Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-28T09:54:48.890Z Has data issue: false hasContentIssue false
  • English
  • Français

The Role of the Laboratory in Infection Prevention and Control Programs in Long-Term–Care Facilities for the Elderly

Published online by Cambridge University Press:  02 January 2015

Andrew E. Simor
Andrew E. Simor*
Affiliation:
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, and the Infection Prevention and Control Service, Baycrest Centre for Geriatric Care, University of Toronto, Toronto, Ontario, Canada
*
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, B121-2075 Bayview Ave, North York, Ontario, M4N 3M5, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Hospital infection prevention and control programs rely extensively on diagnostic microbiology laboratory testing. However, specimens for microbiological evaluation are less likely to be obtained from elderly residents of long-term–care facilities (LTCFs). In this article, issues regarding laboratory utilization and the potential role of the microbiology laboratory in infection prevention and control programs in LTCFs are reviewed. The role of the laboratory in infection surveillance, in the management of antimicrobial resistance, and in outbreak investigation are highlighted.

Type
Topics in Long-Term Care
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 7 , July 2001 , pp. 459 - 463
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Nicolle, LE, Garibaldi, R, Strausbaugh, LJ. Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev 1996;9:1–17.Google Scholar
2.Nicolle, LE. Infection control in long-term care facilities. Clin Infect Dis 2000;31:752–756.Google Scholar
3.Strausbaugh, LJ, Crossley, KB, Nurse, BA, Thrupp, LD, SHEA Long-Term-Care Committee. Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol 1996;17:129–140.Google Scholar
4.Smith, PW, Rusnak, PG. Infection prevention and control in the long-term-care facility. Infect Control Hosp Epidemiol 1997;18:831–849.CrossRefGoogle ScholarPubMed
5.Goldrick, BA. Infection control programs in long-term-care facilities: structure and process. Infect Control Hosp Epidemiol 1999;20:764–769.Google Scholar
6.Emori, TG, Gaynes, RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993;6:428–442.Google Scholar
7.Smith, PW. Infection surveillance in long-term care facilities. Infect Control Hosp Epidemiol 1991;12:55–58.Google Scholar
8.Goldrick, BA. Infection control programs in skilled nursing long-term care facilities: an assessment, 1995. Am J Infect Control 1999;27:4–9.Google Scholar
9.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
10.Fein, AM. Pneumonia in the elderly. Special diagnostic and therapeutic considerations. Med Clin North Am 1994;8:1015–1033.CrossRefGoogle Scholar
11.Nicolle, LE. Urinary tract infections in long-term care facilities. Infect Control Hosp Epidemiol 1993;14:220–225.Google Scholar
12.Orr, PH, Nicolle, LE, Duckworth, H, Brunka, J, Kennedy, J, Murray, D, et al.Febrile urinary infection in the institutionalized elderly. Am J Med 1996;100:71–77.CrossRefGoogle ScholarPubMed
13.Pearson, DA, Checko, PJ, Hierholzer WJ Jr, Jekel, JF. Infection control practices in Connecticut's skilled nursing facilities. Am J Infect Control 1990;18:269–276.Google Scholar
14.Smith, PW. Consensus conference on nosocomial infections in long-term care facilities. Am J Infect Control 1987;15:97–100.CrossRefGoogle ScholarPubMed
15.McGeer, A, Campbell, B, Emori, TG, Hierholzer, WJ, Jackson, MM, Nicolle, LE, et al.Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991;19:1–7.Google Scholar
16.Jackson, MM, Fierer, J, Barrett-Connor, E, Fraser, D, Klauber, MR, Hatch, R, et al.Intensive surveillance for infections in a three-year study of nursing home patients. Am J Epidemiol 1992;135:685–696.Google Scholar
17.Terpenning, MS, Bradley, SF, Wan, JY, Chenoweth, CE, Jorgensen, KA, Kauffman, CA. Colonization and infection with antibiotic-resistant bacteria in a long-term care facility. J Am Geriatr Soc 1994;42:1062–1069.Google Scholar
