Infection Control in Long Term Care
Settings
Moderator: Carol Goldman, RN, BScN, CIC
Infection Control Consultant
IFIC Board member, CHICA-Canada
Expert Guest: Allison McGeer, MD, FRCP
Director, Infection Prevention and
Control Dept.
Mount Sinai, Hospital Toronto, Canada
Infection Control in Long Term Care Settings
Thank you for sponsoring this
workshop
Infection Control in Long Term Care
Settings
Format for today’s workshop:
• Define and review long term care (LTC)
settings
• Discuss common infections and outbreaks
associated in LTC
• Review surveillance in LTC
• Work collaboratively in groups to review and
present the elements of an IPC programme in
LTC
Infection Control in Long Term Care
Settings
• A facility that provides rehabilitative,
restorative, and/or ongoing skilled care for
those of all ages in need of assistance with
activities of daily living
– nursing homes
– rehabilitation facilities,
– Extended care situations – behaviour health,
psychiatric, physical and mental challenges
– long-term chronic care
Infection Control in Long Term Care
Settings
The differences of Infection Control in a LTC vs. Acute
Care
• fewer resources
• less expertise/increased turnover
• multiple duties
• diagnostic facilities
• residence
• medical record
• limited research
Infection Control in Long Term Care
Settings
•
•
•
•
urinary infections
respiratory infections
skin and soft tissue infections
Outbreaks also occur frequently, and some
facilities have a high prevalence of
colonization of residents with antimicrobialresistant organisms.
Infection Control in Long Term Care
Settings
• Prevalence of infection documented between 5.4 and 32.7 per
100 residents per month
• Infection incidence rates have been documented between 1.5
and 9.4 per 1,000 resident days
• An estimated 1.5 million infections occur annually in LTC
facilities in the United States
• Facility-acquired infections account for 30% of all hospital
admissions from nursing homes
• Are the most common immediate cause of death in nursing
home residents
• NURSING HOMES, May, 2006 by Linda L. Spaulding
Infection Control in Long Term Care
Settings
• 3 yr study looking at respiratory infections in Toronto
• 0.42 infections per 1000 resident-days
• Outbreaks occurred year round, with no seasonal
pattern
• Pneumonia developed in 72 (15%)
• 58 (12%) required transfer to hospital
• The case-fatality rate was 8% (37/480)
CMAJ, April 2000, McGeer et al
Infections in residential long term
care for the elderly in Canada,
1994-6
Rate of infection per 1000
resident days
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
Respiratory
Skin
Gastro
Urinary
Prevalence of infections in Italian
long term care facilities
30
25
20
Percent of
15
residents
10
5
0
Lower resp
Skin
Conjunctivitis
Urinary
Infection Control in Long Term Care Settings
questions you need to ask
Who are your patients and what kind of
infections are they most at risk of?
- slide on NH distribution
- but it depends on populations
Are these infections sporadic, or do they occur as
outbreaks?
What opportunities are there to prevent disease?