The annual rate of infection occurrence in nursing homes in the US has exceeded two million during the last decade (Strausbaugh L, Joseph C. 674). This estimate includes a broad range of infections commonly found in the elderly. The high rate of infection spread, which is even escalating, has been associated with serious consequences including extended hospitalization, frequent readmissions, chronic disease complications, medication interactions, increased healthcare expenses, clinical toxicities, and mortality.
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The fact that majority of the resident population in SNFs comprises older patients with concomitant diseases and compromised immunity, justifies the higher susceptibility of infection in them. In addition, the use of indwelling devices, recent admission to an acute care setting, lack of mobility, polypharmacy, and multi-organ diseases also contribute to higher infection rates in the elderly. For example, tube-fed patients in SNFs are more likely to get infected with aspiration pneumonia (15–23%), skin and soft tissue infections, and other mechanical complications. Likewise, urinary catheters enhance the risk of acquiring urinary tract infections, bacteremia, and septicemia in them (Cogen R, Weinryb J. 1509). Another aspect that is even more alarming, is the multidrug-resistant nature of these infectious diseases. This further complicates the healthcare needs of elder patients and can lead to higher death rates in SNF residents.
The most common infections in SNFs are of the urinary tract, respiratory system, and skin and soft tissue infections where the infections caused by multidrug-resistant organisms are more prevalent. Unfortunately, infection prevention and risk monitoring is often overlooked and unrecognized in institutional settings. The gravity of this situation demands implementation of serious measures as well as continuous monitoring of the implemented programs in long-term care facilities. The following suggestions are hereby presented in this regard:
1. Improving hygienic practices
The first and foremost factor that predominantly determines the infection prevention and control, is the level of hygienic practices displayed by the residents as well as healthcare staff.
In addition to the stated protocol of maintaining a healthy environment in the facility, all the entry points of microbes should be cautiously monitored in daily practices. Friendly reminders should be given to nursing and associated staff in the form of little stick-on banners, emails, or in weekly meetings. Special populations such as immobile adults or older patients with cognitive impairment who cannot comply with personal hygiene should be given extra care to save them from infections as well as to reduce the transmission of infections. Patient isolation should be ensured in case of serious infection, whenever needed.
Also, the visitors can be a substantial source of entry of pathogens into the care facility. SNFs websites should be regularly updated with infection control protocol so that the families of residents can be informed about the due measures required before visiting the care facility.
2. Ensuring effectiveness of implemented measures
While the specific guidelines for infection control programs in nursing care facilities have been developed, there is still limited evaluation of the effectiveness of these programs or specific interventions made in this respect. Measures to control and prevent infection transmission cannot eradicate the risk effectively unless their effectiveness is ensured from time to time. Infection control and prevention committees, or other bodies can be established in this regard, and their operation can be made proactive providing they are already in place. An accountability program should be held in place for their functioning.
Such committees can take part in national surveys or can conduct surveys of their own to ensure the proper control of infections in SNF settings. It will also help them identify the critical parameters that need additional attention for their management. Nursing students and internees can be hired for conducting surveys and evaluation of implemented measures since burdening the nursing staff with such additional work will result in poor outcomes of these initiatives.
The prime questions that these surveys should target are; what interventions are required to prevent endemic infections, what means should be employed for early identification of outbreaks, and how to control and prevent the transmission of resistant pathogens.
3. Smooth admissions and transitions
The residents who need to be transferred back to the hospital, to a different nursing facility, to home, or to hospice facilities, greatly carry the risk of transmission of multidrug-resistant organisms. If this transitioning process can be made smooth and innovative where all healthcare members can co-decide, the spread of these lethal infections can be largely minimized. Such digital solutions are offered by some professional services that ease the process of hospital discharge and facilitate the patients and their caretakers in multiple ways. These digital solutions offer user-friendly ways of transition from acute to post-acute care settings in just a few clicks.
4. Ensuring optimal use of antibiotics
The optimal use of antibiotics is a challenging yet necessary step to dissipate the risk of rising infections, morbidity, and mortality. It is also essential for preventing rehospitalization and lowering treatment expenses. Antibiotic overuse should also be discouraged since it can largely contribute to the rise in antibiotic-resistant organisms and infection complications.
Programs to optimize antimicrobial use should be formed. An additional clinical staff member with expertise in antimicrobial therapy can be a useful resource in this regard. Frequent communication between clinical staff and the primary care physician of residents should be encouraged and ease of access should be ensured for this communication process. Besides, the clinical care team should be prompted to attend workshops or seminars to get an in-depth insight into the updated protocols for antimicrobial drug resistance and its management. In this way, they can better manage acute or chronic infections or reinfections in residents.
5. Digitizing communication and data access
Since older residents are unlikely to recall their antibiotic history when it comes to the selection of an effective antibiotic for a new or chronic infection, advanced digital measures can be put in place to improve this process. It has been observed that the communication gap between residents or their families and nursing care staff has contributed to medical and medication complexities in general. If the data of residents are regularly updated on their database and exchanged with family members then infection management can be effectively implemented. SNFs can designate some sections of their digital platforms for this purpose. Using digital solutions, infection control and prevention processes can be made easy and efficient.
In conclusion, it can be said that the widespread dissemination of infections in SNFs is a major threat to the safety of old, feeble, and ailing residents. In view of the above guidelines, the dire consequences of infections outbreak in SNFs can be prevented. Moreover, an efficient post-discharge communication process can also be helpful in ensuring the safe use of antibiotic medications thus preventing the emergence of resistant infection. Through these measures, the additional healthcare expenses can be reduced and the safety of residents can be ensured.
Cogen, Raymond, and Joan Weinryb. "Aspiration pneumonia in nursing home patients fed via gastrostomy tubes." American Journal of Gastroenterology (Springer Nature) 84.12 (1989). Strausbaugh, Larry J., and Carol L. Joseph. "The burden of infection in long-term care." Infection Control & Hospital Epidemiology 21.10 (2000): 674-679.