European survey finds gaps in infection prevention, antimicrobial stewardship in long-term care

News brief

A surveillance study conducted by the European Centre for Disease Prevention and Control (ECDC) found that more than 3% of long-term care facility (LTCF) residents in Europe had at least one healthcare-associated infection (HAI) in 2023 or 2024.

The point prevalence study was conducted in 1,097 LTCFs in 18 European Union/European Economic Area countries and involved 66,112 residents. Of the surveyed LCTFs, at least one staff member with infection prevention and control (IPC) training was available in 77.5%, 40.5% reported having an IPC committee, and 94.2% had a written hand-hygiene protocol. But 38.8% did not have any of the 10 specified antimicrobial stewardship elements.

Nurse with patient in nursing home — AlexRaths / iStock

The crude prevalence of residents with at least one HAI was 3.1%. The most frequently reported HAIs were urinary tract infections (34.1%), respiratory tract infections (27.3%), and skin infections (23.9%). Overall, only 20% of HAIs had positive microbiologic confirmation at the time of the study.

Among the confirmed infections, the most frequently reported microorganisms were Escherichia coli (32.6%), SARS-CoV-2 (14.1%), Klebsiella pneumoniae (9.8%), and Staphylococcus aureus (7.9%).

The crude prevalence of residents receiving at least one antimicrobial was 4.1%. Nearly one-third (29.1%) of prescriptions were given for prophylactic (preventive) purposes.

Enhanced IPC efforts needed

ECDC officials say the results indicate that national health authorities and LTCF managers need to allocate adequate resources for IPC programs, implement robust quality control and surveillance systems, and ensure core competencies for IPC professionals.

"Good data are the foundation for effective action," ECDC Chief Scientist Piotr Kramarz, MD, PhD, said in a press release. "This survey shows we need to better protect long-term care residents through evidence-based strategies, enhanced surveillance, and a firm commitment to real change."

Data link long-term COVID-related loss of smell to depression, anxiety

News brief

Mary Van Beusekom, MS

Woman smelling flower — *Jorge / Flickr cc*

COVID-19 survivors who lose their sense of smell for at least 6 months have more serious depression and anxiety than those without the dysfunction, University of Mons researchers in Belgium write in the Journal of Otolaryngology-Head and Neck Surgery.

At a single medical center, 218 patients with olfactory dysfunction (OD) and 102 asymptomatic controls completed the Olfactory Disorder Questionnaire, General Anxiety Disorder (GAD-7) questionnaire, and Patient Health Questionnaire (PHQ-9) and underwent the Sino-Nasal Outcome Test-22 and threshold, identification, and discrimination testing from August 2023 to January 2024.

The average age was 51.3 years in OD patients and 41.2 in controls. Thirteen OD patients (5.9%) and 5 (4.9%) controls reported a depression diagnosis in the last 5 years.

"The olfaction plays a crucial role in human social interactions, in transforming eating from a simple vital function to a pleasant activity, and for detecting environmental hazards," the authors noted.

Women had higher burden of both measured conditions

At enrollment, the average duration of OD was 31.1 months. OD patients had anosmia (loss of smell; 26.3%), hyposmia (reduced ability to smell; 33.7%), or parosmia (distorted sense of smell; 40.0%), respectively.

While the causality relationship remains unclear, depression and anxiety symptoms must be investigated in this subgroup of patients with long COVID-19.

The average PHQ-9 score was significantly higher in OD patients (6.12; mild depression) than in controls (4.4; minimal depression), as were average GAD-7 scores (4.6 vs 3.5; mild and minimal anxiety, respectively).

Rates of mild-to-severe depression (51.2% vs 44.1%) and mild-to-severe anxiety (39.5% vs 32.4%) were significantly higher in OD patients than in controls; OD patients had a significantly higher percentage of moderate and severe depression and anxiety than those with intact olfaction.

Relative to hyposmia and parosmia, anosmia was tied to severe anxiety. Women scored higher on the GAD-7 and PHQ-9 than men. The average PHQ-9 scores of unvaccinated patients were significantly higher than those of vaccinated participants, indicating a higher depression burden (6.9 vs 5.9). The severity of depression and anxiety increased with OD severity and nasal symptoms.

"While the causality relationship remains unclear, depression and anxiety symptoms must be investigated in this subgroup of patients with long COVID-19," the authors concluded.