational study. Data were collected at baseline, at 6 and 12 months by trained staff.

SETTING AND PARTICIPANTS

A total of 371 NHRs (mean age 85.91 ± 7.34) dwelling in Southern France.

METHODS

A baseline IC composite score was constructed from scores in the Short Physical Performance Battery, Abbreviated Mental Test, 10-item Geriatric Depression Scale, The Short Form of the Mini-Nutritional Assessment, and self-reported hearing and vision impairments. Adverse outcomes were registered by medical records checking. Functional status evolution was evaluated through changes in the Katz Index. Cox regression was used for associations between IC and its domains and adverse outcomes. Linear mixed models were used in the case of functional status evolution.

RESULTS

Our analysis revealed associations between a composite score of IC and death [hazard ratio 0.33; 95% confidence interval (CI) 0.15-0.73] and functional status evolution (β = 0.14; 95% CI 0.018-0.29) in our population. Although greater values in IC vitality/nutrition domain were associated with survival (HR 0.84; 95% CI 0.70-0.99), IC cognitive domain was associated with decreased odds of hospitalization (HR 0.91; 95% CI 0.84-0.99) and lower declines in functional status (β = 0.04; 95% CI 0.01-0.07), whereas the IC locomotion domain was inversely associated with pneumonia incidence (HR 0.84; 95% CI 0.72-0.98).

CONCLUSIONS AND IMPLICATIONS

Our results contribute to preliminary evidence linking greater IC levels and lower risk of late-life adverse outcomes.

The effect of a hand hygiene intervention on infections in residents of nursing homes: a cluster randomized controlled trial

BACKGROUND

The primary goal of hand hygiene is to reduce infectious disease rates. We examined if a nursing home's participation in a hand hygiene intervention resulted in residents having fewer healthcare associated infections (HAIs) when compared to nursing homes without the hand hygiene intervention.

METHODS

This study is a part of a cluster randomized controlled trial (RCT) in 33 nursing homes to improve hand hygiene (HANDSOME). The incidence of five illnesses was followed over 13 months: gastroenteritis, influenza-like illness, pneumonia, urinary tract infections and infections from methicillin-resistant Staphylococcus aureus (MRSA). Incidence rates per study arm were reported for baseline (October-December 2016) and two follow-up periods (January-April 2017, May-October 2017). HAI rates were compared in a Poisson multilevel analysis, correcting for baseline differences (the baseline infection incidence and the size of the nursing home), clustering of observations within nursing homes, and period in the study.

RESULTS

There was statistically significantly more gastroenteritis (p < 0.001) and statistically significantly less influenza-like illness (p < 0.01) in the intervention arm when compared to the control arm. There were no statistically significant differences or pneumonia, urinary tract infections, and MRSA infections in the intervention arm when compared to the control arm. In a sensitivity analysis, gastroenteritis was no longer statistically significantly higher in the intervention arm (p = 0.92).

CONCLUSIONS

As in comparable studies, we could not conclusively demonstrate the effectiveness of an HH intervention in reducing HAIs among residents of nursing homes, despite the use of clearly defined outcome measures, a standardized reporting instrument, and directly observed HH in a multicenter cluster RCT. Trial registration Netherlands Trial Register, trial NL6049 (NTR6188). Registered October 25, 2016, https://www.trialregister.nl/trial/6049 .

Development and Application of a Surveillance Method for Healthcare-Associated Infections in Long-Term Care Hospitals in Korea

Background

This study developed a surveillance method for healthcare-associated infections (HAIs) in long-term care hospitals (LTCHs) and investigated the current status of HAIs in LTCHs in Korea.

Methods

We applied the HAI-related surveillance criteria for long-term care facilities developed by McGeer in six LTCHs.

Results

The 197 confirmed HAIs corresponded to incidence rates of 30.38/100 inpatients and 1.57/1,000 days of hospitalization and included 84 cases of respiratory tract infection (43.8%), 78 cases of systemic infection (40.6%), 24 cases of gastrointestinal tract infection (12.5%), and 6 cases of skin and soft tissue mucosal infection (2.1%). The subtypes included 78 cases of unexplained febrile illness (40.6%); 40 cases of pneumonia (20.8%); 27 cases of lower respiratory tract infection (14.1%); 21 cases of gastroenteritis (10.9%); 9 cases of influenza-like illness (4.7%); 8 cases of common cold or pharyngitis (4.2%); 4 cases of cellulitis, soft tissue, or wound infection (2.1%); 3 cases of Clostridium difficile infection (1.6%); 1 case of conjunctivitis (0.5%); and 1 case of fungal oral/perioral and skin infection (0.5%).

Conclusion

Establishing an HAI surveillance method for LTCHs and identifying HAI rates and risk factors among LTCH patients may help prevent HAIs in LTCHs in Korea.

