197932 Nursing Home-Associated Infections in the Department of Veterans Affairs Community Living Centers

Tuesday, November 10, 2009: 4:30 PM

Linda Tsan, MD , Office of the Medical Inspector (10MI ), US Dept. of Veterans Affairs, Washinton, DC, DC
Robert Langberg, MA , Office of the Medical Inspector (10MI ), US Dept. of Veterans Affairs, Washington DC, DC
Suzanne Bradley, MD , Grecc 11G, Ann Arbor VA Medical Center, Ann Arbor, MI
Ona Montgomery, RN , Department of Infectious Diseases, Amarillo VA Medical Center, Amarillo, TX
Chester Davis, ScD , Office of the Medical Inspector ( 10MI ), US Dept. of Veterans Affairs, Washington, DC, DC
Linda Danko, RN , Office of Infectious Diseases, US Dept. of Veterans Affairs, Cinncinati VA Medical Center, Cincinnati, OH
John R. Pierce, MD , Office of the Medical Inspector (10MI ), US Dept. of Veterans Affairs, Washington, DC, DC
Christa Hojlo, PhD, RN , Office of Geriatrics and Extended Care, US Dept. of Veterans Affairs, Washington, DC, DC
Robert Gaynes, MD , Department of Infectious Diseases, Atlanta VA Medical Center and US Centers for Disease Prevention and Control, Decatur, GA
Chesley Richards, MD , Centers for Disease Control and Prevention, National Center for Preparedness,Division of Healthcare Quality Promotion, Atlanta, GA
Cynthia Gibert, MD , Dept. of Infectious Diseases, Washington DC VA Medical Center, Washinton DC, DC
Gary Roselle, MD , Office of Infectious Diseases, US Dept. of Veterans Affairs, Cincinnati VA Medical Center, Cincinnati, OH

Introduction: Nursing home residents are at risk for nursing home-associated infections (NHAIs). However, factors contributing to NHAIs are incompletely understood. We conducted a NHAI point-prevalence survey of residents at all VA Community Living Centers (CLCs) (previously called Nursing Home Care Units). The purpose was to determine the prevalence of NHAIs and any association with medical indwelling devices. In addition, we explored the differences in prevalence between residents in geographically designated specialized units such as dementia units, rehabilitation units, etc., and those in dispersed settings where the entire resident population was housed together. We also surveyed the prevalence of NHAIs and indwelling devices stratified by VA CLC treatment codes.

Methods: We conducted a web-based point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections in 133 VA CLCs on November 14, 2007.

Results: From a population of 10,939 CLC residents, 575 had at least one NHAI for a point prevalence rate of 5.3%. Urinary tract infection, skin infection, asymptomatic bacteriuria, pneumonia, and soft tissue infection were most common constituting 65.9% of all NHAIs. A total of 2,687 residents had one or more indwelling devices, and 290 of these residents also had NHAIs for a prevalence of 10.8%. In contrast, the prevalence of NHAIs in residents without indwelling devices was 3.5% (p < 0.0001). Indwelling urinary catheter, percutaneous gastrostomy tube, peripherally inserted central catheter, suprapubic urinary catheter, and intravenous peripheral line were most common accounting for 79.7 % of all devices used. There were 4,027 residents in designated units, while 6,912 residents were in dispersed settings. The rate of indwelling device use in designated settings was 21.4%, versus 26.4% in dispersed settings. The prevalence of NHAIs in designated settings was 5.4%, versus 5.7% in dispersed settings. Prevalence rates of NHAIs and device use varied greatly among various treatment codes. For the fourteen treatment codes, there was a positive correlation between rates of device use and rates of NHAIs (correlation co-efficient = 0.68; n = 14; P= 0.008.)

Conclusions: The results of this VA NHAI survey are consistent with those of the VA survey conducted in 2005, with NHAI point prevalences of 5.3% and 5.2%, respectively. This suggests that the survey instruments used are reproducible. Both surveys revealed that indwelling device use was associated with a threefold increase in the prevalence of NHAIs. Reducing the use of indwelling device may decrease NHAIs.

Learning Objectives:
List the most common nursing home- associated infections. Articulate the impact of indwelling devices on the prevalence of nursing home-associated infections. Develop effective public health approach to prevent, monitor and control nursing home-associated infections.

Keywords: Nursing Homes, Infectious Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This abstract builds upon previous APHA abstracts presented and resulted in several peer review journal publications which contributed to generalizable knowledge of system-wide nursing home infection surveillance in 133 VA nursing homes.The publications and presentations are: the American Journal of Infection Control (2005 and 2007);the American Journal of Medical Quality (2007);two abstract presentations at the APHA annual meetings (2006,2007).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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