New tools aim to improve infection tracking in long-term care

Sep 19, 2012 (CIDRAP News) – A national medical organization and the Centers for Disease Control and Prevention (CDC) have released a pair of new tools designed to set a national standard for the tracking of healthcare-associated infections (HAI) in long-term care settings.

The Society for Healthcare Epidemiology of America (SHEA) released updated infection definitions and guidance that provide uniform criteria for nursing homes and other long-term care facilities (LTCFs). The information was published this week as a position paper in the SHEA journal, Infection Control and Hospital Epidemiology.

In addition, the CDC's National Healthcare Safety Network (NHSN) recently launched a new online tool, based on the SHEA guidance, to help LTCFs track infections. The tool covers drug-resistant infections such as Clostridium difficile and methicillin-resistant Staphylococcus aureus, urinary tract infections, and healthcare worker compliance with infection prevention measures.

"The unsettling truth is that our best estimates of healthcare-associated infections in long-term care facilities, such as nursing homes, most likely understate the true problem," Nimalie Stone, MD, a CDC medical epidemiologist and lead author of the guidance, said in a SHEA press release that was e-mailed to journalists.

"Clinicians in nursing homes cannot prevent healthcare-associated infections unless they know where and how they are occurring," she said. "Tracking infections within facilities is the first step toward prevention and ultimately saves lives."

The SHEA guidance includes evidence gathered since the previous surveillance definitions for LTCFs, known as the McGeer Criteria, were published in 1991. Most of the definitions have been retained, but definitions for C difficile and norovirus gastroenteritis have been added, and definitions for urinary tract infections have been made more specific, SHEA officials said.

The SHEA position paper says the McGeer Criteria were designed specifically for use in LTCFs with older adults and are still applicable in skilled nursing facilities that care for postacute and frail elderly people, but the criteria were not intended for use in long-term acute-care hospitals, acute inpatient rehabilitation facilities, or pediatric LTCFs.

A SHEA committee of long-term care experts decided in 2009, the guidance says, that the surveillance definitions of infections in LTCFs needed updating in view of a substantial increase in evidence about infections in the elderly in LTCFs, improved diagnostics for infection surveillance, the changing populations of patients cared for in nonhospital settings, and the updated acute-care hospital surveillance definitions of the NHSN.

The process of updating the McGeer Criteria included an evidence-based structured review of the literature and consensus opinions from industry leaders, including infectious-diseases physicians and epidemiologists, infection preventionists, geriatricians, and public health officials, according to SHEA.

The new guidance has been endorsed by the American Medical Directors Association, the Association of Medical Microbiology and Infectious Disease–Canada, the Association for Professionals in Infection Control and Epidemiology, the Community and Hospital Infection Control Association–Canada, and the National Association of Directors of Nursing Administration in Long Term Care.

See also:

SHEA position paper in Infect Control Hosp Epidemiol

CDC NHSN tool for tracking infections in LTCFs

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