Reducing Healthcare-Associated Infections (HAIs) in Long-Term Care (LTC): Current Strategies and Challenges

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Slide 1

Session 61, Track A: Reducing Healthcare-Associated Infections (HAIs) in Long-Term Care (LTC): Current Strategies and Challenges

AHRQ Annual Meeting
August 7, 2012

Nursing Home Staffing

Lance R. Peterson, MD
Epidemiologist
Director, Microbiology and ID Research
NorthShore University HealthSystem, Evanston, IL
Clinical Professor, University of Chicago
Chicago, IL USA

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The 'DERAIL MRSA' Program (Detection, Education, Research And decolonization without Isolation in Long-term care to control MRSA)

(Detection, Education, Research And decolonization without Isolation in Long-term care to control MRSA)

• Goal: Develop a strategy for Infection Control and Prevention in Acute care to Partner with LTCFs:
  • Program began in early 2011; MRSA was proof of concept pathogen.
  • To date more than 8,500 MRSA tests done on LTCF patients as part of periodic resident testing and all admission surveillance.
  • Close relationship between 3 nursing home senior management and IPs.

Slide 3

Overall Incidence of Organisms in LTCFs

Image: A bar graph shows the following data:

• S. aureus - 13.1.
• CNS - 12.1.
• P. mirabilis - 11.6.
• E. coli - 11.1.
• Enterococcus - 9.4.
• P. aeruginosa - 6.3.
• Streptococcus spp. - 6.15.
• K. pneumonia - 5.6.
• Yeast - 4.8.
• Providencia spp. - 3.5.
• Enterobacter spp. - 2.
• Citrobacter spp. - 2.
• M. morganii - 1.1.

(n=4,954)

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Leverage of Acute Care Data

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Can Acute Care Leverage IC Practice in LTCFs?

• Initial discussion with LTCF manager elicited little interest in working with acute hospital IC group:
  • IC 'assigned' to senior nursing staff.
• Acute care organization leadership indicated need to cease use of 'high risk' LTCFs.
• Owner requested Epidemiologists to visit and discuss how to improve IC in LTCFs:
  • Agreed to hire full time IP.

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What About LTCF Staff Turnover?

• All staff:
  • Comprehensive review found inconsistent and contradictory conclusions regarding staffing and care quality.

    — K Spilsbury et al. Intl J Nurs Studies 48:732-50, 2011.

  • Recent state-wide report (2002-2009) found retention (experience) lowered hospital readmission but turnover (frequent change in selected positions) did not.

    —KS Thomas et al. The Gerontologist (Adv. Access Aug 30, 2012.

• IP staff:
  • No reports found.
  • The number of beds justifying a full time IP is not known

    —2008 SHEA/APIC LTCF Guideline.

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Acute Care and LTCF Relationship

• Annual visit to meet with LTCF managers and senior staff/owners.
• IPs from LTCFs invited to attend weekly IC meeting at Acute Care facility.
• IPs from LTCFs encouraged to call Acute Care IP whenever consultation is needed.

Slide 8

Questions for Consideration

• What strategies have you used to engage LTCF leadership interest in an ongoing relationship with IC that is more readily available in acute care facilities?
• Have you observed any organizational models that enhance general staff commitment to LTCFs—are there incentives that work and disincentives to avoid?
• Do you have any idea(s) on how to specifically stabilize IP (IC) staff to reduce turnover/increase retention for these workers in LTCFs?