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Surveillance of infection burden in residential aged care facilities
Ching Jou Lim1, Susan C McLellan, Allen C Cheng
1Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia.
Objectives:
To explore the burden of illness associated with infectious syndromes and to measure the associated use of antimicrobials in residential aged care facilities (RACFs).
Design, Setting And Subjects:
Retrospective analysis of data for January 2006 to December 2010 from an infection surveillance system covering residents of four co-located RACFs, with a total of 150 residential care beds, in Melbourne, Victoria.
Main Outcome Measures:
Number of episodes and incidence of health care-associated infection (HCAI); rate of antimicrobial use; prescribing concordance with McGeer criteria for infection; frequency of clinical specimen collection.
Results:
There were 1114 episodes of an infectious syndrome over 267, 684 occuppied bed-days (OBD), affording an average HCAI rate of 4.16 episodes/1000 OBD annually over 5 years (95% CI, 3.92-4.41). The mean rate of antimicrobial use was 7.07 courses/1000 OBD (range, 6.71-7.84). Around 40% of antimicrobial prescribing was for episodes that did not fulfil the McGeer criteria for clinical infection; this included about half of suspected urinary tract and upper respiratory tract infections (URTI), and about one-third of suspected lower respiratory tract and skin infections. Antimicrobials were routinely prescribed for URTI and bronchitis. Of all episodes treated with antimicrobials, 36% had documentation that a clinical specimen was obtained.
Conclusions:
The HCAI rate remained relatively stable over time. Routine surveillance and feedback of infection rates to the facilities did not result in a noticeable decrease of infection burden over time. It is of immediate concern that antimicrobials were being prescribed for a large proportion of suspected infections that did not meet criteria for clinical infection. Opportunities exist to further improve the use of antimicrobials in the RACF setting.
Insights
Infectious syndromes in aged care facilities (RACFs) show a stable healthcare-associated infection (HCAI) rate. However, antimicrobials are frequently overprescribed for infections not meeting clinical criteria, indicating a need for improved antimicrobial stewardship.
Area of Science:
- Gerontology and Geriatric Medicine
- Infectious Diseases and Epidemiology
- Healthcare Quality and Safety
Background:
- Residential aged care facilities (RACFs) are vulnerable settings for infectious syndromes.
- Antimicrobial use in RACFs requires careful monitoring to prevent resistance and adverse events.
- Understanding the burden of illness and prescribing patterns is crucial for targeted interventions.
Purpose of the Study:
- To determine the incidence and burden of infectious syndromes in RACFs.
- To quantify antimicrobial utilization within these facilities.
- To assess the appropriateness of antimicrobial prescribing based on established clinical criteria.
Main Methods:
- Retrospective analysis of infection surveillance data from four RACFs (2006-2010).
- Inclusion of 150 residential care beds in Melbourne, Victoria.
- Measurement of healthcare-associated infection (HCAI) rates, antimicrobial use, and prescribing concordance with McGeer criteria.
Main Results:
- An average HCAI rate of 4.16 episodes per 1000 occupied bed-days was observed annually.
- The mean antimicrobial use rate was 7.07 courses per 1000 occupied bed-days.
- Approximately 40% of antimicrobial prescriptions did not meet McGeer criteria, particularly for suspected urinary tract and respiratory infections.
Conclusions:
- Healthcare-associated infection rates remained stable, with no significant reduction observed despite routine surveillance.
- A substantial proportion of antimicrobial prescriptions were inappropriate, highlighting a critical need for improved prescribing practices.
- Opportunities exist to optimize antimicrobial stewardship programs within RACFs to reduce unnecessary use.
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