Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities

doi:10.1016/S0196-6553(00)90004-X

American Journal of Infection Control

Volume 28, Issue 1, February 2000, Pages 3-7

https://doi.org/10.1016/S0196-6553(00)90004-X Get rights and content

Abstract

Background: Control of infection within the long-term care facility is a daunting problem. Elderly patients are at high risk for contracting infection because of reduced innate immunity, malnutrition, and the presence of chronic medical conditions. This small study tested the effect of developing and implementing a comprehensive preventive infection control program in the long-term care setting and examined the resultant incidence of infections. Methods: Eight private, freestanding, long-term care facilities in urban and suburban settings were selected for the study. The 4 test sites had a total of 443 beds; there were 447 beds in 4 matched control sites. Data on infection rates were accrued in both preintervention and intervention years. The control homes maintained their existing infection control policies and procedures. The test homes were provided with an infection control educational program and replaced all currently used germicidal products with single-branded products for a 12-month period. A criteria-based standardized infection control surveillance system was used to monitor and report infections in all facilities. Results: In the preintervention year, the test sites experienced 743 infections (incidence density rate, 6.33) and the control homes experienced 614 infections (incidence density rate, 3.39). In the intervention year, the test homes reported 621 infections, a decrease of 122 infections (incidence density rate, 4.15); in the control homes, the number of infections increased slightly, to 626 (incidence density rate, 3.15). The greatest reduction in infections in the test homes was in upper respiratory infections (P =.06). Conclusions: This study provides additional evidence that a comprehensive infection control program that includes handwashing and environmental cleaning and disinfecting may help reduce infections among the elderly residing in long-term care settings. (AJIC Am J Infect Control 2000;28:3-7)

Section snippets

Study design and population

Eight private, freestanding LTCFs were selected for the study. The facilities were located in New Jersey and Delaware. All were enrolled in the Medisys, Inc (an infection control consulting firm) infection control surveillance program. The 8 facilities were selected on the basis of similarity with respect to admission rate, size, acuity levels (intermediate and skilled), availability of services (the same off-site laboratory and radiology service), overall infection rates, and in-house

Results

Data were compared from all LTCFs during the preintervention and intervention years. Pathogenic organisms were identified but have not been noted in the results of this study. As shown in Table 1, during the preintervention period the test sites experienced a total of 743 infections and had an IDR of 6.33 infections per 1000 patient days; the most commonly seen infections were upper respiratory tract infection (n = 228) and genitourinary tract infection (n = 215).

. Total infections and IDRs for

Discussion

Because infections are a major cause of morbidity and mortality in the long-term care setting, attempts to control infections have demanded increasing attention.2, 10 Pneumonia is the most frequent cause of death in the institutionalized elderly.10, 11 Muder et al¹⁰ estimated that the cost of admission of a patient with pneumonia to an acute care facility in 1992 was $14,600. Mor¹² calculated that treating moderate to severe infections with a third-generation cephalosporin exclusively in the

Acknowledgements

We thank Theresa Ritchie for her technical and administrative assistance on this project.

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Major ArticlesEffect of a comprehensive infection control program on the incidence of infections in long-term care facilities*,**,*

Abstract

Section snippets

Study design and population

Results

Discussion

Acknowledgements

Clinic Geriatr Med

Emerg Med Clin North Am

Am J Infect Control

Lancet

Am J Infect Control

Intensive surveillance for infections in the three year study of nursing home patients

Am J Epidemiol

Nosocomial infections in long term care facilities

J Gerontol

Infections and infection risk in residents of long-term care facilities: a review of the literature, 1970-1984

Am J Infect Control

Immunodeficiency of the elderly

Rev Infect Dis

Nursing home utilization by current residents: United States, Vital and Health Statistics, Series 13.

Nonparametic statistical methods

Pneumonia in a long-term care facility: a prospective study of outcome

Arch Intern Med

Autopsy study of the elderly institutionalized patient: a review of 234 autopsies

Arch Intern Med

Major Articles
Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities*,**,*