Monitoring Deadly Infections in Nursing Homes

The Society for Healthcare Epidemiology of America (SHEA) and Centers for Disease Control and Prevention (CDC) have both produced some tools and information that can help track deadly healthcare-associated infections in nursing homes and other long-term care settings. These infections are known to strike volumes of nursing home residents each year, and reports suggest that up to 2.8 million infections can occur in this population on an annual basis.

Published this week in Infection Control and Hospital Epidemiology, the journal of SHEA, an expert panel published updated infection definitions and guidance that establishes a standardized set of criteria for nursing home and other long-term care facilities to track and monitor healthcare-associated infections (HAIs). These revamped surveillance definitions, coordinated by SHEA's Long-Term Care Special Interest Group, incorporate evidence published over the past two decades, with definitions for norovirus gastroenteritis and Clostridium difficile infection added, and more in-depth definitions for urinary tract infections included.

Working alongside SHEA, CDC's National Healthcare Safety Network (NHSN) released a new tracking component that allows nursing homes and other long term care facilities to closely monitor HAIs. The newly published guidance serves as the foundation for the new NHSN component. When facilities track infections, they can identify potential problems, implement prevention measures and monitor the progress made towards stopping infections completely. State and local health officials can also use this system to monitor the impact of regional prevention efforts. On a national level, data entered into NHSN will guage progress toward national infection prevention goals.

"The unsettling truth is that our best estimates of healthcare-associated infections in long-term care facilities, such as nursing homes, most likely understate the true problem," said Nimalie Stone, M.D., a lead author of the guidance and a medical epidemiologist at the Centers for Disease Control and Prevention (CDC). "Clinicians in nursing homes cannot prevent healthcare-associated infections unless they know where and how they are occurring. Tracking infections within facilities is the first step toward prevention and ultimately saves lives."

The new NHSN component allows nursing homes and other long term care facilities to track Clostridum difficile (a serious diarrheal infection), drug-resistant infections like methicillin-resistant staphylococcus aureus (MRSA), urinary tract infections, and healthcare worker adherence to basic infection control procedures including hand washing and glove use.

"With the rising number of individuals receiving more complex medical care in nursing homes, these new tools provide a needed means for these resource-limited care settings to help track and monitor their facility's infections using criteria that reflect the care they provide and the patients they see," said Suzanne Bradley, MD, a co-author of the paper and editor-in-chief of Infection Control and Hospital Epidemiology.

CDC is one of several federal agencies working to protect long-term patients. The Department of Health and Human services has released a National Action Plan to Prevent HAIs and addresses several goals regarding infections among nursing home residents. These include reducing catheter-associated urinary tract infections and infections from Clostridium difficile.

The new surveillance guidance has received endorsement by the American Medical Directors Association, the Association of Medical Microbiology and Infectious Disease-Canada, the Association for Professionals in Infection Control and Epidemiology, the Community and Hospital Infection Control Association-Canada and the National Association of Directors of Nursing Administration in Long Term Care.

For more information visit the CDC's website here (http://www.cdc.gov/nhsn/LTC/index.html) and to preview the new surveillance guidance visit http://www.jstor.org/stable/10.1086/667743 andhttp://www.eurekalert.org/pub_releases/2012-09/sfhe-nth091812.php.