Infection Control in Nursing Homes

The research revealed that each year, from 2000 to 2007, 15% of almost all nursing homes in the United States were cited for deficiencies in infection control.

Risk factors for citation included low levels of nursing staff and poor quality of care overall.

Infection control seemed to grow worse over time. "An upward trend was evident, from 12.87% of nursing homes in 2000 to 17.31% in 2007," write the authors, led by Nicholas G. Castle, PhD, from the University of Pittsburgh's Graduate School of Public Health in Pennsylvania.

Infection is the leading cause of morbidity and mortality among the 1.7 million nursing home residents in the United States, the authors explain in an article published in the May issue of the American Journal of Infection Control. Between 1.6 million and 3.8 million infections occur in this population each year, accounting for nearly 388,000 deaths annually, with costs ranging from $673 million to $2 billion. Yet, the authors point out, "despite the significance of infections and infection control in nursing homes and despite the interest in the lay press, little empirical research has been conducted in this area." To assess the efficacy of infection control measures in nursing homes, the researchers examined deficiency citations at facilities across the United States.

They used data from the Online Survey, Certification, and Reporting database — publicly available data collected as part of the certification process for Medicare and Medicaid. Nursing homes in every state must have Medicare or Medicaid certification to become licensed. The certification process relies on information taken from interviews, records, and direct observations gathered by teams of surveyors, who use the data to determine whether a facility meets certification standards, including infection control. If a nursing home does not meet a particular standard, it receives a citation. The citation for infection control is known as F-Tag 441. The F-Tag 441 citations range in severity from "A" (least serious) to "L" (most serious).

Using these data, the authors examined the number of nursing homes in each state that received F-Tag 441 citations annually between 2000 and 2007. Roughly 16,000 nursing homes were included in the data each year, representing 96% of all such facilities in the United States.

Nearly half — 48.6% — of the citations received were at the "D" level, representing the potential for more than minimal harm in terms of severity and isolated cases in terms of scope. Many of the F-Tag 441 citations were associated with low staffing levels of nurse aides (adjusted odds ratio [aOR], .91; P ≥ .001), licensed practical nurses (aOR, .92; P ≥ .05), and registered nurses (aOR, .89; P ≥ .001). "With low staffing levels, these caregivers are likely hurried and may skimp on infection control measures, such as hand hygiene," the authors explain. They also found that receiving an F-Tag 441 citation for infection control was associated with a poor quality of care overall.

Some of the lapses reported may represent problems in "paper compliance" with regulations, and not actual lapses in infection control by the staff, the authors note. In addition, many of the citations may have been for minor infractions.

They point out that the World Health Organization has started a Clean Care is Safer Care campaign to address the rising global incidence of healthcare-related infections by focusing on guidelines for hand hygiene. "Our findings clearly demonstrate the need for this kind of focus in US nursing homes."

The authors have disclosed no relevant financial relationships.



Source: www.medscape.com