Question

Does your risk of an infection increase in nursing homes? If so what are the most common types of infections

Answer 1

A spread of Infection is very common in long-term care facilities like nursing homes. They are the major cause of morbidity and mortality among institutionalized Elderly clients. The consequences include high rates of morbidity and mortality, re-hospitalization, extended hospital stay and substantial healthcare expenses. The setting of a nursing home and presence of indwelling devices aids the spread of infectious diseases unless properly cared. Residents are grouped together in a confined living arrangement many daily activities often take place together. The cognitive impairment will add to the situation and many are unable to follow basic hygiene precautions.

In many situations care providers are often inadequately trained and have little

knowledge of fundamental principles of infection control. Non-adherence to universal precautions will also contribute to the situation. Understaffing is also another common problem in nursing homes, which will impact the standardized care.

The physiological changes associated with old age and the comorbid underlying diseases also predispose them to site-specific infections. Sometimes it is difficult to diagnose infections in the elderly which in turn causes a delayed diagnosis and treatment.

According to the 2004 National Nursing Home Survey, over 1.5 million people live in 16,000 nursing homes in the USA. Among them, more than 88% are 65 years of age and older, and 45% are age 85 years and older. The estimated increase is 5.3 million by 2030. In each year approximately 2 million infections occur NHs in US.^1,2,3

The most common types of infections seen in nursing homes are endemic infections and outbreaks. The endemic infections usually seen are respiratory, urinary, gastrointestinal, skin and soft tissue infections. Another particular concern is colonization and infection with antimicrobial drug-resistant microorganisms.

Respiratory Tract Infections

Respiratory tract infection outbreaks in nursing homes occur from residents or nonresidents like staff and visitors with acute or chronic respiratory infection.

The pathogens of respiratory tract infection disseminate rapidly among residents and staff, once introduced into the facility. Air born infections can spread via large respiratory droplets, direct or indirect contact, or airborne droplet nuclei. These outbreaks occur throughout the year. The organism commonly involved are influenza virus A&B, parainfluenza virus, respiratory syncytial virus (RSV), Chlamydia pneumoniae, Pneumococci and Legionella sainthelensi. Multiple pathogens are also involved in outbreaks.

Gastrointestinal (GI) Tract Infections

Public health reports suggest that Gastrointestinal (GI) Tract Infection

outbreaks are frequent in NHs.The New York State Department of Health received 188 reports of GI infection outbreaks in NHs in the state in 1992, accounts for 34.5% of all outbreaks reported that year. ⁴ 30% of older person deaths from diarrheal illness occur in elderly persons, and among nursing home residents. ⁵

Common respiratory tract infections includes pharyngitis, bronchitis, and pneumonia. Causative organisms can be viral or bacterial agents. Viral infections are majority of outbreaks of GI infection in nursing homes. The organisms involved are Caliciviridae family, Rotaviruses, Enteric adenoviruses, Salmonella species, Escherichia coli, Clostridium species, both Clostridium difficile and Clostridium perfringens, Staphylococcus aureus, Shigella species, Campylobacter jejuni, Bacillus cereus, and Aeromonas hydrophila

Skin And Soft-Tissue Infections

Skin and Soft-Tissue Infections can spread easily in institutionalized settings due to the close contact of inmates. The skin and soft-tissue infections include cellulitis, wound infection, conjunctivitis, impetigo, and necrotizing fasciitis. Bacteremia, involvement of distal body parts and streptococcal toxic shock syndrome complicates both dermatological and respiratory tract infection outbreaks in nursing homes.

The causative organisms are Group A Streptococci (S. pyogenes), Sarcoptes scabiei var. hominis.

Antimicrobial-Resistant Bacteria due to wide spread use of antibiotics.

MDRSs

References:

1. Jones A, Dwyer L, Bercovitz A, et al. The National Nursing Home Survey: 2004 overview. Vital Health Stat. 2009;13:1–155. [PubMed]

2. Knickman J, Snell E. The 2030 problem: caring for aging baby boomers. Health Serv. Res. 2002;37:849–884. [PMC free article] [PubMed]

3. Strausbaugh L, Joseph C. The burden of infection in long-term care. Infect. Control Hosp. Epidemiol. 2000;21:674–679. [PubMed]

4.       Li J, Birkhead GS, Strogatz DS, Coles FB. Impact of institution size, staffing patterns, and infection control practices on communicable disease outbreaks in New York state nursing homes, Am J Epidemiol , 1996, vol. 143 (pg. 1042-9)

5. Lew J, Glass R, Gangarosa RE, et al. Diarrheal deaths in the United States: 1979 through 1987, JAMA , 1991, vol. 265 (pg. 3280-5)