Skip to main content Accessibility help
×
Home

Healthcare-Associated Pathogens and Nursing Home Policies and Practices: Results From a National Survey

  • Zhiqiu Ye (a1), Dana B. Mukamel (a2), Susan S. Huang (a3), Yue Li (a1) and Helena Temkin-Greener (a1)...

Abstract

OBJECTIVE

To examine the prevalence of healthcare-associated pathogens and the infection control policies and practices in a national sample of nursing homes (NHs).

METHODS

In 2012, we conducted a national survey about the extent to which NHs follow suggested infection control practices with regard to 3 common healthcare-associated pathogens: methicillin-resistant Staphylococcus aureus, Clostridium difficile, and extended-spectrum β-lactamase producers, and their prevalence in NHs. We adapted a previously used and validated NH infection control survey, including questions on prevalence, admission and screening policies, contact precautions, decolonization, and cleaning practices.

RESULTS

A total of 1,002 surveys were returned. Of the responding NHs, 14.2% were less likely to accept residents with methicillin-resistant Staphylococcus aureus, with the principal reason being lack of single or cohort rooms. NHs do not routinely perform admission screening (96.4%) because it is not required by regulation (56.2%) and would not change care provision (30.7%). Isolation strategies vary substantially, with gloves being most commonly used. Most NHs (75.1%) do not decolonize carriers of methicillin-resistant Staphylococcus aureus, but some (10.6%) decolonize more than 90% of residents. Despite no guidance on how resident rooms on contact precautions should be cleaned, 59.3% of NHs report enhanced cleaning for such rooms.

CONCLUSION

Overall, NHs tend to follow voluntary infection control guidelines only if doing so does not require substantial financial investment in new or dedicated staff or infrastructure.

Infect Control Hosp Epidemiol 2015;36(7):759–766

Copyright

Corresponding author

Address correspondence to Helena Temkin-Greener, PhD, Department of Public Health Science, University of Rochester Medical Center, 265 Crittenden Blvd, CU420644, Rochester, NY 14642 (Helena_Temkin-Greener@urmc.rochester.edu).

Footnotes

Hide All

Presented in part: American Public Health Association Annual Meeting; Boston, Massachusetts; November 5, 2013 (Abstract 278035).