18.Wiener, J, Quinn, JP, Bradford, PA, Goering, RV, Nathan, C, Bush, K, et al.Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281:517–523.Google Scholar
19.Smith, PW, Seip, CW, Schaefer, SC, Bell-Dixon, C. Microbiologic survey of long-term care facilities. Am J Infect Control 2000;28:8–13.Google Scholar
20.Bonomo, RA. Multiple antibiotic-resistant bacteria in long-term-care facilities: an emerging problem in the practice of infectious diseases. Clin Infect Dis 2000;31:1414–1422.Google Scholar
21.Bradley, SF. Methicillin-resistant Staphylococcus aureus in nursing homes. Epidemiology, prevention, and management. Drugs Aging 1997;10:185–198.Google Scholar
22.Nicolle, LE, Bentley, DW, Garibaldi, R, Neuhaus, EG, Smith, PW, the SHEA Long Term-Care Committee. Antimicrobial use in long-term-care facilities. Infect Control Hosp Epidemiol 2000;21:537–545.Google Scholar
23.Jones, SR, Parker, DF, Liebow, SE, Kimbrough, RC III, Frear, RS. Appropriateness of antibiotic therapy in long-term care facilities. Am J Med 1987;83:499–502.Google Scholar
24.Warren, JW, Palumbo, FB, Fitterman, L, Speedie, SM. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc 1991;39:963–972.Google Scholar
25.Pickering, T-D, Gurwitz, JH, Zaleznik, D, Noonan, JP, Avorn, J. The appropriateness of oral fluoroquinolone-prescribing in the long-term care setting. J Am Geriatr Soc 1994;42:28–32.Google Scholar
26.Mylotte, JM. Measuring antibiotic use in a long-term care facility. Am J Infect Control 1996;24:174–179.Google Scholar
27.Zimmer, JG, Bentley, DW, Valenti, WM, Watson, NM. Systemic antibiotic use in nursing homes. A quality assessment. J Am Geriatr Soc 1986;34:703–710.CrossRefGoogle ScholarPubMed
28.Katz, PR, Beam, TR Jr, Brand, F, Boyce, K. Antibiotic use in the nursing home. Physician practice patterns. Arch Intern Med 1990;150:1465–1468.Google Scholar
29.Nicolle, LE. Urinary tract infection in long-term-care facility residents. Clin Infect Dis 2000;31:757–761.Google Scholar
30.Nicolle, LE, Orr, P, Duckworth, H, Brunka, J, Kennedy, J, Urias, B, et al.Prospective study of decubitus ulcers in two long term care facilities. Can J Infect Control 1994;9:35–38.Google Scholar
31.Walker, S, McGeer, A, Simor, AE, Armstrong-Evans, M, Loeb, M. Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people? Can Med Assoc J 2000;163:273–277.Google Scholar
32.Magaziner, J, Tenney, JH, DeForge, B, Hevel, JR, Muncie, HL Jr, Warren, JW. Prevalence and characteristics of nursing home-acquired infections in the aged. J Am Geriatr Soc 1991;39:1071–1078.Google Scholar
33.Franson, TR, Schicker, JM, LeClair, SM, Hoffmann, RG, Duthie, EH Jr. Documentation and evaluation of fevers in hospital-based and community-based nursing homes. Infect Control Hosp Epidemiol 1988;9:447–450.Google Scholar
34.Bentley, DW, Bradley, S, High, K, Schoenbaum, S, Taler, G, Yoshikawa, TT. Practice guidelines for evaluation of fever and infection in long-term care facilities. Clin Infect Dis 2000;31:640–653.Google Scholar
35.Bonten, MJ, Weinstein, RA. The role of colonization in the pathogenesis of nosocomial infection. Infect Control Hosp Epidemiol 1996;17:193–200.Google Scholar
36.Garibaldi, RA, Burke, J. Surveillance and control of antibiotic use in the hospital. Am J Inject Control 1991;19:164–170.Google Scholar
37.Loeb, M, McGeer, A, McArthur, M, Peeling, RW, Petric, M, Simor, AE. Surveillance for outbreaks of respiratory tract infections in nursing homes. Can Med Assoc J 2000;162:1133–1137.Google Scholar
38.Strausbaugh, LJ, Joseph, CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol 2000;21:674–679.Google Scholar
39.Kludt, P, Lett, SM, DeMaria, A, Crutcher, JM, Curtis, NM, Garvey, CW, et al.Outbreaks of pneumococcal pneumonia among unvaccinated residents in chronic-care facilities—Massachusetts, October 1995, Oklahoma, February 1996, and Maryland, May-June 1996. MMWR 1997;46:60–62.Google Scholar
40.Nuorti, JP, Butler, JC, Crutcher, JM, Guevara, R, Welch, D, Holder, P, et al.An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents. N Engl J Med 1998;338:1861–1868.Google Scholar
