Call to monitor infections in nursing homes

HEALTHCARE-ASSOCIATED infections in nursing homes should be monitored, audited and reported through a systematic surveillance…

HEALTHCARE-ASSOCIATED infections in nursing homes should be monitored, audited and reported through a systematic surveillance programme, the Royal College of Physicians of Ireland (RCPI) said yesterday.

It said while infections such as MRSA and Clostridium difficile occurring in acute hospital settings are monitored and reported, this is not the case in relation to infections occurring in long-term care settings.

It wants this imbalance addressed in the interests of minimising infections and improving safety for the 20,000 older people living in long-term care settings.

Prof Hilary Humphreys, head of the RCPI’s policy group on healthcare-associated infections and a consultant microbiologist at Dublin’s Beaumont Hospital, said while the emphasis up to now has been on healthcare-associated infections in hospitals, many may also be acquired in other parts of the health system including nursing homes and GP surgeries.

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He said international surveys showed between 5 and 16 per cent of nursing home residents have a healthcare-associated infection at any one time but there was no accurate data in relation to the prevalence of such infections among nursing home residents in Ireland.

However, a survey being conducted this year, which will collect data from long-term care settings across Europe including Ireland, should provide some much-needed data, he said.

There were particular challenges in preventing healthcare-associated infections in nursing homes, he added. These included the fact that residents are frail and at higher risk of infections. Also basic hygiene precautions may not be followed, especially by residents with cognitive impairment.

A position paper on the topic published by the RCPI yesterday says it is more difficult to recognise and diagnose infections in the elderly and nursing homes may not always have access to laboratory services to confirm the types of infections present. As a result antibiotics may be prescribed by GPs on “a best guess” basis.

In addition it says the knowledge and training on infection prevention and control among carers of residents may be sub-optimal.

The RCPI wants doctors and other medical staff to receive training in managing healthcare-associated infections in long-term care settings and wants to see antibiotic stewardship in nursing homes enhanced. More research is also needed, it says, to evaluate the effectiveness of measures advised to prevent healthcare-associated infections in nursing homes.