Prospective surveillance for healthcare-associated infections in German nursing home residents

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Summary

We undertook a prospective surveillance study in order to determine the incidence of healthcare-associated infections (HCAIs) in German nursing home residents. All people residing for more than one day in a 103-bed nursing home for the elderly in Bonn, Germany between December 1998 and November 1999 were included. Active surveillance was based on previously published consensus definitions. Rates for HCAIs and urinary tract infections (UTIs) were calculated based on resident-days and device-utilization days, respectively. The overall incidence of HCAIs was 6.0 per 1000 resident-days, with respiratory tract infections, gastroenteritis, skin/soft tissue infections and UTIs representing 94% of all HCAIs (2.2, 1.2, 1.2 and 1.0 infections per 1000 resident-days, respectively). Residents with pneumonia were more likely to die than residents with other HCAIs (RR=5.09; 95%CI 1.87–13.89; P=0.011). We conclude that HCAIs are a serious health problem in German nursing home residents. Standardized surveillance in nursing homes is important to assess the effectiveness of infection control standards, and should be based on consensus definitions in order to allow for meaningful interfacility comparisons. In Germany, the implementation of a hospital reimbursement system based on diagnosis-related groups is likely further to increase the proportion of vulnerable populations in long-term-care facilities.

Introduction

Elderly people are at increased risk for nosocomial and healthcare-associated infections (HCAIs),1 and available data from the USA show that infections are an increasing problem for long-term-care facilities and nursing homes.2 To date, however, most surveillance studies of nursing home infections have been conducted in the USA;3, 4, 5, 6 only a few have been performed in European countries such as Norway,7 the Netherlands8 and Belgium,9 and none have been conducted in Germany. In Germany, the increasing population >65 years of age and the forthcoming implementation of a hospital reimbursement system based on diagnosis-related groups is likely to lead to more rapid transfer of hospitalized patients to long-term-care facilities, resulting in a further increase of the population at risk and people with specific risk factors in nursing homes. To determine the incidence and characterize the spectrum of HCAIs in a German nursing home population, we undertook a prospective surveillance study.

Section snippets

Population characteristics and setting

All people residing for more than one day in a 103-bed nursing home for the elderly in Bonn, Germany between December 1998 and November 1999 were included in the study. The 125 residents had a median of three (range 0–5) concomitant diseases (Table I, Table II), required an average of 2.2 h of skilled nursing care per day (Table III), mean age was 83.1 years (range 59–99 years), and 92 (73.6%) of them were female. Overall, 16.0% were confined to their bed for prolonged periods, 33.6% were

Results

During the 12-month surveillance period, 208 infections were recorded for the 125 residents (34 793 resident-days) for an HCAI rate of 6.0 per 1000 resident-days (Table IV, Table V).

More than one-third of all HCAIs were respiratory tract infections, most (58.7%) of which were infections of the lower respiratory tract. The rate was significantly higher during the winter (i.e. from December to April; see Table IV). Nursing home residents with chronic obstructive pulmonary disease (COPD) or

Discussion

This is the first published surveillance study about the incidence of HCAIs, many of which are severe or even fatal, in German nursing home residents. It shows that German nursing home residents have a high rate of infections, comparable to that found in other European countries and the USA (data ranging between three and eight infections per 1000 resident-days).4, 11, 12, 13 For example, the incidence of pneumonia requiring hospitalization in our study was 56 per 1000 residents; Fein14

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