Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-07T22:24:07.514Z Has data issue: false hasContentIssue false
  • English
  • Français

Non-respiratory infections – specific considerations in care homes

Published online by Cambridge University Press:  21 October 2010

Victoria Ewan  and
Adam Gordon
Victoria Ewan
Affiliation:
Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne
Adam Gordon*
Affiliation:
Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
*
Address for correspondence: Dr Adam Gordon, Clinical Lecturer and Acting Consultant in Medicine of Older People, Room B99, Division of Rehabilitation & Ageing, University of Nottingham Medical School, Queens Medical Centre, Nottingham NG7 2UH. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

This review provides an update on current evidence surrounding the epidemiology, treatment and prevention of non-respiratory infections in care homes. It covers urinary tract infection (UTI), methicillin-resistant Staphylococcus aureus (MRSA), decubitus ulcers, scabies, tinea infections and viral and bacterial gastroenteritis. The care home sector provides a unique ecological niche for infections, housing frail older people with multiple co-morbidities and frequent contact with healthcare services in a semi-closed environment. This leads to differences in the diagnosis and management of infections – particularly of outbreaks – when compared with community-dwelling counterparts. It is essential that care home staff play a role in the early recognition, isolation and treatment of infections, but they are often not trained as healthcare professionals – this presents a challenge to systematized response. Effective interface between care homes, public health and infection control services are essential to the delivery of care, yet it is not clear how to structure such links most effectively.

Keywords

nursing homesresidential facilitieshomes for the agedinfectioninfection control
Type
Intermediate care and rehabilitation
Information
Reviews in Clinical Gerontology , Volume 21 , Issue 1 , February 2011 , pp. 78 - 90
Copyright
Copyright © Cambridge University Press 2010

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

1Bajekal, M. Health Survey for England 2000: Characteristics of Care Homes and Their Residents. London: The Stationery Office, 2002.Google Scholar
2Bowman, C, Whistler, J, Ellerby, M. A national census of care home residents. Age Ageing 2004; 33: 561–66.CrossRefGoogle ScholarPubMed
3Nicolle, LE, Strausbaugh, LJ, Garibaldi, RA. Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev 1996; 9: 1–17.CrossRefGoogle ScholarPubMed
4Nicolle, L. Infection control in long term care facilities. Clin Infect Dis 2000; 31: 752–56.CrossRefGoogle ScholarPubMed
5Gordon, A, Ewan, V. Pneumonia and influenza: specific considerations in care homes. Rev Clin Gerontol 2010; 20: 69–80.CrossRefGoogle Scholar
6Great Britain Department of Health. Care Standards Act 2000. London: Stationery Office, 2001.Google Scholar
7Ribbe, MW, Ljunggren, G, Steel, K, Topinková, E, Hawes, C, Ikegami, N, Henrard, JC, Jónnson, PV. Nursing homes in 10 nations: a comparison between countries and settings. Age Ageing 1997; 26: 3–12.CrossRefGoogle Scholar
8Conroy, S, Van Der Cammen, T, Schols, J, Van Balen, R, Peteroff, P, Luxton, T. Medical services for older people in nursing homes – comparing services in England and the Netherlands. J Nutr Health Aging 2009; 13: 559–63.CrossRefGoogle ScholarPubMed
