Infections among patients in nursing homes: policies, prevalence, problems

We performed one-day surveys in seven skilled-care nursing homes in order to evaluate their infection-control policies and to determine the prevalence of infections among their residents. Infection-control programs were not well developed at any of the home surveyed. We noted high patient-to-staff ratios, staffing by nonprofessional personnel, frequent job turnover, infrequent compensation for employee sick leave, and no general policies on immunization of patients or staff. The prevalence of infections among 532 patients was 16.2 per cent. Infected decubitus ulcers, conjunctivitis, symptomatic urinary-tract infections, and lower-respiratory tract infections were the most common types. Eight-five per cent of patients with indwelling urinary catheters had asymptomatic bacteriuria; many were colonized with antibiotic-resistant bacteria. Clustering of cases of upper-respiratory tract infections, diarrhea, conjunctivitis, and specific types of bacteriuria suggested that localized out-breaks of infectious occurred frequently. The high prevalence of infectious diseases and clustering of cases may reflect an increased susceptibility of patients in nursing homes to infections, high employee turnover, or lack of attention to infection-control practices.