41.Auerbach, SB, Schwartz, B, Williams, D, Fiorilli, MG, Adimora, AA, Breiman, RF, et al.Outbreak of invasive group A streptococcal infections in a nursing home. Lessons on prevention and control. Arch Intern Med 1992;152:1017–1022.Google Scholar
42.Schwartz, B, Ussery, XT. Group A streptococcal outbreaks in nursing homes. Infect Control Hosp Epidemiol 1992;13:742–747.Google Scholar
43.Stead, WW, Lofgren, JP, Warren, E, Thomas, C. Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. N Engl J Med 1985;312:1483–1487.Google Scholar
44.Bentley, DW. Tuberculosis in long-term care facilities. Infect Control Hosp Epidemiol 1990;11:42–46.Google Scholar
45.Holness, DL, DeKoven, JG, Nethercott, JR. Scabies in chronic health care institutions. Arch Dermatol 1992;128:1257–1260.CrossRefGoogle ScholarPubMed
46.Mathur, U, Bentley, DW, Hall, CB. Concurrent respiratory syncytial virus and influenza A infections in the institutionalized elderly and chronically ill. Ann Intern Med 1980;93:49–52.Google Scholar
47.Bradley, SF, Long-Term-Care Committee of the Society for Healthcare Epidemiology of America. Prevention of influenza in long-term-care facilities. Infect Control Hosp Epidemiol 1999;20:629–637.Google Scholar
48.Falsey, A, Treanor, JJ, Betts, RF, Walsh, EE. Viral respiratory infections in the institutionalized elderly: clinical and epidemiological findings. J Am Geriatr Soc 1992;40:115–119.Google Scholar
49.Wald, TG, Miller, BA, Shult, P, Drinka, P, Langer, L, Gravenstein, S. Can respiratory syncytial virus and influenza A be distinguished clinically in institutionalized older persons? J Am Geriatr Soc 1995;43:170–174.Google Scholar
50.Waner, JL, Todd, SJ, Shalaby, H, Murphy, P, Wall, LV. Comparison of Directigen FLU-A with viral isolation and direct immunofluorescence for the rapid detection and identification of influenza A virus. J Clin Microbiol 1991;29:479–482.Google Scholar
51.Leonardi, GP, Leib, H, Birkhead, GS, Smith, C, Costello, P, Conron, W. Comparison of rapid detection methods for influenza A virus and their value in health-care management of institutionalized geriatric patients. J Clin Microbiol 1994;32:70–74.Google Scholar
52.Gomolin, IH, Leib, HB, Arden, NH, Sherman, FT. Control of influenza outbreaks in the nursing home: guidelines for diagnosis and management. J Am Geriatr Soc 1995;43:71–74.Google Scholar
53.Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(RR-3):1–38.Google Scholar
54.Barnham, M, Kerby, J. Streptococcus pyogenes pneumonia in residential homes: probable spread of infection from the staff. J Hosp Infect 1981;2:255–257.Google Scholar
55.Thomas, JC, Bridge, J, Waterman, S, Vogt, J, Kilman, L, Hancock, G. Transmission and control of methicillin-resistant Staphylococcus aureus in a skilled nursing facility. Infect Control Hosp Epidemiol 1989;10:106–110.Google Scholar
56.Simor, AE, Augustin, A, Ng, J, Betschel, S, McArthur, M. Control of MRSA in a long-term care facility. Infect Control Hosp Epidemiol 1994;15:69–70.Google Scholar
57.Armstrong-Evans, M, Lift, M, McArthur, MA, Willey, B, Cann, D, Liska, S, et al.Control of transmission of vancomycin-resistant Enterococcus faecium in a long-term-care facility. Infect Control Hosp Epidemiol 1999;20:312–317.Google Scholar
58.Brooks, SE, Veal, RO, Kramer, M, Dore, L, Schupf, N, Adachi, M. Reduction in the incidence of Clostridium difficile-associated diarrhea in an acute care hospital and a skilled nursing facility following replacement of electronic thermometers with single-use disposables. Infect Control Hosp Epidemiol 1992;13:98–103.Google Scholar
59.Patterson, JE, Madden, GM, Krisiunas, EP, Masecar, B, Hierholzer, WJ Jr, Zervos, MJ, et al.A nosocomial outbreak of ampicillin-resistant Haemophilus influenzae type b in a geriatric unit. J Infect Dis 1988;157:1002–1007.Google Scholar
60.Maslow, JN, Mulligan, ME, Arbeit, RD. Molecular epidemiology: application of contemporary techniques to the typing of microorganisms. Clin Infect Dis 1993;17:153–164.Google Scholar
61.Fang, FC, McClelland, M, Guiney, DG, Jackson, MM, Hartstein, AI, Morthland, VH, et al.Value of molecular epidemiologic analysis in a nosocomial methicillin-resistant Staphylococcus aureus outbreak. JAMA 1993;270:1323–1328.Google Scholar