Changes in colonization of residents and staff of a long-term care facility and an adjacent acute-care hospital geriatric unit by multidrug-resistant bacteria over a four-year period

2013 ◽  
Vol 46 (2) ◽  
pp. 114-122 ◽  
Author(s):  
Albert March ◽  
Richard Aschbacher ◽  
Elisabetta Pagani ◽  
Ferisa Sleghel ◽  
Gertrud Soelva ◽  
...  
Keyword(s):  
Long Term Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Care Hospital ◽  
Term Care ◽  
Long Term Care Facility ◽  
Geriatric Unit

Clostridium difficileInfection in a Long-Term Care Facility: Hospital-Associated Illness Compared with Long-Term Care-Associated Illness

2011 ◽  
Vol 32 (7) ◽  
pp. 656-660 ◽  
Author(s):  
Jong Hun Kim ◽  
Diana Toy ◽  
Robert R. Muder
Keyword(s):  
Acute Care ◽  
Long Term Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Optimal Strategies ◽  
Care Hospital ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

Background.Controversy exists over whetherClostridium difficileinfection (CDI) commonly occurs in long-term care facility residents who have not been recently transferred from an acute care hospital.Objective.To assess the incidence and outcome of CDI in a long-term care facility.Methods.Retrospective cohort study in a 262-bed long-term care Veterans Affairs facility in Pittsburgh, Pennsylvania, for the period January 2004 through June 2010. CDI was identified by positive stoolC. difficiletoxin assay and acute diarrhea. Patients were categorized as hospital-associated CDI (HACDI) or long-term care facility–associated CDI (LACDI) and followed for 6 months.Results.The annual rate of CDI varied between 0.11 and 0.23 per 1,000 resident-days for HACDI patients and between 0.04 and 0.28 per 1,000 resident-days for LACDI patients. We identified 162 patients, 96 patients (59.3%) with HACDI and 66 patients (40.7%) with LACDI. Median age was 74 and 77 years, respectively, for HACDI and LACDI (P= .055) patients. There were more patients with at least 1 relapse of CDI during 6 months of follow up in LACDI patients (32/66, 48.5%) than in HACDI patients (28/96, 29.2%;P= .009). Logistic regression showed that ages of at least 75 years (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.07–5.07;P= .033), more than 2 transfers to an acute care hospital (OR, 7.88; 95% CI, 1.88–32.95;P= .005), and LACDI (OR, 3.15; 95% CI, 1.41–7.05;P= .005) were associated with relapse of CDI.Conclusions.Forty percent of CDI cases were acquired within the long-term care facility, indicating a substantial degree of transmission. Optimal strategies to prevent CDI in the long-term care facility are needed.

scholarly journals Comparative Effectiveness of Standard and Contingency-based Cleaning in Acute and Long-Term Care Facilities amidst Staff Shortages and a COVID-19 Surge

2021 ◽  
Author(s):  
Emil Lesho ◽  
Donna Newhart ◽  
Lisa Reno ◽  
Scott Sleeper ◽  
Julia Nary ◽  
...  
Keyword(s):  
Long Term Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Care Hospital ◽  
Term Care ◽  
Long Term Care Facility ◽  
Residential Units ◽  
Before And After ◽  
Uv C

Background: Cleanliness of hospital surfaces helps prevent healthcare-associated infections, but larger evaluations of the effectiveness of various cleaning strategies during SARS-CoV-2 surges and worker shortages are scarce. Methods: In an acute care hospital (ACH) and a long-term care facility (LTCF), 417 surfaces were tested for SARS-CoV-2 and adenosine triphosphate before and after various cleaning strategies, including ultraviolet light (UV-C), electrostatic spraying, and room fogging. Results: ACH surface contamination differed among outbreak and non-outbreak wards (p = 0.001). RNA was detected on 66% of surfaces before cleaning and on 23% of those surfaces immediately after terminal cleaning, for a 65% post-cleaning reduction (p = 0.001). UV-C resulted in an 87% reduction (p = 0.023), while spraying with electrostatic bleach resulted in a 47% reduction (p = 0.010). LTCF contamination rates differed between the dementia, rehabilitation, and the residential units (p = 0.005). 67% of surfaces had RNA after room fogging without terminal-style wiping. Fogging with wiping led to an 11% reduction in the proportion of positive surfaces. Discussion: Baseline contamination varied by type of unit and outbreak conditions, but not facility type. Removal of viral RNA varied according to strategy. Unlike previous reports, time spent cleaning was associated with cleaning thoroughness.

