Abstract
The burden of healthcare-associated infections (HAIs) and antimicrobial use in Swiss long-term care facilities (LTCFs) is currently unknown. This study assessed the prevalence of HAIs and antibiotic use among LTCF residents in Switzerland. A point-prevalence study was undertaken in LTCFs in eastern and western Switzerland from August to October 2019 according to the 'Healthcare-associated infections in long-term care facilities' (HALT) protocol. Characteristics of residents (age, sex, wounds, dementia, indwelling catheters) and institutions (specific factors, geographic region) were assessed. LTCF residents were screened for HAIs and current antibiotic treatment. Personal and institutional factors associated with HAIs were assessed. In total, 1185 residents from 16 LTCFs (eight per geographic region) were screened for HAIs and antibiotic treatment. Median age was 87 years (interquartile range 79-91) and 71% were female. The prevalence of HAIs was 4.2% (west 4.3% vs east 4.2%; P=0.93), with mucocutaneous skin infections (36%) and respiratory tract infections (30%) being the most common. Independent risk factors for the presence of HAIs were presence of a chronic wound [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1-5.0; P=0.02] and being immobile (OR 1.8, 95% CI 1.0-3.3; P=0.04). Antibiotics were given to 2.9% of residents (west 3.9% vs east 1.8%; P=0.05) on the day of the survey. The most commonly prescribed antibiotics were amoxicillin-clavulanic acid and quinolones. The prevalence of HAIs in Swiss LTCFs is similar to that in other European countries, whereas antibiotic consumption is lower. Further point-prevalence surveys on a broader scale are recommended to improve understanding of the burden of HAIs and antibiotic consumption in this setting.
Highlights
Healthcare-associated infections (HAIs) are a major concern in long-term care facilities (LTCFs) due to significant morbidity and mortality [1]. Antibiotic use is another concern as studies have reported that almost half of the antibiotics prescribed in LTCFs are inappropriate [2]
The use of antibiotics is an important driver of antimicrobial resistance and is associated with complications such as Clostridiodes difficile infection [3,4]
Most residents in eastern LTCFs are followed-up by a personal general practitioner (GP), whereas residents in western LTCFs are mainly served by both personal GPs and physicians that are employed by the LTCF (P1⁄40.026)
Summary
Healthcare-associated infections (HAIs) are a major concern in long-term care facilities (LTCFs) due to significant morbidity and mortality [1] Antibiotic use is another concern as studies have reported that almost half of the antibiotics prescribed in LTCFs are inappropriate [2]. In 2008, the European Centre for Disease Prevention and Control (ECDC) initiated a surveillance programme for HAIs and antibiotic consumption in LTCFs within the framework of ‘Healthcare-associated infections in long-term care facilities’ (HALT) [5]. This programme monitors the extent of the problem in LTCFs, compares data across countries, and guides specialists and LTCF staff in the implementation of targeted interventions. One purpose was to enable systematic surveillance of HAIs in LTCFs, and subsequently encourage the implementation of measures to reduce the burden of HAIs [7]
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