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485 PRIAM survey : Prevalence of Infections in French Nursing Homes, A Cross-Sectional Nationwide Survey

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Kathleen Chami, PharmD, MSc , Geriatric Infection Risk Monitoring Organization, PARIS VI, EHESP, INSERM UMR S 707, Charles Foix Hospital (AP-HP), Ivry sur Seine, France
Gaëtan Gavazzi, MD, PhD , Geriatric Infection Risk Monitoring Organization,EHESP, Charles Foix Hospital, Michallon University Hospital of Grenoble, Grenoble, France
Benoît de Wazières, MD, PhD , Geriatric Infection Risk Monitoring Organization,EHESP, Charles Foix Hospital,Carémeau University Hospital of Nîmes, Nîmes, France
Benoist Lejeune, MD, PhD , European university of Brittany- medical university, Brest, France
François Piette, MD, PhD , Geriatric Infection Risk Monitoring Organization, EHESP, Charles Foix Hospital (AP-HP), Ivry sur Seine, France
Monique Rothan-Tondeur, PhD , Geriatric Infection Risk Monitoring Organization, PARIS VI, EHESP, INSERM UMR S 707, Charles Foix Hospital (AP-HP), Ivry sur Seine, France
Background:

Ageing is a major risk factor for infection . In France, in 2006, where 443 765 elderly people are institutionalized in 6 460 Nursing Homes, hardly any data on infection risk have been published.

Objective: The survey aimed to assess the prevalence of infections and to identify their potential risk factors among residents of these facilities.

Methods: A multicenter, observational (cross-sectional) survey was conducted in five waves, each lasting one month between 2006 and 2007 France-wide, among residents in French Nursing Homes, aged 65 years and older. Data were collected prospectively predominantly online. Cases of infections (community and long-term care acquired) were classified as “Confirmed” if they met the specific criteria for the geriatric settings as listed by Dr McGeer and as “Suspected” if they fulfilled the criteria for infection as listed by the working team of ORIG. The prevalence rates of infections were estimated for the whole sample and by survey period. Multiple regression models were constructed to investigate the association between infections and risk factors.

Results:

At baseline, 44 870 residents living in 577 volunteer facilities, were enrolled. Women predominated over men (75.7 vs 24.3%). The mean age was 86. Overall prevalence rate of infections was 11.2 per 100 residents (CI 95% 10.9-11.5). Upper and lower respiratory tract infections were the most common (41%), followed by symptomatic urinary tract infections (24%). The multivariate analysis assessed that infections were significantly associated with dependency (Adjusted OR (ORa) 1.3 [95% CI 1.2-1.4]), urinary catheterization (ORa 3.4[95% CI 3.0-4.0]), pressure ulcers (ORa 2.6[95% CI 2.3-2.9]) and the surveillance period (January-February versus June (ORa, 1.7[95% CI 1.5-1.9]).

Conclusions:

The real prevalence of infections might be substantially underestimated in elderly people living in Nursing Homes in France. However, the infectious risk seems to be important in these facilities. Since the results, a consensus was organized with the aim of developping written guidelines for prevention of infections in Nursing Homes. Also launched, and still under way, is a cluster randomized trial with the purpose of evaluating the effectiveness of an interventional program.