9Care of Elderly: UK Market Survey. London: Laing and Buisson, 2009.Google Scholar
10Fell, G. Preparedness of residential and nursing homes for pandemic flu. J Public Health 2008; 30: 99–102.CrossRefGoogle ScholarPubMed
11Cheesebrough, JS, Green, J, Gallimore, CI, Wright, PA, Brown, DWG. Widespread environmental contamination with Norwalk-like viruses (NLV) detected in a prolonged hotel outbreak of gastroenteritis. Epidemiol Infect 2000; 125: 93–98.CrossRefGoogle Scholar
12Strausbaugh, LJ, Joseph, CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol 2000; 21: 674–79.CrossRefGoogle ScholarPubMed
13Tsan, L, Davis, C, Langberg, R, Hojlo, C, Pierce, J, Miller, M, Gaynes, R, Gibert, C, Montgomery, O, Bradley, S, Richards, C, Danko, L, Roselle, G. Prevalence of nursing home-associated infections in the Department of Veterans Affairs nursing home care units. Am J Infect Control 2008; 36: 173–79.CrossRefGoogle ScholarPubMed
14Andersen, BM, Rasch, M. Hospital-acquired infections in Norwegian long-term-care institutions. A three-year survey of hospital-acquired infections and antibiotic treatment in nursing/residential homes, including 4500 residents in Oslo. J Hosp Infect 2000; 46: 288–96.CrossRefGoogle ScholarPubMed
15Eriksen, HM, Iversen, BG, Aavitsland, P. Prevalence of nosocomial infections and use of antibiotics in long-term care facilities in Norway, 2002 and 2003. J Hosp Infect 2004; 57: 316–20.CrossRefGoogle Scholar
16Engelhart, ST, Hanses-Derendorf, L, Exner, M, Kramer, MH. Prospective surveillance for healthcare-associated infections in German nursing home residents. J Hosp Infect 2005; 60: 46–50.CrossRefGoogle ScholarPubMed
17Cools, HJM, van der Meer, JWM. Infection control in a skilled nursing facility: a 6-year survey. J Hosp Infect 1988; 12: 117–24.CrossRefGoogle Scholar
18Moens, GF, Haenen, R, Jacques, P. The prevalence of infections in nursing homes in Belgium. J Hosp Infect 1996; 34: 336–37.CrossRefGoogle ScholarPubMed
19Beck-Sague, C, Banerjee, S, Jarvis, WR. Infectious diseases and mortality among US nursing home residents. Am J Public Health 1993; 83: 1739–42.CrossRefGoogle ScholarPubMed
20Garibaldi, RA. Residential care and the elderly: the burden of infection. J Hosp Infect 1999; 43 suppl: S9–18.CrossRefGoogle ScholarPubMed
21Beck-Sague, C, Villarino, E, Giuliano, D, Welbel, S, Latts, L, Manangan, LM, Sinkowitz, RL, Jarvis, WR. Infectious diseases and death among nursing home residents: results of surveillance in 13 nursing homes. Infect Control Hospital Epidemiol 1994; 15: 494–96.CrossRefGoogle ScholarPubMed
22Nicolle, LE. Urinary tract infection in long-term-care facility residents. Clin Infect Dis 2000; 31: 757–61.CrossRefGoogle ScholarPubMed
23Hedin, K, Petersson, C, Widebäck, K, Kahlmeter, G, Mölstad, S. Asymptomatic bacteriuria in a population of elderly in municipal institutional care. Scand J Primary Health Care 2002; 20: 166–68.CrossRefGoogle Scholar
24Aguirre-Avalos, G, Zavala-Silva, ML, Daz-Nava, A, Amaya-Tapia, G, Aguilar-Benavides, S. Asymptomatic bacteriuria and inflammatory response to urinary tract infection of elderly ambulatory women in nursing homes – molecular pathogenesis and clinical management. Archives Med Res 1999; 30: 29–32.CrossRefGoogle Scholar
25Vromen, M, van der Ven, AJ, Knols, A, Stobberingh, EE. Antimicrobial resistance patterns in urinary isolates from nursing home residents. Fifteen years of data reviewed. J Antimicrob Chemother 1999; 44: 113–16.CrossRefGoogle ScholarPubMed