Decisional issues in antibiotic prescribing in French nursing homes: An ethnographic study

Background:Medication prescription is generally the responsibility of doctors. In nursing homes, the nursing staff is often the first to suspect an infection. Today, physicians are more confident with nursing assessment, relying primarily on nursing staff information. Very few studies have investigated the nurses' influence on decision of medical prescription. This study investigates the role of nurses in antibiotic prescribing for the treatment of suspected infections in nursing home residents. Design and methods:An ethnographic study based on semi-structured interviews and participant observations was conducted. Sixteen nurses and five doctors working in five nursing homes in Paris, France participated between October 2015 and January 2016. Results:Given their proximity to elderly residents, registered nurses at the nursing homes occasionally assisted doctors in their medical diagnostic. However, nurses who are theoretically incompetent have met difficulties in their ability to participate in their decisions to prescribe antibiotics when managing residents' infections. Conclusion: if proximity and nursing skills reinforce the relevance of the clinical judgment of nurses, the effective and collaborative communication between the nurse and the doctor may help the nurse to enhance their role in the antibiotic prescribing in nursing homes, which would enhance antimicrobial stewardship efficiency.

Prevalence of healthcare-associated infections in long-term care facilities in Catalonia. VINCat Program

INTRODUCTION

Long-term care facilities (LTCFs) have become receptors of patients with a high risk of healthcare-associated infections (HAIs).

OBJECTIVE

To determine the prevalence of HAIs in LTCFs.

METHOD

During the period 2011-2014 2 annual prevalence studies were performed according to Healthcare-associated infections in long-term-care facilities (HALT) study definitions and methodology.

RESULTS

A total of 28,360 patients were included in the study. The overall prevalence rate of HAIs was 10.2%. Subacute units and palliative care units showed the highest rates, 22.3% and 18.7%, respectively. Main infections were respiratory tract infection (35.8%) and urinary tract infection (35.8%).

CONCLUSION

These results were higher than other similar experiences, a fact that suggests the need to extend the specific strategies and programs to LTCFs, and ensuring a sufficient number of specialised staff in infection control.

Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives

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.

Incidence and economical effects of pneumonia in the older population living in French nursing homes: design and methods of the INCUR study

Background

Among the most burdensome clinical conditions occurring in older persons, respiratory infections are particularly relevant. In fact, the onset of pneumonias is associated with a significant worsening of the individual’s global health status and significant increase of healthcare costs. The clinical and economical negative consequences of pneumonia may be particularly evident among the frailest groups of elders, in particular those living in nursing home. Nevertheless, specific research on incidence and economical effects of pneumonia in nursing homes residents is still scarce. In the present article, we present the rationale, the design and the methods of the “Incidence of pNeumonia and related ConseqUences in nursing home Resident (INCUR) study, specifically aimed at filling some of the gaps currently present in the field.

Methods/design

INCUR is an observational longitudinal study recruiting 800 residents across 13 randomly selected nursing homes in France. Multidimensional evaluations of participants are conducted at the baseline, mid-term (at 6 months), and end of the study (at 12 months) visits in order to measure and follow-up their physical function, nutrition, cognition, depression, quality of life, and healthcare costs. Incident pneumonia as well as the onset/recurrence of other major health-related events are monitored during the study follow-up.

Discussion

The INCUR study will provide valuable information about older persons living in nursing homes. Results from INCUR study may constitute the basis for the development of future preventive campaigns against pneumonia and its consequences.

Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria

(See the commentary by Moro, on pages 978-980 .) Infection surveillance definitions for long-term care facilities (ie, the McGeer Criteria) have not been updated since 1991. An expert consensus panel modified these definitions on the basis of a structured review of the literature. Significant changes were made to the criteria defining urinary tract and respiratory tract infections. New definitions were added for norovirus gastroenteritis and Clostridum difficile infections.

A short-term, multicomponent infection control program in nursing homes: a cluster randomized controlled trial

OBJECTIVES

To assess the impact of a hygiene-encouragement program on reducing infection rates (primary end point) by 5%.

DESIGN

A cluster randomized study was carried out over a 5-month period.

SETTINGS AND PARTICIPANTS

Fifty nursing homes (NHs) with 4345 beds in France were randomly assigned by stratified-block randomization to either a multicomponent intervention (25 NHs) or an assessment only (25 NHs).

INTERVENTION

The multicomponent intervention was targeted to caregivers and consisted of implementing a bundle of infection prevention consensual measures. Interactive educational meetings using a slideshow were organized at the intervention NHs. The NHs were also provided with color posters emphasizing hand hygiene and a kit that included hygienic products such as alcoholic-based hand sanitizers. Knowledge surveys were performed periodically and served as reminders.

MEASUREMENTS

The primary end point was the total infection rate (urinary, respiratory, and gastrointestinal infections) in those infection cases classified either as definite or probable. Analyses corresponded to the underlying design and were performed according to the intention-to-treat principle. This study was registered (#NCT01069497).

RESULTS

Forty-seven NHs (4515 residents) were included and followed. The incidence rate of the first episode of infection was 2.11 per 1000 resident-days in the interventional group and 2.15 per 1000 resident-days in the control group; however, the difference between the groups did not reach statistical significance in either the unadjusted (Hazard Ratio [HR] = 1.00 [95% confidence interval (CI) 0.89-1.13]; P = .93]) or the adjusted (HR = 0.99 [95% CI 0.87-1.12]; P = .86]) analysis.

CONCLUSION

Disentangling the impact of this type of intervention involving behavioral change in routine practice in caregivers from the prevailing environmental and contextual determinants is often complicated and confusing to interpret the results.