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Improving Surveillance of Pneumonia in Nursing Homes

Published online by Cambridge University Press:  02 November 2020

Theresa Rowe
Affiliation:
Northwestern University Feinberg School of Medicine
Taniece Eure
Affiliation:
Centers for Disease Control and Prevention
Nimalie Stone
Affiliation:
Centers for Disease Control and Prevention
Nicola Thompson
Affiliation:
Centers for Disease Control and Prevention
Angela Anttila
Affiliation:
Centers for Disease Control and Prevention
Ghinwa Dumyati
Affiliation:
University of Rochester
Erin Epson
Affiliation:
California Department of Public Health, Healthcare-Associated Infections Program
Christina B. Felsen
Affiliation:
University of Rochester Medical Center
Linda Frank
Affiliation:
California Emerging Infections Program
Deborah Godine
Affiliation:
California Emerging Infections Program
Marion Kainer
Affiliation:
Western Health
Joelle Nadle
Affiliation:
California Emerging Infections Program
Susan Ray
Affiliation:
Emory Univ Sch of Med and Grady Health System
Sarah Shrum
Affiliation:
New Mexico Department of Health
Marla Sievers
Affiliation:
New Mexico Department of Health
Srinivasan Krithika
Affiliation:
Yale University
Alexia Zhang
Affiliation:
Oregon Health Authority
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Abstract

Background: Pneumonia (PNA) is an important cause of morbidity and mortality among nursing home residents. The McGeer surveillance definitions were revised in 2012 to help NHs better monitor infections for quality improvement purposes. However, the concordance between surveillance definitions and clinically diagnosed PNA has not been well studied. Our objectives were to identify nursing home residents who met the revised McGeer PNA definition, to compare them with residents with clinician documented PNA, and determine whether modifications to the surveillance criteria could increase concordance. Methods: We analyzed respiratory tract infection (RTI) data from 161 nursing homes in 10 states that participated in a 1-day healthcare-associated infection point-prevalence survey in 2017. Trained surveillance officers from the CDC Emerging Infections Program collected data on residents with clinician documentation, signs, symptoms, and diagnostic testing potentially indicating an RTI. Clinician-documented pneumonia was defined as any resident with a diagnosis of pneumonia identified in the medical chart. We identified the proportion of residents with clinician documented PNA who met the revised McGeer PNA definition. We evaluated the criteria reported to develop 3 modified PNA surveillance definitions (Box), and we compared them to residents with clinician documented PNA.

Results: Among the 15,296 NH residents surveyed, 353 (2%) had >1 signs and/or symptoms potentially indicating RTI. Among the 353 residents, the average age was 76 years, 105 (30%) were admitted to postacute care or rehabilitation, and 108 (31%) had clinician-documented PNA. Among those with PNA, 28 (26%) met the Revised McGeer definition. Among 81 residents who did not meet the definition, 39 (48%) were missing the chest x-ray requirement, and among the remaining 42, only 3 (7%) met the constitutional criteria requirement (Fig. 1). Modification of the constitutional criteria requirement increased the detection of clinically documented PNA from 28 (26%) to 36 (33%) using modified definition 1; to 51 (47%) for modified definition 2; and to 55 (51%) for modified definition 3. Conclusions: Tracking PNA among nursing home residents using a standard definition is essential to improving detection and, therefore, informing prevention efforts. Modifying the PNA criteria increased the identification of clinically diagnosed PNA. Better concordance with clinically diagnosed PNA may improve provider acceptance and adoption of the surveillance definition, but additional research is needed to test its validity.

Funding: None

Disclosures: None

Type
Poster Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
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