26Muder, RR, Brennen, C, Wagener, MM, Goetz, AM. Bacteremia in a long-term-care facility: a five-year prospective study of 163 consecutive episodes. Clin Infect Dis 1992; 14: 647–54.CrossRefGoogle Scholar
27Cohen, AE, Lautenbach, E, Morales, KH, Linkin, DR. Fluoroquinolone-resistant Escherichia coli in the long-term care setting. Am J Med 2006; 119: 958–63.CrossRefGoogle ScholarPubMed
28Hassanzadeh, P, Motamedifar, M. The prevalence of asymptomatic bacteriuria in long term care facility residents in Shiraz, Southwest Iran: a cross-sectional study. Pak J Biol Sci 2007; 10: 3890–94.Google ScholarPubMed
29SIGN. Management of suspected bacterial urinary tract infection in adults. A national clinical guideline 2006. Available at: www.sign.ac.uk/pdf/sign88.pdf (accessed 20 June 2010).Google Scholar
30Stevenson, KB, Moore, JW, Sleeper, B. Validity of the minimum data set in identifying urinary tract infections in residents of long-term care facilities. J Am Geriatr Soc 2004; 52: 707–11.CrossRefGoogle ScholarPubMed
31Loeb, M, Bentley, DW, Bradley, S, Crossley, K, Garibaldi, R, Gantz, N, McGeer, A, Muder, RR, Mylotte, J, Nicolle, LE, Nurse, B, Paton, S, Simor, AE, Smith, P, Strausbaugh, L. Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol 2001; 22: 120–24.CrossRefGoogle ScholarPubMed
32McMurdo, M, Gillespie, N. Commentary. Urinary tract infection in old age: over-diagnosed and over-treated. Age Ageing 2000; 29: 297–98.CrossRefGoogle Scholar
33Juthani-Mehta, M, Quagliarello, V, Perrelli, E, Towle, V, Van Ness, PH, Tinetti, M. Clinical features to identify urinary tract infection in nursing home residents: a cohort study. J Am Geriatr Soc 2009; 57: 963–70.CrossRefGoogle ScholarPubMed
34HPA. Diagnosis of UTI. Quick reference guide for primary care 2009. Available at: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947404720. (accessed 20 June 2010).Google Scholar
35Macfarlane, PI, Ellis, R, Hughes, C, Houghton, C, Lord, R. Urine collection pads: are samples reliable for urine biochemistry and microscopy? Pediatric Nephrol 2005; 20: 170–79.CrossRefGoogle ScholarPubMed
36Farrell, M, Devine, K, Lancaster, G, Judd, B. A method comparison study to assess the reliability of urine collection pads as a means of obtaining urine specimens from non-toilet-trained children for microbiological examination. J Adv Nursing 2002; 37: 387–93.CrossRefGoogle ScholarPubMed
37Beier, MT. Management of urinary tract infections in the nursing home elderly: a proposed algorithmic approach. Int J Antimicrob Agents 1999; 11: 275–84.CrossRefGoogle ScholarPubMed
38Albert, X, Huertas, I, Pereiró, II, Sanfélix, J, Gosalbes, V, Perrota, C. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev 2004; (3): CD001209.CrossRefGoogle Scholar
39McMurdo, MET, Argo, I, Phillips, G, Daly, F, Davey, P. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women. J Antimicrob Chemother 2009; 63: 389–95.CrossRefGoogle ScholarPubMed
40Sumukadas, D, Davey, P, McMurdo, MET. Recurrent urinary tract infections in older people: the role of cranberry products. Age Ageing 2009; 38: 255–57.CrossRefGoogle ScholarPubMed
41Lutters, M, Vogt-Ferrier, NB. Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Cochrane Database Syst Rev 2008; (3): CD001535.CrossRefGoogle Scholar
42Baldwin, NS, Gilpin, DF, Hughes, CM, Kearney, MP, Gardiner, DA, Cardwell, C, Tunney, MM. Prevalence of methicillin-resistant Staphylococcus aureus colonization in residents and staff in nursing homes in Northern Ireland. J Am Geriatr Soc 2009; 57: 620–26.CrossRefGoogle ScholarPubMed
