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Infection prevention issues in long-term care

Nicolle, Lindsay E.

Current Opinion in Infectious Diseases: August 2014 - Volume 27 - Issue 4 - p 363–369
doi: 10.1097/QCO.0000000000000071
NOSOCOMIAL AND HEALTHCARE RELATED INFECTIONS: Edited by Trish M. Perl

Purpose of review Infections and antimicrobial use are common in residents of long-term care facilities. This review discusses recent articles that address infection prevention and control and antimicrobial stewardship in these facilities.

Recent findings National surveys confirm the continuing high prevalence of infections in residents of long-term care facilities, with the greatest risk for patients with the highest acuity and greatest functional disability. Long-term acute care facilities are a unique environment where residents are characterized by high levels of indwelling device use and antimicrobial-resistant organisms. The major determinant of antimicrobial resistance in long-term care facilities is antimicrobial use. The Centers for Disease Control (CDC) has proposed revised evidence-based definitions for surveillance of infections on the basis of the original McGeer criteria. Consensus national performance standards for infection prevention and antimicrobial stewardship programs in long-term care facilities have been developed in a European initiative. Evidence to support the efficacy of infection control programs is limited. Antimicrobial stewardship programs may, however, be effective in reducing inappropriate antimicrobial use.

Summary The extent to which endemic infections or antimicrobial resistance in long-term care facilities can be prevented remains unclear. Efforts to limit infections in these facilities should focus on outbreak prevention and standard procedures for environmental cleaning, food preparation, and hand hygiene, together with optimal resident medical care. Antimicrobial stewardship programs should be implemented.

Department of Internal Medicine and Medical Microbiology, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada

Correspondence to Lindsay E. Nicolle, Department of Internal Medicine and Medical Microbiology, Health Sciences Centre, University of Manitoba, Rm GG443, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada. Tel: +1 204 787 7029; fax: +1 204 787 4826; e-mail: lnicolle@hsc.mb.ca

© 2014 Lippincott Williams & Wilkins, Inc.