Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Principles of infection control in long-term care facilities

INTRODUCTION

Rather than being just "old folks homes," long-term care facilities (LTCFs) represent a complex group of ever-evolving health care systems that serve persons from all age groups and provide variable levels of care to individuals unable to care for themselves. This diverse group of facilities includes nursing homes, skilled-nursing facilities providing post-acute care, assisted living facilities, retirement homes, rehabilitation centers, long-term care hospitals, long-term psychiatric facilities, and institutions for those with intellectual disabilities.

These facilities provide a unique environment favoring the transmission of infections to residents. Infection control practices should allow for the fact that these facilities are a home for many residents as well as a place of nursing, medical and/or psychosocial care for their residents. Facilities differ considerably, and an effective infection control program should be designed around the specific needs and risks of the residents as well as available resources. There may be specific risks (eg, hepatitis B transmission in psychiatric facilities) relating to the type of facility.

The general issues involved in infection control in LTCFs will be reviewed here, emphasizing the more important and topical areas of this expanding field. Such infections are a form of non-nosocomial (outpatient) healthcare associated infections as opposed to hospital-acquired (nosocomial) healthcare associated infections.

Specific sites and pathogens responsible for infections in these facilities are discussed separately. (See "Important sites and pathogens causing infections in long-term care facilities".)

EPIDEMIOLOGY

As the population ages and technology improves to care for patients with previously fatal conditions, both the number and proportion of persons in LTCFs will increase. There are 15,000 nursing homes in the US, and the mean age of residents is over 80 years [1]. Approximately 1.5 million Americans now live in these facilities. Five percent of Americans over the age of 65 currently reside in nursing homes, and up to 43 percent of those turning 65 in the US will be admitted to a nursing home before they die. It is estimated that by 2040, 21 percent of the US population will be greater than 65 years of age [2]. In Norway, there were twice as many long-term care beds in 2000 as compared to 1984 [3]. Changes in acute care practices are moving more acutely ill persons from hospitals into LTCFs, resulting in changes in both the composition and number of persons in LTCFs. Residents of LTCFs may now occasionally have central venous lines and even require mechanical ventilation.