43Barr, B, Wilcox, MH, Brady, A, Parnell, P, Darby, B, Tompkins, D. Prevalence of methicillin resistant Staphylococcus aureus colonization among older residents of care homes in the United Kingdom. Infect Control Hosp Epidemiol 2007; 28: 853–59.CrossRefGoogle ScholarPubMed
44Maudsley, J, Stone, SP, Kibbler, CC, Iliffe, SR, Conaty, SJ, Cookson, BD, Duckworth, GJ, Johnson, A, Wallace, PG. The community prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in older people living in their own homes: implications for treatment, screening and surveillance in the UK. J Hosp Infect 2004; 57: 258–62.CrossRefGoogle ScholarPubMed
45Hori, S, Sunley, R, Tami, A, Grundmann, H. The Nottingham Staphylococcus aureus population study: prevalence of MRSA among the elderly in a university hospital. J Hosp Infect 2002; 50: 25–29.CrossRefGoogle ScholarPubMed
46Baum, H, Schmidt, C, Svoboda, D, Bock, Hensley, O, Wendt, C. Risk factors for methicillin resistant Staphylococcus aureus carriage in residents of German nursing homes. Infect Control Hosp Epidemiol 2002; 23: 511–15.CrossRefGoogle Scholar
47O'Sullivan, NP, Keane, CT. The prevalence of methicillin-resistant Staphylococcus aureus among the residents of six nursing homes for the elderly. J Hosp Infect 2000; 45: 322–29.CrossRefGoogle ScholarPubMed
48Denis, O, Jans, B, Deplano, A, Nonhoff, C, De Ryck, R, Suetens, C, Struelens MJ. Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) among residents of nursing homes in Belgium. J Antimicrob Chemother 2009; 64: 1299–306.CrossRefGoogle ScholarPubMed
49Talon, DR, Bertrand, X. Methicillin resistant Staphylococcus aureus in geriatric patients: usefulness of screening in a chronic care setting. Infect Control Hosp Epidemiol 2001; 22: 505–9.CrossRefGoogle Scholar
50Manzur, A, Gudiol, F. Methicillin-resistant Staphylococcus aureus in long-term-care facilities. Clin Microbiol Infect 2009; 15: 26–30.CrossRefGoogle ScholarPubMed
51Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin resistant and methicillin susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003; 36: 53–59.CrossRefGoogle ScholarPubMed
52Bradley, SF. Methicillin-resistant Staphylococcus aureus: long-term care concerns. Am J Med 1999; 106: 2–10.CrossRefGoogle ScholarPubMed
53Mody, L, Maheshwari, S, Galecki, A, Kauffman, CA, Bradley, SF. Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group. J Am Geriatr Soc 2007; 55: 1921–26.CrossRefGoogle ScholarPubMed
54Bradley, SF, Terpenning, MS, Ramsey, MA, Zarins, LT, Jorgensen, KA, Sottile, WS, Schaberg, DR, Kauffman, CA. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Annals Int Med 1991; 115: 417–22.CrossRefGoogle ScholarPubMed
55O'Sullivan, NP, Keane, CT. Risk factors for colonization with methicillin-resistant Staphylococcus aureus among nursing home residents. J Hosp Infect 2000; 45: 206–10.CrossRefGoogle ScholarPubMed
56Manzur, A, Gavalda, L, Ruiz de Gopegui, E, Mariscal, D, Dominguez, MA, Perez, JL, Segura, F, Pujol, M; Group of the Spanish Network for Research in Infectious Diseases. Prevalence of methicillin-resistant Staphylococcus aureus and factors associated with colonization among residents in community long-term-care facilities in Spain. Clin Microbiol Infect 2008; 14: 867–72.CrossRefGoogle Scholar
57Brugnaro, P, Fedeli, U, Pellizzer, G, Buonfrate, D, Rassu, M, Boldrin, C, Parisi, SG, Grossato, A, Palù, G, Spolaore P. Clustering and risk factors of methicillin-resistant Staphylococcus aureus carriage in two Italian long-term care facilities. Infection 2009; 37: 216–21.CrossRefGoogle ScholarPubMed
