Principles of infection control in long-term care facilities
- Michael J Richards, MD, FRACP
Michael J Richards, MD, FRACP
- The Royal Melbourne Hospital
- Victoria, Australia
- Rhonda L Stuart, MBBS, FRACP, PhD
Rhonda L Stuart, MBBS, FRACP, PhD
- Infectious Diseases Physician, Medical Director Infection Control
- Monash Health
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".)
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 . 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 . In Norway, there were twice as many long-term care beds in 2000 as compared to 1984 . 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.
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- PRIORITIZING INFECTION CONTROL
- Prior deficits in infection control
- Regulatory requirements
- STRUCTURE OF AN INFECTION CONTROL PROGRAM
- Infection control committee
- Infection control practitioner
- Facility wide versus targeted surveillance
- Surveillance definitions
- Data collection
- Infection rates
- Process measures
- Data use, analysis and presentation
- Reporting of notifiable diseases
- Outbreaks of infectious diseases
- PREVENTION PRACTICES
- Written procedures and guidelines
- Hand hygiene
- Sharp injuries
- ANTIMICROBIAL USE AND STEWARDSHIP
- Antibiotic resistant bacteria in LTCFs
- HEALTH POLICIES FOR RESIDENTS AND EMPLOYEES
- Immunizations for residents
- Employee health policies
- - Initial assessment
- - Vaccinations
- - Tuberculosis
- - Blood borne infections
- - Hand hygiene
- - Reporting of ill health
- THE FUTURE