Rise in nursing home infection rates lead to avoidable complications, deaths

Infections among nursing home residents are rising, according to a study presented Oct. 8, 2014, at IDWeek (an international gathering of experts in infectious disease and epidemiology).

Image by Ulrich Joho via flickr.

Image by Ulrich Joho via flickr.

Researchers from Columbia University School of Nursing and RAND Corporation analyzed infections in nursing homes over a five-year period from 2006-2010, using Minimum Data Set assessment data – the information submitted by the facilities to the Centers for Medicare and Medicaid. They found significantly increased infection rates for pneumonia, urinary tract infections (UTIs), viral hepatitis, septicemia, wound infections, and multiple drug-resistant organisms (MDROs), conditions that raise the risk of complications and death. Only tuberculosis rates did not show an increase.

Approximately 1.6 million to 3.8 million infections occur among U.S. nursing home residents each year. The new study found that UTIs remain, by far, the most frequently reported type of infection, but they also showed the smallest rise in prevalence – just 1 percent. Pneumonia was the second most common infection, and its prevalence rose 11 percent from 2006 to 2010. Infection rates increased 69.7 percent  for viral hepatitis, 25.2 percent for septicemia, 24.1 percent for pneumonia, 15.7 percent for MDRO and 4.6 percent for wound infections.

Many of these infections are preventable, according to the researchers. For example, reducing use of catheters and more frequent diaper changes for residents who are incontinent can virtually eliminate UTIs. Proper hand hygiene and use of hand sanitizers by staff, residents and visitors can minimize transmission of infections like pneumonia or other conditions that are spread through the air or hard surfaces. Additionally, routine screening of all residents for bacterial infections like MRSA and isolating the sickest patients indicates a facility has a proactive approach to infection control.

“The nursing home population is expected to increase as individuals live longer,” said Carolyn Herzig, M.S., lead researcher and a doctoral student at the Columbia Mailman School of Public Health. “This problem is only going to get worse as aging baby boomers live with more complex chronic conditions.”

Herzig’s investigation is part of a larger study by the Prevention of Nosocomial Infections and Cost-Effectiveness in Nursing Homes (P-NICE) study at Columbia University. The next step is to look at what might be causing these increases, Herzig said.

Almost all state health department websites post nursing home inspection reports and each state has a nursing home ombudsman. The CMS Nursing Home Compare website can also help families determine if facilities have issues with infection rates. Herzig said that if families are aware of problems that are not being addressed by the facility, they should report the issue to their state health department.  “Hopefully the work that we’re doing might ultimately contribute to changes in policy,” Herzig said.

Although most people want to age at home, the reality is that for some, nursing homes are the only option. Families often have to choose a facility with little time to conduct due diligence, Herzig noted. “Having more resources available for to help families make that decision would be helpful.”

Resources for Reporters:

The Infectious Diseases Society of America (IDSA) — physicians, scientists and other health care professionals who specialize in infectious diseases.

The Society for Healthcare Epidemiology of America (SHEA) — global organization of health professionals with expertise in healthcare epidemiology and infection prevention and control.

American Health Care Association — trade organization of long term care providers.

The National Consumer Voice for Quality Long Term Care — national association focused on protecting patient and family rights.

Prior study by Herzig surveying state health departments on nursing home acquired infections.


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