58Fraise, AP, Mitchell, K, Brien, SJ, Oldfield, K, Wise, R. Methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes in a major UK city: an anonymized point prevalence survey. Epidemiol Infect 1997; 118: 1–5.CrossRefGoogle Scholar
59Cooper, BS, Medley, GF, Stone, SP, Kibbler, CC, Cookson, BD, Roberts, JA, Duckworth, G, Lai, R, Ebrahim, S. Methicillin-resistant Staphylococcus aureus in hospitals and the community: Stealth dynamics and control catastrophes. Proc Natl Acad Sci USA 2004; 101: 10223–28.CrossRefGoogle ScholarPubMed
60Hughes, CM, Smith, MBH, Tunney, MM. Infection control strategies for preventing the transmission of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people. Cochrane Database Syst Rev 2008; (1).CrossRefGoogle Scholar
61Loeb, M, Main, C, Walker-Dilks, C, Eady, A. Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database Syst Rev 2003; (4).CrossRefGoogle Scholar
62Vanderwee, K, Clark, M, Dealey, C, Gunningberg, L, Defloor, T. Pressure ulcer prevalence in Europe: a pilot study. J Evaluation Clin Prac 2007; 13: 227–35.CrossRefGoogle ScholarPubMed
63Tannen, A, Dietz, E, Dassen, T, Halfens, R. Explaining the national differences in pressure ulcer prevalence between the Netherlands and Germany adjusted for personal risk factors and institutional quality indicators. J Evaluation Clin Prac 2009; 15: 85–90.CrossRefGoogle ScholarPubMed
64Bergstrom, N, Braden, B. A prospective study of pressure sore risk among institutionalized elderly. J Am Geriatr Soc 1992; 40: 747–58.CrossRefGoogle ScholarPubMed
65Wiener, J, Quinn, JP, Bradford, PA, Goering, RV, Nathan, C, Bush, K, Weinstein, RA. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999; 281: 517–23.CrossRefGoogle Scholar
66European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Treatment of pressure ulcers: Quick Reference Guide. Washington DC: National Pressure Ulcer Advisory Panel, 2009.Google Scholar
67National Institute of Clinical Excellence. CG29 – The management of pressure ulcers in primary and secondary care: a clinical practice guideline. London: National Insitute of Clinical Excellence/Royal College of Nursing, 2005.Google Scholar
68Smith, DM. Pressure ulcers in the nursing home. Ann Int Med 1995; 123: 433–38.CrossRefGoogle ScholarPubMed
69Gannon, KL, Braun, T. Osteomyelitis. Essential Infectious Disease Topics for Primary Care 2008; pp. 213–23.CrossRefGoogle Scholar
70Holness, DL, DeKoven, JG, Nethercott, JR. Scabies in chronic health care institutions. Arch Dermatol 1992; 128: 1257–60.CrossRefGoogle ScholarPubMed
71Tjioe, M, Vissers, WHPM. Scabies outbreaks in nursing homes for the elderly: recognition, treatment options and control of reinfestation. Drugs Aging 2008; 25: 299–306.CrossRefGoogle Scholar
72Garcia, RG, Lopez-Areal, J, Martinez, CA. Scabies in the elderly. J Eur Acad Dermatol Venereol 2004; 18: 105–7.CrossRefGoogle Scholar
73Heukelbach, J, Feldmeier, H. Scabies. Lancet 2006; 367: 1767–74.CrossRefGoogle ScholarPubMed
74Roberts, LJ, Huffam, SE, Walton, SF, Currie, BJ. Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature. J Infect 2005; 50: 375–81.CrossRefGoogle Scholar
75Mellanby, K. Transmission of scabies. Br Med J 1941; 2: 405–6.CrossRefGoogle ScholarPubMed
76Chosidow, O. Scabies and pediculosis. Lancet 2000; 355: 818.CrossRefGoogle ScholarPubMed
