Online Program

Nursing home policies and practices for healthcare acquired infections: Results from a national survey

Tuesday, November 5, 2013 : 10:42 a.m. - 10:54 a.m.

Helena Temkin-Greener, PhD, Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
Susan Huang, MD, MPH, Department of Medicine, University of California, Irvine, Orange, CA
Yue Li, PhD, Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY
Zhiqiu Ye, BSN, RN, Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY
Dana B. Mukamel, PhD, Department of Medicine, University of California, Irvine, Irvine, CA
Currently, there is no national-level data on the prevalence of healthcare-acquired infections (HAIs) in nursing homes (NHs) and policies/practices they adopt. In 2012, we conducted a national survey of NHs, focusing on the most common HAIs: methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C diff), and Extended Spectrum Beta-Lactamase producers (ESBLs). The survey included questions regarding prevalence, admission and screening policies, contact precautions, decolonization, and cleaning practices. 1,002 surveys were returned. For MRSA, carrier prevalence was 4.04% (SD=6.00%) and infection was 0.71% (SD=1.41%). 14.2% of NHs were less likely to accept residents with MRSA. The principal reason for denying admission was lack of single/cohort rooms. Majority of NHs (96.4%) did not perform routine admission screening because: it was not required by regulatory agencies (56.2%); would not change care provision (30.7%); and due to screening costs (17.5%). Isolation strategies differed widely - 50.6% adhered to national guidelines by using contact precautions for infected patients with draining wounds while 39.0% went beyond guidance. Despite no guidance for differential cleaning of MRSA carriers' rooms, 59.3% reported increased cleaning, including more frequent cleaning (21.8%) or cleaning more items (44.6%) per room. Similar information about prevalence, policies and practices with respect to Cdiff and ESBL will be presented.HAIs are frequently found in NHs, but policies denying admission to HAI carriers do not appear to be common. NHs lack standardized approaches to infection prevention, and large variations in practices exist. Many facilities have adopted isolation, decolonization and cleaning practices that extend beyond current guidance.

Learning Areas:

Public health or related research

Learning Objectives:
Demonstrate prevalence of healthcare-acquired infections in US nursing homes. Identify nursing home practices and policies with regard to healthcare-acquired infections.

Keyword(s): Infectious Diseases, Nursing Homes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Information presented is in my area of expertise. My research interests include outcomes research with a focus on the elderly, long-term care, and end-of-life. I am co-author of several articles on these topics.
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.