A multicomponent control programme in nursing homes in Singapore

Nursing home (NH) residents are vulnerable to infections and avoidable hospital transfers. The Infectious Diseases Community Program was developed as a multicomponent intervention to strengthen infection prevention and control (IPC), improve vaccination uptake, and support clinical decisionmaking in NHs.

The authors conducted a retrospective cohort study in 6 NHs in western Singapore with pre- and post-implementation data, in collaboration with an acute hospital. A total of 4801 admissions were screened, of which 2045 fever-related admissions were included. The intervention comprised IPC training, policy and process reviews, vaccination support, antimicrobial guidance, and implementation of a structured fever and desaturation pathway to standardise hospital transfer decisions.

New methicillin-resistant Staphylococcus aureus (MRSA) acquisitions declined from 14.6% to 9.7% (relative reduction 33.6%, 95% confidence interval [CI] -6.8 to -3.1, P<0.001). Inappropriate fever-related transfers decreased from 12.0% (108/898) to 7.3% (61/839), a relative reduction of 39.2% (absolute reduction 4.8%, 95% CI -7.5 to -2.0, P<0.001). Influenza vaccination coverage exceeded 90% by 2022. Staff surveys indicated sustained adoption, with 84% reporting regular use of the pathway.

A collaborative model integrating acute hospital expertise with NH teams was associated with improved IPC outcomes, increased vaccination coverage, and reduced inappropriate transfers, supporting safer care delivery in long-term care.