Abstract
We studied trends in the incidence of health care-associated infections (HAIs) in LTCFs between 2009 and 2015 and determined the effect of participation in our network. Elder-care physicians reported weekly the number of cases of influenza-like illness, gastroenteritis, (probable) pneumonia, urinary tract infections (UTIs) and all-cause mortality. Trends in the incidence of infection and mortality in relation to LTCF characteristics were calculated using multilevel univariate and multivariate logistic regression. Thirty LTCF participated for 3 years or more, 16 for 2 years and the remaining 12 LTCF for 1 year. During the study period, the median number of beds decreased from 158 to 139, whereas the percentage of residents with private bedrooms increased from 14% to 87%. UTIs were the most frequently reported infections, followed by (probable) pneumonia and gastroenteritis. Adjusted for calendar year and season, we observed a statistically significant decrease in the incidence of influenza-like illness (odds ratio (OR) = 0.8, P < 0.01) and (probable) pneumonia (OR = 0.8, P < 0.01) for each extra year an LTCF participated. Although there are other likely contributors, such as more private rooms and enhanced infection control measures, the decreasing trend of HAI in LTCFs participating in surveillance implies that surveillance is a valuable addition to current strategies to optimise infection control.
Highlights
People have a higher risk of acquiring an infection and of experiencing a more severe disease course following infection than other age groups have [1,2,3], as a result of underlying chronic illnesses, functional impairment, malnutrition and polypharmacy
58 long-term care facilities (LTCFs) participated in the surveillance network in this period; five of these LTCFs participated for 7 years, three for 6 years, four for 5 years, seven for 4 years, 11 for 3 years, 16 for 2 years and the remaining 12 for 1 year (Fig. 1)
The incidence of infections fluctuated per year, the incidence of influenza-like illness and probable pneumonia significantly decreased over time for each extra year a LTCF participated in the SNIV network
Summary
People have a higher risk of acquiring an infection and of experiencing a more severe disease course following infection than other age groups have [1,2,3], as a result of underlying chronic illnesses, functional impairment, malnutrition and polypharmacy. Frail elderly residents in long-term care facilities (LTCFs) are especially at risk of acquiring health care-associated infections (HAIs) due to their dependence on care, sharing of facilities with other residents and living in a confined environment [4,5,6]. A number of studies on HAIs in long-term care settings in several European countries have reported incidences of HAIs between 2.7 and 11.8 per 1000 resident days [5, 10,11,12,13,14] and prevalence between 2.2% and 4.4% [15,16,17]. It is difficult to compare the incidences and prevalence reported in these studies, due to differences in methodology (e.g. definition of HAIs and duration of follow-up) and study population/case mix between countries
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