Caregiver & Elder Care News
Tips for Slowing Increase in Nursing Home Infections
Infections are a leading cause of deaths and
complications for nursing home residents
Oct. 9, 2014 A study, which examined
infections in U.S. nursing homes over a five-year period, found
increased infection rates for pneumonia, urinary tract infections (UTIs),
viral hepatitis, septicemia, wound infections, and multiple
drug-resistant organisms (MDROs). This alarming increase found in the
study from Columbia University School of Nursing suggests more must be
done to protect residents of these facilities - mostly senior citizens -
from preventable complications.
"Infections are a leading cause of deaths and
complications for nursing home residents, and with the exception of
tuberculosis we found a significant increase in infection rates across
the board," said lead study author Carolyn Herzig, MS, project director
of the Prevention of Nosocomial Infections & Cost Effectiveness in
Nursing Homes (PNICE-NH) study at Columbia Nursing.
"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."
Herzig and a team of researchers from
Columbia Nursing and RAND Corporation 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, infection prevalence increased the most 48
percent for viral hepatitis. Herzig presented findings from the study
at IDWeek 2014 in Philadelphia.
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 1 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
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," Herzig added.
Herzig is a doctoral student in epidemiology
at Columbia's Mailman School of Public Health. Co-authors from Columbia
Nursing include PhD student Catherine Crawford, RN; and Patricia Stone,
PhD, FAAN, Centennial Professor of Health Policy and director of the
Center for Health Policy.
The project was supported by the National
Institute of Nursing Research.
Columbia University School of Nursing is part
of the Columbia University Medical Center, which also includes the
College of Physicians & Surgeons, the Mailman School of Public Health,
and the College of Dental Medicine. For more information, visit: