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The Burden of Infection in Long-Term Care

Published online by Cambridge University Press:  02 January 2015

Larry J. Strausbaugh  and
Carol L. Joseph
Larry J. Strausbaugh*
Affiliation:
Infectious Disease Section, Medical Service, Veterans Affairs Medical Center; and the Division of Infectious Diseases, Department of Medicine, School of Medicine, Oregon Health Sciences University, Portland, Oregon
Carol L. Joseph
Affiliation:
Geriatrics, Rehabilitation, and Extended Care Division, Honolulu Veterans Affairs Medical Center, and the John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
*
Medical Service (P-3-ID), Veterans Affairs Medical Center, PO Box 1034, Portland, OR 97207
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Abstract

Available data, although fragmentary, indicate that infections impose a large burden on long-term–care facilities (LTCFs) in the United States. Endemic infections occur with frequencies estimated to range between 1.64 and 3.83 million per year. These estimates rival or exceed the annual tally for nosocomial infections in acute-care settings. Infections associated with outbreaks caused by respiratory, gastrointestinal, and antimicrobial-resistant pathogens burden LTCFs even further. As judged by antimicrobial use, transfers to hospital, and mortality figures, infections in LTCFs are not trivial. Moreover, annual costs associated with these infections appear to exceed $1 billion. Recognition of the burden associated with infection in LTCFs helps to identify research priorities for this rapidly growing area of healthcare.

Type
Topics in Long-Term Care
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 10 , October 2000 , pp. 674 - 679
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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References

1. Strausbaugh, LJ, Joseph, C. Epidemiology and prevention of infections in residents of long-term care facilities. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 2nd ed. New York, NY: Lippincott, Williams & Wilkins; 1999:1461–1482.Google Scholar
2. Strahan, GW. An overview of nursing homes and their current residents. Data from the 1995 National Nursing Home Survey. Washington, DC: National Center for Health Statistics; 1997;280:1–12.Google Scholar
3. National Center for Health Statistics. Highlights of Trends in the Health of Older Americans: United States, 1994. Washington, DC: US Department of Health and Human Services; 1995.Google Scholar
4. Lee, YL, Thrupp, LD, Friis, RH, Fine, M, Maleki, P, Cesario, TC. Nosocomial infection and antibiotic utilization in geriatric patients: a pilot prospective surveillance program in skilled nursing facilities. Gerontology 1992;38:223–232.CrossRefGoogle ScholarPubMed
5. Stevenson, KB. Regional data set of infection rates for long-term care facilities: description of a valuable benchmarking tool. Am J Infect Control 1999;27:20–26.CrossRefGoogle ScholarPubMed
6. Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.CrossRefGoogle ScholarPubMed
7. Schwartz, B, Ussery, XT. Group A streptococcal outbreaks in nursing homes. Infect Control Hosp Epidemiol 1992;13:742–747.CrossRefGoogle Scholar
8. Levine, WC, Smart, JF, Archer, DL, Bean, NH, Tauxe, RV. Foodborne disease outbreaks in nursing homes, 1975 through 1987. JAMA 1991;266:2105–2109.CrossRefGoogle ScholarPubMed
9. Jackson, MM, Fierer, J. Infection and infection risk in residents of long-term care facilities: a review of the literature, 1970-1984. Am J Infect Control 1985;13:63–77.CrossRefGoogle ScholarPubMed
10. Strausbaugh, LJ, Crossley, KB, Nurse, BA, Thrupp, LD. Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol 1996;17:129–140.Google Scholar
11. Bonilla, HF, Zervos, MA, Lyons, MJ, Bradley, SF, Hedderwick, SA, Ramsey, MA, et al. Colonization with vancomycin-resistant Enterococcus faecium: comparison of a long-term–care unit with an acute-care hospital. Infect Control Hosp Epidemiol 1997;18:333–339.Google ScholarPubMed
12. Brennen, C, Wagener, MM, Muder, RR. Vancomycin-resistant Enterococcus faecium in a long-term care facility. J Am Geriatr Soc 1998;46:157–160.CrossRefGoogle ScholarPubMed
13. Nuorti, JP, Butler, JC, Crutcher, JM, Guevara, R, Welch, D, Holder, P, et al. An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents. N Engl J Med 1998;338:1861–1868.CrossRefGoogle ScholarPubMed
14. Lee, YL, Cesario, T, McCauley, V, Flionis, L, Pax, A, Thrupp, L. Low-level colonization and infection with ciprofloxacin-resistant gram-negative bacilli in a skilled nursing facility. Am J Infect Control 1998;26:552–557.CrossRefGoogle Scholar
15. Nicolle, LE, Bentley, D, Garibaldi, R, Neuhaus, E, Smith, P. Antimicrobial use in long-term–care facilities. Infect Control Hosp Epidemiol 1996;17:119–128.CrossRefGoogle ScholarPubMed
16. Mylotte, JM. Antimicrobial prescribing in long-term care facilities: prospective evaluation of potential antimicrobial use and cost indicators. Am J Infect Control 1999;27:10–19.CrossRefGoogle ScholarPubMed
17. Avorn, J, Gurwitz, JH. Drug use in the nursing home. Ann Intern Med 1995;123:195–204.CrossRefGoogle ScholarPubMed
18. Warren, JW, Palumbo, FB, Fitterman, L, Speedie, SM. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc 1991;39:963–972.CrossRefGoogle ScholarPubMed
19. Yakabowich, MR, Keeley, G, Montgomery, PR. Impact of a formulary on personal care homes in Manitoba. CMAJ 1994;150:1601–1607.Google ScholarPubMed
20. Castle, NG, Mor, V. Hospitalization of nursing home residents: a review of the literature, 1980-1995. Med Care Res Rev 1996;53:123–148.CrossRefGoogle ScholarPubMed
21. Irvine, PW, Van Buren, N, Crossley, K. Causes for hospitalization of nursing home residents: the role of infection. J Am Geriatr Soc 1984;32:103–107.CrossRefGoogle ScholarPubMed
22. Teresi, JA, Holmes, D, Bloom, HG, Monaco, C, Rosen, S. Factors differentiating hospital transfers from long-term care facilities with high and low transfer rates. Gerontologist 1991;31:795–806.CrossRefGoogle ScholarPubMed
23. Mott, PD, Barker, WH. Treatment decisions for infections occurring in nursing home residents. J Am Geriatr Soc 1988;36:820–824.CrossRefGoogle ScholarPubMed
24. Fried, TR, Gillick, MR, Lipsitz, LA. Whether to transfer? Factors associated with hospitalization and outcome of elderly long-term care patients with pneumonia. J Gen Intern Med 1995;10:246–250.CrossRefGoogle ScholarPubMed
25. Fried, TR, Gillick, MR, Lipsitz, LA. Short-term functional outcomes of long-term care residents with pneumonia treated with and without hospital transfer. J Am Geriatr Soc 1997;45:302–306.CrossRefGoogle ScholarPubMed
26. Bergman, H, Clarfield, AM. Appropriateness of patient transfer from a nursing home to an acute-care hospital: a study of emergency room visits and hospital admissions. J Am Geriatr Soc 1991;39:1164–1168.CrossRefGoogle Scholar
27. Kerr, HD, Byrd, JC. Nursing home patients transferred by ambulance to a VA emergency department. J Am Geriatr Soc 1991;39:132–136.CrossRefGoogle ScholarPubMed
28. Nicolle, LE, McIntyre, M, Zacharias, H, MacDonell, JA. Twelve-month surveillance of infections in institutionalized elderly men. J Am Geriatr Soc 1984;32:513–519.CrossRefGoogle ScholarPubMed
29. Scheckler, WE, Peterson, PJ. Infections and infection control among residents of eight rural Wisconsin nursing homes. Arch Intern Med 1986;146:1981–1984.CrossRefGoogle ScholarPubMed
30. Jackson, MM, Fierer, J, Barrett-Connor, E, Fraser, D, Klauber, MR, Hatch, R, et al. Intensive surveillance for infections in a three-year study of nursing home patients. Am J Epidemiol 1992;135:685–696.CrossRefGoogle Scholar
31. Jacobson, C, Strausbaugh, LJ. Incidence and impact of infection in a nursing home care unit. Am J Infect Control 1990;18:151–159.CrossRefGoogle Scholar
32. Finnegan, TP, Austin, TW, Cape, RD. A 12-month fever surveillance study in a veterans' long-stay institution. J Am Geriatr Soc 1985;33:590–594.CrossRefGoogle Scholar
33. Muder, RR. Pneumonia in residents of long-term care facilities: epidemiology, etiology, management, and prevention. Am J Med 1998;105:319–330.CrossRefGoogle ScholarPubMed
34. Bradley, SF. Prevention of influenza in long-term–care facilities. Long-Term–Care Committee of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1999;20:629–637.CrossRefGoogle ScholarPubMed
35. Patriarca, PA, Arden, NH, Koplan, JP, Goodman, RA. Prevention and control of type A influenza infections in nursing homes. Benefits and costs of four approaches using vaccination and amantadine. Ann Intern Med 1987;107:732–740.CrossRefGoogle ScholarPubMed
36. Barnett, PG. Research without billing data. Econometric estimation of patient-specific costs. Med Care 1997;35:553–563.CrossRefGoogle ScholarPubMed
37. Papia, G, Louie, M, Tralla, A, Johnson, C, Collins, V, Simor, AE. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiol 1999;20:473–477.CrossRefGoogle Scholar
38. Mullooly, JP, Bennett, MD, Hornbrook, MC, Barker, WH, Williams, WW, Patriarca, PA, et al. Influenza vaccination programs for elderly persons: cost-effectiveness in a health maintenance organization. Ann Intern Med 1994;121:947–952.CrossRefGoogle Scholar
39. Barker, WH, Zimmer, JG, Hall, WJ, Ruff, BC, Freundlich, CB, Eggert, GM. Rates, patterns, causes, and costs of hospitalization of nursing home residents: a population-based study. Am J Public Health 1994;84:1615–1620.CrossRefGoogle ScholarPubMed
40. Hu, TW. Impact of urinary incontinence on health-care costs. J Am Geriatr Soc 1990;38:292–295.CrossRefGoogle ScholarPubMed
41. Hu, TW. The economic impact of urinary incontinence. Clin Geriatr Med 1986;2:673–687.Google ScholarPubMed
42. Choi, M, Yoshikawa, TT, Bridge, J, Schlaifer, A, Osterweil, D, Reid, D, et al. Salmonella outbreak in a nursing home. J Am Geriatr Soc 1990;38:531–534.CrossRefGoogle ScholarPubMed
43. Bryce, EA, Tiffin, SM, Isaac-Renton, JL, Wright, CJ. Evidence of delays in transferring patients with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus to long-term–care facilities. Infect Control Hosp Epidemiol 2000;21:270–271.CrossRefGoogle ScholarPubMed
44. Levit, KR, Lazenby, HC, Braden, BR. National Health Expenditures, 1996. Health Care Financ Rev 1997;19:161–200.Google Scholar