77Clinical Effectiveness Group of the British Association of Sexual Health and HIV. United Kingdom National Guideline on the Management of Scabies Infestation; available at: http://www.bashh.org/documents/27/27.pdf (accessed 20 June 2010).Google Scholar
78Strong, M, Johnstone, PW. Interventions for treating scabies. Cochrane Database Syst Rev 2007; (3).CrossRefGoogle Scholar
79Health Protection Agency (North West). The Management of Scabies in the Community; available at: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947308867 (accessed 14 August 2010).Google Scholar
80Meinking, TL, Taplin, D, Herminda, JL, Pardo, R, Kerdel, FA. The treatment of scabies with ivermectin. N Engl J Med 1995; 333: 26–30.CrossRefGoogle ScholarPubMed
81Barkwell, R, Shields, S. Deaths associated with ivermectin treatment of scabies. Lancet 1997; 349: 1144–45.CrossRefGoogle ScholarPubMed
82Diazgranados, JA, Costa, JL. Deaths after ivermectin treatment. Lancet 1997; 349: 1698.CrossRefGoogle ScholarPubMed
83Reintjes, R, Hoek, C. Deaths associated with ivermectin for scabies. Lancet 1997; 350: 215.CrossRefGoogle ScholarPubMed
84Scheinfeld, N. Controlling scabies in institutional settings: a review of medications, treatment models, and implementation. Am J Clin Dermatol 2004; 5: 31–37.CrossRefGoogle ScholarPubMed
85Arlian, LG, Runyan, RA, Achar, S, Estes, SA. Survival and infectivity of Sarcoptes scabiei var. canis and var. hominis. J Am Acad Dermatol 1984; 11: 210–15.CrossRefGoogle ScholarPubMed
86Havlickova, B, Czaika, VA, Friedrich, M. Epidemiological trends in skin mycoses worldwide. Mycoses 2008; 51: 2–15.CrossRefGoogle ScholarPubMed
87Summerbell, RC, Krajden, S, Kane, J. Dermatophytosis in institutions for the elderly. CMAJ 1989; 140: 112.Google ScholarPubMed
88Kakutani, H, Kakutani, T, Mochizuki, T. Trichophyton violaceum infection occurring in a nursing home. Nippon Ishinkin Gakkai Zasshi 2005; 46: 279–84.CrossRefGoogle ScholarPubMed
89Kirk, MD, Roberts, L, Horvath, J. Understanding gastroenteritis in elderly residents of aged-care facilities. Med J Aust 2008; 189: 476–77.CrossRefGoogle ScholarPubMed
90Frenzen, PD. Mortality due to gastroenteritis of unknown etiology in the United States. J Infect Dis 2003; 187: 441–52.CrossRefGoogle ScholarPubMed
91Marshall, J, Botes, J, Gorrie, G, Boardman, C, Gregory, J, Griffith, J, Hogg, G, Dimitriadis, A, Catton, M, Bishop, R. Rotavirus detection and characterisation in outbreaks of gastroenteritis in aged-care facilities. J Clin Virol 2003; 28: 331–40.CrossRefGoogle ScholarPubMed
92Norovirus activity – United States, 2006–2007. MMWR Morb Mortal Wkly Rep 2007; 56: 842–46.Google Scholar
93Fretz, R, Svoboda, P, Thi, TM, Tanner, M, Baumgartner, A. Outbreaks of gastroenteritis due to infections with Norovirus in Switzerland, 2001 and 2003. Epidemiol Infect 2005; 133: 429–37.CrossRefGoogle Scholar
94Lopman, BA, Adak, GK, Reacher, MH, Brown, DWG. Two epidemiologic patterns of norovirus outbreaks: surveillance in England and Wales, 1992–2000. Emerg Infect Dis 2003; 9: 71–77.CrossRefGoogle ScholarPubMed
95Recurring norovirus outbreaks in a long-term residential treatment facility – Oregon, 2007. MMWR Morb Mortal Wkly Rep 2009; 58: 694–98.Google Scholar
96Kaplan, JE, Feldman, R, Campbell, DS, Lookabaugh, C, Gary, GW. The frequency of a Norwalk-like pattern of illness in outbreaks of acute gastroenteritis. Am J Public Health 1982; 72: 1329–32.CrossRefGoogle ScholarPubMed
97Chadwick, PR, Beards, G, Brown, D, Caul, EO, Cheesbrough, J, Clarke, I, Curry, A, O'Brien, S, Quigley, K, Sellwood, J, Westmoreland, D. Management of hospital outbreaks of gastro-enteritis due to small roundstructured viruses. J Hosp Infect 2000; 45: 1–10.CrossRefGoogle ScholarPubMed
