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

ABSTRACT

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.