                                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2014. | This topic last updated: Oct 14, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Smith PW, Bennett G, Bradley S, et al. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 2008; 29:785.
  2. A Profile of Older Americans: 2012 http://www.aoa.gov/Aging_Statistics/Profile/2012/docs/2012profile.pdf (Accessed on July 09, 2014).
  3. Eriksen HM, Iversen BG, Aavitsland P. Prevalence of nosocomial infections and use of antibiotics in long-term care facilities in Norway, 2002 and 2003. J Hosp Infect 2004; 57:316.
  4. Strausbaugh LJ, Joseph CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol 2000; 21:674.
  5. Smith PW. Infection control in the long-term healthcare facility. Geriatrics 1989; 44 Suppl A:11.
  6. Lin MY, Lyles-Banks RD, Lolans K, et al. The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2013; 57:1246.
  7. Nicolle LE, Bentley DW, Garibaldi R, et al. Antimicrobial use in long-term-care facilities. SHEA Long-Term-Care Committee. Infect Control Hosp Epidemiol 2000; 21:537.
  8. Garibaldi RA, Brodine S, Matsumiya S. Infections among patients in nursing homes: policies, prevalence, problems. N Engl J Med 1981; 305:731.
  9. Khabbaz RF, Tenney JH. Infection control in Maryland nursing homes. Infect Control Hosp Epidemiol 1988; 9:159.
  10. Smith PW, Helget V, Sonksen D. Survey of infection control training program graduates: long-term care facility and small hospital practitioners. Am J Infect Control 2002; 30:311.
  11. Roup BJ, Roche JC, Pass M. Infection control program disparities between acute and long-term care facilities in Maryland. Am J Infect Control 2006; 34:122.
  12. Mody L, Langa KM, Saint S, Bradley SF. Preventing infections in nursing homes: a survey of infection control practices in southeast Michigan. Am J Infect Control 2005; 33:489.
  13. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3319407/ (Accessed on July 09, 2014).
  14. Medicare and Medicaid; requirements for long term care facilities--HCFA. Final rule. Fed Regist 1991; 56:48826.
  15. The Joint Commission on Accreditation of Healthcare Organizations. Comprehensive Accreditation Manual for Long Term Care. The Joint Commission on Accreditation of Healthcare Organizations, Chicago, 1996.
  16. Smith PW. Consensus conference on nosocomial infections in long-term care facilities. Am J Infect Control 1987; 15:97.
  17. Stevenson KB, Loeb M. Performance improvement in the long-term-care setting: building on the foundation of infection control. Infect Control Hosp Epidemiol 2004; 25:72.
  18. McGeer A, Campbell B, Emori TG, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991; 19:1.
  19. Stone ND, Ashraf MS, Calder J, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol 2012; 33:965.
  20. Stevenson KB. Regional data set of infection rates for long-term care facilities: description of a valuable benchmarking tool. Am J Infect Control 1999; 27:20.
  21. Mylotte JM. Antimicrobial prescribing in long-term care facilities: prospective evaluation of potential antimicrobial use and cost indicators. Am J Infect Control 1999; 27:10.
  22. Libow LS, Starer P. Care of the nursing home patient. N Engl J Med 1989; 321:93.
  23. Smith PW, Rusnak PG. APIC guideline for infection prevention and control in the long-term care facility. Am J Infect Control 1991; 19:198.
  24. Cahill CK, Rosenberg J. Guideline for prevention and control of antibiotic-resistant microorganisms in california long-term care facilities. Centers for Disease Control. J Gerontol Nurs 1996; 22:40.
  25. Thompson BL, Dwyer DM, Ussery XT, et al. Handwashing and glove use in a long-term-care facility. Infect Control Hosp Epidemiol 1997; 18:97.
  26. Crossley K, Willenbring K, Thurn J. Needlestick injuries and needle disposal in Minnesota nursing homes. J Am Geriatr Soc 1990; 38:793.
  27. Centers for Disease Control and Prevention (CDC). Nosocomial hepatitis B virus infection associated with reusable fingerstick blood sampling devices--Ohio and New York City, 1996. MMWR Morb Mortal Wkly Rep 1997; 46:217.
  28. Montgomery P, Semenchuk M, Nicolle LE. Antimicrobial use in nursing homes in Manitoba. J Geriatric Drug Therapy 1995; 9:55.
  29. Warren JW, Palumbo FB, Fitterman L, Speedie SM. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc 1991; 39:963.
  30. Jones SR, Parker DF, Liebow ES, et al. Appropriateness of antibiotic therapy in long-term care facilities. Am J Med 1987; 83:499.
  31. Katz PR, Beam TR Jr, Brand F, Boyce K. Antibiotic use in the nursing home. Physician practice patterns. Arch Intern Med 1990; 150:1465.
  32. Nicolle LE, Bentley D, Garibaldi R, et al. Antimicrobial use in long-term-care facilities. Infect Control Hosp Epidemiol 1996; 17:119.
  33. Loeb M, Bentley DW, Bradley S, et al. Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol 2001; 22:120.
  34. Bentley DW, Bradley S, High K, et al. Practice guideline for evaluation of fever and infection in long-term care facilities. Clin Infect Dis 2000; 31:640.
  35. Nicolle LE. Antimicrobial stewardship in long term care facilities: what is effective? Antimicrob Resist Infect Control 2014; 3:6.
  36. Rhee SM, Stone ND. Antimicrobial stewardship in long-term care facilities. Infect Dis Clin North Am 2014; 28:237.
  37. Strausbaugh LJ, Crossley KB, Nurse BA, Thrupp LD. Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol 1996; 17:129.
  38. Bonomo RA, Rice LB. Emerging issues in antibiotic resistant infections in long-term care facilities. J Gerontol A Biol Sci Med Sci 1999; 54:B260.
  39. Flournoy DJ. Antimicrobial susceptibilities of bacteria from nursing home residents in Oklahoma. Gerontology 1994; 40:53.
  40. Trick WE, Kuehnert MJ, Quirk SB, et al. Regional dissemination of vancomycin-resistant enterococci resulting from interfacility transfer of colonized patients. J Infect Dis 1999; 180:391.
  41. Bjork DT, Pelletier LL, Tight RR. Urinary tract infections with antibiotic resistant organisms in catheterized nursing home patients. Infect Control 1984; 5:173.
  42. Loeb MB, Craven S, McGeer AJ, et al. Risk factors for resistance to antimicrobial agents among nursing home residents. Am J Epidemiol 2003; 157:40.
  43. Rice LB, Willey SH, Papanicolaou GA, et al. Outbreak of ceftazidime resistance caused by extended-spectrum beta-lactamases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother 1990; 34:2193.
  44. Kupronis BA, Richards CL, Whitney CG, Active Bacterial Core Surveillance Team. Invasive pneumococcal disease in older adults residing in long-term care facilities and in the community. J Am Geriatr Soc 2003; 51:1520.
  45. McKibben LJ, Stange PV, Sneller VP, et al. Use of standing orders programs to increase adult vaccination rates. MMWR Recomm Rep 2000; 49:15.
  46. Schneider EL. Infectious diseases in the elderly. Ann Intern Med 1983; 98:395.
  47. Carman WF, Elder AG, Wallace LA, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000; 355:93.
  48. Potter J, Stott DJ, Roberts MA, et al. Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis 1997; 175:1.
  49. Hayward AC, Harling R, Wetten S, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ 2006; 333:1241.
  50. Lemaitre M, Meret T, Rothan-Tondeur M, et al. Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial. J Am Geriatr Soc 2009; 57:1580.
  51. Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. Cochrane Database Syst Rev 2013; 7:CD005187.
  52. Prather MC, Hoff GL, Biery RM, Bayer WL. Patient with AIDS in nursing home. Am J Infect Control 1987; 15:182.
  53. Gropper EI. Can your nursing home resident possibly have AIDS? Geriatr Nurs 1990; 11:240.