98Drinka, PJ. Norovirus outbreaks in nursing homes. J Am Geriatr Soc 2005; 53: 1839–40.CrossRefGoogle ScholarPubMed
99Graham, DY, Jiang, X, Tanaka, T, Opekun, AR, Madore, HP, Estes, MK. Norwalk virus infection of volunteers: new insights based on improved assays. J Infect Dis 1994; 170: 34–43.CrossRefGoogle ScholarPubMed
100Tu, ET, Bull, RA, Kim, MJ, McIver, CJ, Heron, L, Rawlinson, WD, White, PA. Norovirus excretion in an aged-care setting. J Clin Microbiol 2008; 46: 2119–21.CrossRefGoogle Scholar
101Vivancos, R, Sundkvist, T, Barker, D, Burton, J, Nair, P. Effect of exclusion policy on the control of outbreaks of suspected viral gastroenteritis: Analysis of outbreak investigations in care homes. Am J Infect Control 2010; 38: 139–43.CrossRefGoogle ScholarPubMed
102Gallelli, L, Colosimo, M, Tolotta, GA, Falcone, D, Luberto, L, Curto, LS, Rende, P, Mazzei, F, Marigliano, NM, De Sarro, G, Cucchiara, S. Prospective randomized double-blind trial of racecadotril compared with loperamide in elderly people with gastroenteritis living in nursing homes. Eur J Clin Pharmacol 2010; 66: 137–44.CrossRefGoogle ScholarPubMed
103DeBuono, BA, Brondum, J, Kramer, JM, Gilbert, RJ, Opal, SM. Plasmid, serotypic, and enterotoxin analysis of Bacillus cereus in an outbreak setting. J Clin Microbiol 1988; 26: 1571–74.CrossRefGoogle Scholar
104Frank, C, Buchholz, U, Maass, M, Schröder, A, Bracht, KH, Domke, PG, Rabsch, W, Fell, G. Protracted outbreak of S. enteritidis PT 21c in a large Hamburg nursing home. BMC Public Health 2007; 7: 243.CrossRefGoogle Scholar
105Anonymous. Hemorrhagic colitis in a nursing home in Ontario. CMAJ 1986; 134: 50.Google Scholar
106Reiss, G, Kunz, P, Koin, D, Keeffe, EB. Escherichia coli O157:H7 infection in nursing homes: review of literature and report of recent outbreak. J Am Geriatr Soc 2006; 54: 680–84.CrossRefGoogle ScholarPubMed
107Krishnan, C, Fitzgerald, VA, Dakin, SJ, Behme, RJ. Laboratory investigation of outbreak of hemorrhagic colitis caused by Escherichia coli O157:H7. J Clin Microbiol 1987; 25: 1043–47.CrossRefGoogle ScholarPubMed
108Ryan, CA, Tauxe, RV, Hosek, GW, Wells, JG, Stoesz, PA, McFadden, HW Jr, Smith, PW, Wright, GF, Blake, PA. Escherichia coli O157:H7 diarrhoea in a nursing home: clinical, epidemiological, and pathological findings. J Infect Dis 1986; 154: 631–38.CrossRefGoogle Scholar
109Carter, AO, Borczyk, AA, Carlson, JA, Harvey, B, Hockin, JC, Karmali, MA, Krishnan, C, Korn, DA, Lior, H. A severe outbreak of Escherichia coli O157:H7-associated hemorrhagic colitis in a nursing home. N Engl J Med 1987; 317: 1496–500.CrossRefGoogle ScholarPubMed
110Waters, JR, Sharp, JC, Dev, VJ. Infection caused by Escherichia coli O157:H7 in Alberta, Canada, and in Scotland: a five-year review, 1987–1991. Clin Infect Dis 1994; 19: 834–43.CrossRefGoogle Scholar
111Al-Tureihi, FIJ, Hassoun, A, Wolf-Klein, G, Isenberg, H. Albumin, length of stay, and proton pump inhibitors: key factors in Clostridium difficile-associated disease in nursing home patients. J Am Med Dir Assoc 2005; 6: 105–8.CrossRefGoogle ScholarPubMed
112Crogan, NL, Evans, BC. Clostridium difficile: an emerging epidemic in nursing homes. Geriatric Nursing 2007; 28: 161–64.CrossRefGoogle ScholarPubMed
113Holtz, LR, Neill, MA, Tarr, PI. Acute bloody diarrhoea: a medical emergency for patients of all ages. Gastroenterology 2009; 136: 1887–98.CrossRefGoogle ScholarPubMed