Footnotes

References

Hide All
1. Strausbaugh, LJ, Sukumar, SR, Joseph, CL. Infectious disease outbreaks in nursing homes: an unappreciated hazard for frail elderly persons. Clin Infect Dis 2003;36:870876.
2. Richards, CL Jr. Infection control in long-term care facilities. J Am Med Dir Assoc 2007;8:S18S25.
3. 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;29:785814.
4. Richards, CL Jr Steele, L. Antimicrobial-resistant bacteria in long-term care facilities: infection control considerations. J Am Med Dir Assoc 2003;4:S110S114.
5. Bradley, SF. Staphylococcus aureus infections and antibiotic resistance in older adults. Clin Infect Dis 2002;34:211216.
6. Raghavendran, K, Mylotte, JM, Scannapieco, FA. Nursing home-associated pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia: the contribution of dental biofilms and periodontal inflammation. Periodontol 2000 2007;44:164177.
7. Rooney, PJ, O’Leary, MC, Loughrey, AC, et al. Nursing homes as a reservoir of extended-spectrum beta-lactamase (ESBL)-producing ciprofloxacin-resistant Escherichia coli . J Antimicrob Chemother 2009;64:635641.
8. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:11981208.
9. Pawar, D, Tsay, R, Nelson, DS, et al. Burden of Clostridium difficile infection in long-term care facilities in Monroe County, New York. Infect Control Hosp Epidemiol 2012;33:11071112.
10. Stevens, V, Dumyati, G, Fine, LS, Fisher, SG, van Wijngaarden, E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis 2011;53:4248.
11. US Deparment of Health and Human Serivces. Revisions to appendix PP –“Interpretive guidelines for long-term care facilities, tag F-441.” 2009. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r51soma.pdf. Accessed June 2, 2014.
12. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings. 2006. http://www.cdc.gov/hicpac/mdro/mdro_toc.html. Accessed June 12, 2014.
13. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. 2007. http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html. Accessed June 12, 2014.
14. Iowa Department of Public Health. Report of the Iowa Antibiotic Resistance Task Force: a public health guide. 3rd ed. 2011. http://www.idph.state.ia.us/adper/common/pdf/cade/antibioticreport.pdf. Accessed December 9, 2014.
15. California Department of Health Services. Guideline prevention and control of antibiotic resistant microorganisms California long-term care facilities. 1996. http://www.cdph.ca.gov/pubsforms/Guidelines/Documents/armgdepp1999.pdf. Accessed June 12, 2014.
16. Maryland Department of Health and Mental Hygiene. Guidelines for control of management of methicillin-resistant Staphylococcus aureus in long term care facilities. 2001. http://phpa.dhmh.maryland.gov/IDEHASharedDocuments/guidelines/mrsa-ltcf-guide.pdf. Accessed June 12, 2014.
17. Murphy, CR, Eells, SJ, Quan, V, et al. Methicillin-resistant Staphylococcus aureus burden in nursing homes associated with environmental contamination of common areas. J Am Geriatr Soc 2012;60:10121018.
18. Kreman, T, Hu, J, Pottinger, J, Herwaldt, LA. Survey of long-term-care facilities in Iowa for policies and practices regarding residents with methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2005;26:811815.
19. 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;33:489492.
20. Shaping Long Term Care in America Project at Brown University, funded in part by the National Institute on Aging (1P01AG027296). 2010. http://ltcfocus.org/. Accessed July 6, 2014.
21. Aureden, K, Burdsall, D, Harris, M, Rosenbaum, P. Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) in the Long-Term Care Facility. 2009. Washington, DC: Association for Professionals in Infection Control and Epidemiology. http://www.apic.org/Resource_/EliminationGuideForm/08b12595-9f92-4a64-ad41-4afdd0088224/File/APIC-MRSA-in-Long-Term-Care.pdf. Accessed June 12, 2014.
22. Association for Professionals in Infection Control and Epidemiology. MRSA laws. http://www.apic.org/Resource_/TinyMceFileManager/Advocacy-PDFs/Static_map_-_MRSA_revised_4-21-11.gif. Accessed December 21, 2014.
23. Furuno, JP, Hebden, JN, Standiford, HC, et al. Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a long-term acute care facility. Am J Infect Control 2008;36:468471.
24. Mody, L, Kauffman, CA, Donabedian, S, Zervos, M, Bradley, SF. Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 2008;46:13681373.
25. Kahvecioglu, D, Ramiah, K, McMaughan, D, et al. Multidrug-resistant organism infections in US nursing homes: a national study of prevalence, onset, and transmission across care settings. October 1, 2010-December 31, 2011. Infect Control Hosp Epidemiol 2014;35:S48S55.
26. Centers for Medicare & Medicaid Services. MDS 3.0 RAI Manual. 2014. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html. Accessed November 12, 2014.
27. Morrison, J. Development of a resource model for infection prevention and control programs in acute, long term, and home care settings: conference proceedings of the Infection Prevention and Control Alliance. Am J Infect Control 2004;32:26.
28. Stevenson, KB, Murphy, CL, Samore, MH, et al. Assessing the status of infection control programs in small rural hospitals in the western United States. Am J Infect Control 2004;32:255261.
29. Huang, SS, Avery, TR, Song, Y, et al. Quantifying interhospital patient sharing as a mechanism for infectious disease spread. Infect Control Hosp Epidemiol 2010;31:11601169.
30. Lee, BY, Bartsch, SM, Wong, KF, et al. The importance of nursing homes in the spread of methicillin-resistant Staphylococcus aureus (MRSA) among hospitals. Med Care 2013;51:205215.
31. Reynolds, C, Kim, D, Kaplan, SH, et al. Are nursing homes less likely to admit methicillin-resistant Staphylococcus aureus carriers? Am J Infect Control 2014;42:6365.
32. Mody, L, Bradley, SF, Huang, SS. Keeping the “home” in nursing home: implications for infection prevention. JAMA Intern Med 2013;173:853854.
33. Trick, WE, Weinstein, RA, DeMarais, PL, et al. Comparison of routine glove use and contact-isolation precautions to prevent transmission of multidrug-resistant bacteria in a long-term care facility. J Am Geriatr Soc 2004;52:20032009.
34. McClean, P, Tunney, M, Parsons, C, Gilpin, D, Baldwin, N, Hughes, C. Infection control and meticillin-resistant Staphylococcus aureus decolonization: the perspective of nursing home staff. J Hosp Infect 2012;81:264269.
35. Naylor, MD, Kurtzman, ET, Pauly, MV. Transitions of elders between long-term care and hospitals. Policy Polit Nurs Pract 2009;10:187194.
36. Wolf, R, Lewis, D, Cochran, R, Richards, C. Nursing staff perceptions of methicillin-resistant Staphylococcus aureus and infection control in a long-term care facility. J Am Med Dir Assoc 2008;9:342346.
37. Jarvis, WR, Schlosser, J, Jarvis, AA, Chinn, RY. National point prevalence of Clostridium difficile in US health care facility inpatients, 2008. Am J Infect Control 2009;37:263270.
Type Description Title
PDF
Supplementary materials

Ye supplementary material
Appendix 1

 PDF (123 KB)
123 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed