Preventing HAIs in Nursing Homes

Ashely N. White, Ph.D.

Ashely N. White, Ph.D.

You First Services Research Scientist

The Senior Population Problem

Seniors are currently the fastest-growing population in the United States. It’s expected, between the years 2012 and 2050, the 65-and-over population will expand to 83.7 million (1). Since increased age tends to lead to slower immune response and a drop in our body’s ability to heal itself, (2) our country will begin to see a dramatic rise of people living with an increased risk of infection and disease, especially those in a healthcare setting.

Nursing Home and Long-Term Care (LTC) Facilities

Did you know that 1.4 million American seniors permanently reside in nursing homes and an additional 4 million receive short-term care in nursing home facilities? (3) Due to their age and immune system decline, these seniors are at high risk for developing a healthcare-associated infection (HAI). A 2011 prevalence study reported an 11.5% HAI prevalence rate in patients over the age of 85 (4). Additionally, the overall burden of HAIs in nursing homes is now estimated to exceed that of acute care facilities (5). This is in part due to the emergence of multi-drug resistant organisms (MDROs) in long-term care (LTC) facilities (6). In fact, over 35% of nursing home residents are colonized with MDROs (6-9). LTC facilities now largely serve as reservoirs for resistant organisms in the community. Most residents in such facilities have extensive histories of health care exposure, and many have chronic in-dwelling devices, such as feeding tubes or urinary catheters.

Most Common HAIs in Nursing Homes and LTC Facilities

The most common HAIs in nursing homes include urinary tract infections (UTIs), respiratory infections, skin or wound infections, gastroenteritis, and sepsis. Sepsis is less common; however, it is one of the most lethal infections that nursing home residents can develop. Of these infections, the highest reported infection is that of UTIs, especially those that are associated with an indwelling catheter. These infections are known as catheter-associated urinary tract infections (CAUTIs). It has been recorded that up to 13% of men and 12% of women have an indwelling urinary catheter upon admission to a nursing home (10). Each successive day of catheterization increases the risk of urine colonization by 3 to 8%, such that virtually all patients catheterized for greater than 30 days will experience bacteriuria (bacteria in the bloodstream), and the majority of patients with long-term catheters will experience at least one CAUTI (11-13). CAUTIs are particularly concerning because they can quickly lead to the onset of secondary bloodstream infections, which results in increased morbidity and mortality (10, 14).

HAI Transmission

HAI-causing microorganisms are spread to residents through four common routes of transmission: contact (direct and indirect), respiratory droplets, airborne spread, and common vehicle. Contact and common vehicle transmission are the most frequent modes of transmission in a healthcare setting. Infectious organisms are often transiently transferred to a health care worker (not causing an infection) or an abiotic medical device and are transferred to a susceptible resident who then develops an infection from that organism.

HAI Prevention

The source and transmission of the infecting microorganism needs to be properly eliminated in order to achieve HAI prevention in nursing home and LTC facilities. This requires obvious compliance to hand hygiene practices by the healthcare personnel, as well as the use and frequent replacement of proper personal protective equipment (PPE) (gloves, gowns, masks, etc.) (15). Proper cleaning and disinfection of medical devices is also essential to assure infection prevention and patient safety (15). Unfortunately, traditional manual disinfectants are often sub-optimal when it comes to effective protection against the spread of pathogens. Such disinfectants are not able to fully penetrate and disinfect hard-to-reach areas, and often leave behind a film of residue. This results in inconsistent device disinfection and increased transmission of infection. However, this inconsistency can be effectively addressed with the use of innovative disinfection technologies such as GloTran.

How GloTran Reduces HAIs

GloTran is an automated disinfection system based on cold plasma disinfection technology. Unlike manual disinfectants, GloTran has the ability to penetrate into hard-to-reach areas and mated surfaces. The gas plasma also removes all residues and detoxifies contaminants. The treatment is dry and cool, safe for many non-critical devices and electronics that cannot be treated with wet or high-temperature disinfection methods. The process is automated and effortless and delivers consistent results. Implementing this innovative and standardized technology into nursing homes and LTC facilities nationwide could effectively reduce the prevalence of HAIs and improve the quality of life for their residents.

Learn how GloTran can transform your disinfection process today! 

References:
  • Ortman JM, Velkoff, V.A., Hogan, H. 2014. An Aging Nation: The Older Population in the United States. Population Estimates and Projections. Current Population Reports. Commerce USDo, Economics and Statistics Administration, U.S. Census Bureau, http://usd-apps.usd.edu/coglab/schieber/psyc423/pdf/AgingNation.pdf. 
  • Montecino-Rodriguez E, Berent-Maoz B, Dorshkind K.2013. Causes, consequences, and reversal of immune system aging. J Clin Invest 123:958-65.
  • Grigg C, Palms D, Stone ND, Gualandi N, Bamberg W, Dumyati G, Harrison LH, Lynfield R, Nadle J, Petit S, Ray S, Schaffner W, Townes J, See I.2018. Burden of Invasive Methicillin-Resistant Staphylococcus aureus Infections in Nursing Home Residents. J Am Geriatr Soc 66:1581-1586.
  • Cairns S, Reilly J, Stewart S, Tolson D, Godwin J, Knight P.2011. The prevalence of health care-associated infection in older people in acute care hospitals. Infect Control Hosp Epidemiol 32:763-7.
  • Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K.2008. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 29:785-814.
  • Cassone M, Mody L.2015. Colonization with Multi-Drug Resistant Organisms in Nursing Homes: Scope, Importance, and Management. Curr Geriatr Rep 4:87-95.
  • Kikutani T, Tamura F, Tashiro H, Yoshida M, Konishi K, Hamada R.2015. Relationship between oral bacteria count and pneumonia onset in elderly nursing home residents. Geriatr Gerontol Int 15:417-21.
  • Daneman N, Bronskill SE, Gruneir A, Newman AM, Fischer HD, Rochon PA, Anderson GM, Bell CM.2015. Variability in Antibiotic Use Across Nursing Homes and the Risk of Antibiotic-Related Adverse Outcomes for Individual Residents. JAMA Intern Med 175:1331-9.
  • Fisch J, Lansing B, Wang L, Symons K, Cherian K, McNamara S, Mody L.2012. New acquisition of antibiotic-resistant organisms in skilled nursing facilities. J Clin Microbiol 50:1698-703.
  • Mody L, Greene MT, Meddings J, Krein SL, McNamara SE, Trautner BW, Ratz D, Stone ND, Min L, Schweon SJ, Rolle AJ, Olmsted RN, Burwen DR, Battles J, Edson B, Saint S.2017. A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents. JAMA Intern Med 177:1154-1162.
  • Maki DG, Tambyah PA.2001. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis 7:342-7.
  • Warren JW, Damron D, Tenney JH, Hoopes JM, Deforge B, Muncie HL, Jr.1987. Fever, bacteremia, and death as complications of bacteriuria in women with long-term urethral catheters. J Infect Dis 155:1151-8.
  • Garibaldi RA, Burke JP, Dickman ML, Smith CB.1974. Factors predisposing to bacteriuria during indwelling urethral catheterization. N Engl J Med 291:215-9.
  • Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE.2010. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 50:625-63.
  • Collins AS. Chapter 41 Preventing Health Care-Associated Infections, p.In(ed),   
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