Prospective surveillance for healthcare-associated infections in German nursing home residents

We undertook a prospective surveillance study in order to determine the incidence of healthcare-associated infections (HCAIs) in German nursing home residents. All people residing for more than one day in a 103-bed nursing home for the elderly in Bonn, Germany between December 1998 and November 1999 were included. Active surveillance was based on previously published consensus definitions. Rates for HCAIs and urinary tract infections (UTIs) were calculated based on resident-days and device-utilization days, respectively. The overall incidence of HCAIs was 6.0 per 1000 resident-days, with respiratory tract infections, gastroenteritis, skin/soft tissue infections and UTIs representing 94% of all HCAIs (2.2, 1.2, 1.2 and 1.0 infections per 1000 resident-days, respectively). Residents with pneumonia were more likely to die than residents with other HCAIs (RR=5.09; 95%CI 1.87-13.89; P=0.011). We conclude that HCAIs are a serious health problem in German nursing home residents. Standardized surveillance in nursing homes is important to assess the effectiveness of infection control standards, and should be based on consensus definitions in order to allow for meaningful interfacility comparisons. In Germany, the implementation of a hospital reimbursement system based on diagnosis-related groups is likely further to increase the proportion of vulnerable populations in long-term-care facilities.