Prevalence of Nursing Home Associated Infections in the Department of Veterans Affairs Nursing Home Care Units

ABSTRACT

Introduction: The U.S. Department of Veterans Affairs (VA) is the largest single provider of long term care in the United States. However, the prevalence of nursing home associated infections (NHAIs) among residents of VA nursing home care units (NHCUs) is not known. In 1991, Magaziner reported a prevalence rate of 4.4% NHAIs among 4,259 patients in 53 Maryland nursing homes. In 1996, the French Prevalence Survey Study Group reported a prevalence rate of 7.6% NHAIs among 52,943 LTCF patients from 830 public hospitals. In 2000, Andersen reported an overall prevalence rate of 6.5% NHAIs among 13,762 patients from 65-70 Long Term Care Facilities in Oslo, Norway. Methods: A web-based one day point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections was conducted in 133 VA NHCUs on November 9, 2005. This is the largest such survey in the United States. Results: From a total population of 11,475 NHCU residents, 591 had at least one NHAI for a point prevalence rate of 5.2%. These 591 residents had a total of 640 NHAIs. Urinary tract infection, pneumonia, skin infection, gastroenteritis, and soft tissue infection were most prevalent constituting 72% of all NHAIs. More residents were in the age group between 60 and 79 years (43.4%) than in the age groups of <60 (18.7%) or > 80 (37.9%). The prevalence of NHAIs among these 3 age groups ranging from 4.9% to 5.4%, did not differ significantly (p> 0.05) from each other. A total of 2,817 residents had one or more indwelling devices, of these 309 residents also had one or more NHAIs with a prevalence of 11%. In contrast, the prevalence of NHAIs in residents without indwelling devices was only 3.3%. Indwelling urinary catheter, percutaneous gastrostomy tube, intravenous peripheral line, peripherally inserted central catheter, and suprapubic urinary catheter were most common accounting for 79.3 % of all devices used. Conclusions: Direct comparison of the above reported NHAI prevalence rates is difficult due to differences in case mix and definitions of NHAIs used. Nonetheless, three conclusions may be derived. 1) The prevalence rates of NHAIs were less than 10% in the 1990s and 2000's. Rates reported in the 1980's were mostly 12% or higher. 2) The most common NHAIs remained the same, namely UTI, pneumonia, skin and soft tissue infection, and gastroenteritis. 3) The use of indwelling devices is highly associated with NHAIs.