Prevalence of Healthcare-Associated Infections in Elderly, France, 2006

Background: A prevalence survey of healthcare-associated infections (HAI) was conducted in French healthcare facilities (HCF) in 2006. Specific features of HAI in elderly (patients aged 65 years or older) were studied in this analysis, taking into consideration that this population accounts for 20% of the French population and more than half of inpatients.

Objective: To assess the burden of HAI among elderly (patients aged 65 years or above), describe their characteristics and compare results to the 2001 NI survey results.

Methods: The survey was proposed to all French public and private HCF and used CDC-adapted and Mc Geer definitions for elderly. Individual data were collected in a standardized manner by trained personnel in HCF and sent by encrypted e-mail to regional infection control coordinating centres and the French Institute for Public Health Surveillance. The prevalence of elderly with a HAI (PPHAI) was compared between 2001 and 2006 by Poisson regression, adjusting for characteristics of HCF, wards and patients.

Results: Among 199,716 patients included (representing 55.6% of all hospitalized patients), mostly were admitted in general (42.5%), teaching hospitals (17.1%) or in rehabilitation unit and long take care (12.6%). In this elderly population, the PPHAI was 6.1% vs. 3.5% in other patients. Stratified by 10-year age classes after 65 years, the PPHAI was stable (6.2%) but lower (5.4%) after 94 years. Urinary tract infections, pneumonia, surgical site infections and skin/soft tissue infections accounted for 40, 15, 13 and 12% of HAI, respectively. Escherichia coli (28.0%), Staphylococcus aureus (SA) (18.2%) and Pseudomonas aeruginosa (9.5%) accounted for 55.7% of the 10,055 isolated micro-organisms. The proportion of methicillin-resistant SA was higher in elderly than in other patients (59.1% vs 45.5%). The PPHAI varied from 4.4% in long term to 8.4% in rehabilitation units. Compared to other patients, elderly had more severe underlying diseases (41.8% vs 13.4%), were more immunosuppressed (10.5% vs. 8.4%) and more exposed to urinary catheter (10.4 vs. 8.2%). Both populations were equally exposed to vascular catheters (23.9% vs 24%) but elderly were more exposed to subcutaneous catheter (5,3% vs. 0,5%) and less to central venous catheter (3.8% vs 5.7%). Within the 30 previous days, elderly underwent less surgery than other patients (19.8% vs 23.2%).

Conclusions: The observed decrease of PPHAI among elderly suggests a positive impact of the French national infection control plan in this population. However, the proportion of MRSA remains high and suggests the need for further studies and reinforcing their control. HAI prevalence remains significant, especially in rehabilitation units that require specific studies and programs