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Infection control in long-term care facilities
1Department of Internal Medicine, University of Manitoba, Health Sciences Centre, St. Boniface Hospital, Winnipeg, Manitoba, Canada. lnicolle@hsc.mb.ca
Abstract:
Infections are common in long-term care facilities. The most frequent endemic infections are urinary infection, respiratory infection, and skin and soft tissue infections. Outbreaks also occur frequently, and some facilities have a high prevalence of colonization of residents with antimicrobial-resistant organisms. Our understanding of infections and the development of infection-control programs for long-term care facilities have progressed greatly over the past 15 years. Whereas the occurrence of infections has been described and specific guidelines for infection-control programs in long-term care facilities have been developed, there is still limited evaluation of the effectiveness of programs or specific interventions to support prioritization of infection-control resources. In addition, the spectrum of patients and care delivered in long-term care facilities continues to evolve. Increasingly, chronic care patients, including those requiring chronic respirator therapy, dialysis, or percutaneous feeding tubes, are cared for in these facilities. Our understanding of prevention of infection in these patients remains limited. Important questions include what interventions may prevent endemic infections, what are the most effective means to identify outbreaks early, and what interventions may minimize the prevalence of antimicrobial-resistant organisms. Programs to optimize antimicrobial use need to be developed. Thus, although progress in understanding and practice has been made, important questions remain.
Insights
Long-term care facilities face frequent infections like urinary and respiratory types. More research is needed to evaluate infection control effectiveness and manage antimicrobial resistance in evolving patient populations.
Area of Science:
- Infection control and prevention in healthcare settings.
- Geriatric medicine and long-term care.
- Antimicrobial resistance and public health.
Background:
- Infections, including urinary, respiratory, and skin infections, are prevalent in long-term care facilities (LTCFs).
- Antimicrobial-resistant organism colonization is a significant concern in LTCFs.
- Despite progress, evaluating the effectiveness of infection control programs and interventions remains limited.
Purpose of the Study:
- To highlight the ongoing challenges in infection prevention and control within LTCFs.
- To identify critical knowledge gaps in managing endemic infections and outbreaks.
- To emphasize the need for optimized antimicrobial use programs in LTCFs.
Main Methods:
- Review of current understanding of infection epidemiology in LTCFs.
- Analysis of existing infection control guidelines and their limitations.
- Identification of emerging challenges due to evolving patient populations and care needs.
Main Results:
- Common infections include urinary, respiratory, and skin/soft tissue infections.
- Outbreaks are frequent, with a high prevalence of antimicrobial-resistant organisms.
- Limited data exists on the effectiveness of current infection control programs and interventions.
Conclusions:
- Significant progress has been made in understanding infections in LTCFs, but critical questions remain.
- Further research is needed to evaluate intervention effectiveness and optimize antimicrobial stewardship.
- Adapting infection control strategies for complex chronic care patients is essential.