Disease Detectives: Research in Infection Control
Infection prevention and control is a crucial component to providing quality care in any health care setting. In nursing homes, for example, infections are a leading cause of death and preventable illness among residents. The federal government last month acknowledged that its five-star rating system for the nation’s more than 15,000 nursing homes, one of the most widely used consumer tools for selecting facilities, relied too heavily on self-reported data that wasn’t independently verified. The admission amplified the need for more research on the prevalence and causes of infections in this setting.
In the Prevention of Nosocomial Infections & Cost Effectiveness in Nursing Homes (PNICE-NH) study, being conducted at Columbia Nursing in collaboration with the RAND Corporation, Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy, and her research team are looking for best practices in the prevention of infections in nursing homes. Carolyn Herzig, MS, the study project director, led an initial analysis to see how common infections are in nursing homes. This study was presented last month at the annual IDWeek meeting in Philadelphia. The study examined infections in U.S. nursing homes over a five-year period, and the team found increased infection rates for pneumonia, urinary tract infections (UTIs), viral hepatitis, septicemia, wound infections, and multiple drug-resistant organisms (MDROs).
“Unless we can improve infection prevention and control in nursing homes, this problem is only going to get worse as the baby boomers age and people are able to live longer with increasingly complex, chronic diseases,” said Herzig.
The researchers analyzed infection prevalence from 2006 to 2010, using data that nursing homes submitted to the U.S. Centers for Medicare and Medicaid Services. While UTIs and pneumonia were the most common infections, infection prevalence increased the most – 48 percent – for viral hepatitis.
More research is needed to determine the exact causes behind the increases in infection prevalence, Herzig said. But there are several relatively simple interventions that have been proven to help reduce the risk of infection – and that families should look for when selecting a nursing home for a loved one.
UTIs, far and away the most common infection in nursing homes, increased in prevalence by one percent, the study found. UTIs can be prevented by reducing the use of urinary catheters and increasing the frequency of assisted trips to the toilet or diaper changes for residents who are unable to use the bathroom. Families evaluating which nursing home to choose for a loved one should ask what protocols are in place to decrease catheter use, and they should also ask how the staff cares for residents with diapers, Herzig said.
“Nobody wants to think about diapers, but even if your loved one enters the nursing home able to use the bathroom independently, they may need assistance down the line. Seeing how well toileting needs are met is one way to assess infection risk.”
Pneumonia climbed in prevalence by 11 percent, the study found. For pneumonia, and other infections that can spread through the air or contact with contaminated surfaces, proper hand hygiene is essential for prevention. Residents, visitors, and staff should all have easy access to sanitizer or soap and water to clean their hands and be encouraged to do this frequently.
“When you walk into a nursing home for the first time, you should easily spot hand sanitizer dispensers or hand-washing stations,” Herzig said. “If you don’t see this, it’s an indication that infection control and prevention may be lacking at the facility.”
MDRO infection prevalence increased 18 percent, the study found. Screening for MDROs is an important tool for reducing the risk of MDROs, Herzig said. Families should ask whether residents are routinely screened for bacteria like C. difficile and methicillin-resistant Staphylococcus aureus (MRSA). While some nursing homes may only screen residents who are symptomatic or at high risk for infection, routine screening of all residents upon admission is likely to be more effective, Herzig said. In addition, it’s worth asking whether a nursing home has private rooms to allow for isolation if necessary and whether families are consulted when their loved one shares a room with a resident who has an infection.
“Isolation is a common way to contain MRSA and other infections in hospitals, but in nursing homes this isn’t as common because these facilities are tailored to residential needs. If the nursing home does have rooms for isolation, it suggests a more robust approach to infection prevention and control.”
The study is titled: “Longitudinal Trends in Infection Rates in US Nursing Homes, 2006 – 2011.” Co-authors from Columbia Nursing include PhD student Catherine Crawford, RN; and Patricia Stone, director of the Center for Health Policy.
With the theme, “Advancing Science, Improving Care,” this year’s IDWeek meeting highlighted the latest science and bench-to- bedside approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases across the lifespan. The meeting is sponsored by the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association and the Pediatric Infectious Diseases Society.
A listing of selected presentations at IDweek 2014 follows:
Challenges Associated with Using Biomedical Big Data for Research on Healthcare-Associated and Community-Acquired Infections; Cohen B., Liu J., Larson E.
Comparison of influenza Activity Determined through Community- versus Hospital Laboratory-based Surveillance; Zachariah P., Saiman L., Whittier S., Reed C., Larussa P., Larson E., Vargas C., Finelli L., Stockwell L.
The Impact of State Mandated Healthcare-Associated Infection Reporting on Infection Prevention and Control Departments in Acute Care Hospitals: Results from a National Survey; Herzig C., Pogorzelska-Maziarz M., Reagan J., Larson E., Stone P.
Screening and Isolation/Contact Precautions for Multi-Drug Resistant Organisms (MDRO) in Acute Care Hospitals: Results from a National Survey; Pogorzelska-Maziarz M., Herzig C., Larson E., Furuya E.Y., Stone, P.
Strategies for Success in Emergency Department Catheter-Associated Urinary Tract Infection Prevention Programs; Carter E.J., Pallin D.J., Mandel L., Sinnette C., Schuur J.
The Use of Aerosolized Tobramycin in Children Residing in Pediatric Long Term Care Facilities; Murray M., Pavia M, Jackson O, Keenan M., Cohen B, Neu N, Saiman L.
Utility of Case Definitions for Healthcare-associated Infections (HAIs) used in Adult Long Term Care Facilities (LTCFs) for Residents in Pediatric Long Term Care Facilities (PLTCFs); Murray M., Saiman L., Cohen B., Larson E., Neu N.
Utility of Electronic Medical Records to Assess the Relationship between Total Parenteral Nutrition and Central Line-associated Blood Stream Infections; Ippolito P., Larson E., Furuya E., Liu J., Seres D.