Colonization and Transmission of High-Level Gentamicin-Resistant Enterococci in a Long-Term Care Facility

1994 ◽  
Vol 15 (11) ◽  
pp. 703-709 ◽  
Author(s):  
Carol E. Chenoweth ◽  
Suzanne F. Bradley ◽  
Margaret S. Terpenning ◽  
Lidija T. Zarins ◽  
Mary A. Ramsey ◽  
...  
Keyword(s):  
Acute Care ◽  
Long Term Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Care Hospital ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
High Level

AbstractObjectives:To assess the prevalence of high-level gentamicin-resistant enterococcus (HGRE) colonization, transmission patterns, and spectrum of illness among residents of a long-term care facility.Design:Monthly surveillance for HGRE colonization of wounds, rectum, and perineum over a 1-year period.Setting:A Veterans Affairs long-term care facility attached to an acute-care facility.Patients:All 341 patients in the facility during the observation period.Results:Over the 1-year period, 120 patients (35.2%) were colonized with HGRE at least once, with an overall monthly colonization rate of 20± 1.5%. HGRE were isolated from rectum (12.8%), wounds (11.7%), and perineum (9.3%). Patients with the poorest functional status had the highest rate of colonization (P<0.0005). HGRE-colonized patients were more likely to be colonized with methicillin-resistantStaphylococcus aureus(51% versus 25%; P<0.0005). Seventy-four patients (21.7%) were colonized at admission or at the start of the study. Another 46 patients (13.5%) acquired HGRE during the study, including 36 who acquired HGRE while in the long-term care facility and 10 who were positive when transferred back from the acute-care hospital. Based on plasmid profiles, only two patients appeared to have isolates similar to those of current or previous roommates. Carriage of HGRE was transient in most cases. Only 20 patients were colonized for 4 or more months, and those patients usually carried different strains intermittently. Infections were infrequent, occurring in only 4.1% of total patients.Conclusions:In our long-term care facility, HGRE were endemic, and new acquisition of HGRE occurred frequently. However, only two patients had evidence of acquisition from a roommate, suggesting that cross-infection from a roommate was not a major route of spread of HGRE.

An Outbreak of Norovirus Infection in a Long-Term-Care Unit in Spain

2005 ◽  
Vol 26 (3) ◽  
pp. 259-262 ◽  
Author(s):  
Gemma Navarro ◽  
Rosa M. Sala ◽  
Ferran Segura ◽  
César Arias ◽  
Pilar Varela ◽  
...  
Keyword(s):  
Long Term Care ◽  
Clinical Symptoms ◽  
Care Facility ◽  
Care Hospital ◽  
Term Care ◽  
Long Term Care Facility ◽  
Staff Members ◽  
Genotype 2 ◽  
Stool Cultures

AbstractBackground:Norovirus belongs to the Caliciviridae family and causes outbreaks of infectious enteritis by fecal-oral transmission. In Spain, there have been few outbreaks reported due to this virus. We describe an outbreak on a long-term-care hospital ward.Methods:Cases were classified as probable, confirmed, and secondary. Stool cultures were performed. Polymerase chain reaction detection of norovirus was also performed.Results:The outbreak occurred from December 7 to 28, 2001, involving 60 cases (32 patients, 19 staff members, 8 patients' relatives, and 1 relative of a staff member). Most (82%) of the cases were female. The most frequently involved ages were 20 to 39 years for staff members and 70 to 89 years for patients. The incubation period of secondary cases in patients' families had a median of 48 hours (range, 1 to 7 days). Clinical symptoms included diarrhea (85%), vomiting (75%), fever (37%), nausea (23%), and abdominal pain (12%). Median duration of the disease was 48 hours (range, 1 to 7 days). All cases resolved and the outbreak halted with additional hygienic measures. Stool cultures were all negative for enteropathogenic bacteria and rotaviruses. In 16 of 23 cases, the norovirus genotype 2 antigen was detected.Conclusion:This outbreak of gastroenteritis due to norovirus genotype 2 affected patients, staff members, and their relatives in a long-term-care facility and was controlled in 21 days.

Pneumonia in the Long-Term-Care Facility

2002 ◽  
Vol 23 (3) ◽  
pp. 159-164 ◽  
Author(s):  
Thomas J. Marrie
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Multidrug Resistant ◽  
Term Care ◽  
Long Term Care Facility ◽  
Anticholinergic Medications ◽  
Care Facilities ◽  
Profound Disability ◽  
Common Infection

AbstractPneumonia is a common infection among residents of long-term-care facilities (LTCFs), with an incidence of 1.2 episodes per 1,000 patient-days. This rate is believed to be six- to tenfold higher than the rate of pneumonia among elderly individuals living in the community. The risk factors for pneumonia among residents of LTCFs are profound disability, bedridden state, urinary incontinence, difficulty swallowing, malnutrition, tube feedings, contractures, and use of benzodiazepines and anticholinergic medications. An elevated respiratory rate is often an early clue to pneumonia in this group of patients. Staphylococcus aureus (including methicillin-resistant S. aureus) and aerobic gram-negative bacilli (including multidrug-resistant isolates) are more frequent causes of pneumonia in this setting than in the community. Criteria have been developed that help identify patients for treatment in their LTCFs.

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