Care Home HAI Prevalence Pilot Study

Background: Care homes provide a range of supported living environments for elderly and infirm.  These residents are exposed to many of the risk factors for Healthcare associated infections (HAI) including increased age, poor nutrition status, use of invasive devices and antibiotics prescription.  Little is know about the role that these environments play in the incidence of HAI.

Objective: The objective of this study was to develop and rollout a protocol which will allow local care home staff to monitor HAI by undertaking prevalence surveillance using the combined methodologies of the European Improving Patient Safety In Europe (IPSE) and the European Surveillance of Antimicrobial consumption (ESAC) surveillance of care Home HAI protocols

Methods: A pilot study was undertaken by Health Protection Scotlanf (HPS) in collaboration with the Scottish Care Commission.  Data collection within 18 care homes commenced on 6th April and was completed on the 1st May.  Data were collected for all residents present on the day the survey.  Information relating to resident risk factors, clinical age and symptoms of infection, antimicrobials prescibed and also information on the level of care offered within the care home were collected.   

Results: A total of 922 residents from 18 care homes were included in the pilot survey.  In all care facilities females outnumbered males.  The resident population consisted of 67.8% females, median age of 85 years and median length of stay of 1.8 years.  On the day of survey 86 residents had at least one infection identified, accounting for a total of 87 infections.  The main infection types in rank order were: Urinary Tract 52.3%; Respiratory Tract 28.4%; Skin 12.5%; Eye,Ear,Nose and Mouth 6.8%.  Of the urinary tract infection (UTI) 7 infections were found in residents with indwelling urinary catheter.  Several independant factors were found to affect prevalence of infection found in the care homes surveyed. 

Conclusions: Prevalence of infection in care homes surveyed was 9.3% (95% CL 7.4-11.2).  The most common infection reported was urinary tract infection (52.3%).  The most commonly prescribed group of antimicrobial were penicillins and 12.7% of residents on the day of survey were receiving antimicrobials.  Scotland will contribute to an ECDC EU-wide care home prevalence survey planned for May 2010.