Healthcare-Associated Infection and Antimicrobial Use in Irish Long-Term Care Facilities: Results from the First National Prevalence Study

Background: Healthcare associated infection (HCAI) and the consequences of increasing rates of antimicrobial resistance (AMR) are potentially serious health threats for frail elderly people, including those living in long-term care facilities (LTCFs); however there is very limited data available from Irish LTCFs.

 Objective: The aim of this study was to evaluate the prevalence of HCAI and antimicrobial use in Irish LTCFs.

Methods: A point prevalence study was conducted in June 2010 as part of a European study of HCAI in European LTCFs (HALT). Data was collected by trained local senior clinical staff (nursing or medical) and/or infection prevention and control nurses. Information was collected on; HCAI risk factors, signs and symptoms of infection and antimicrobial use from eligible residents.

Results: A total of 4,170 residents in 69 LTCF were surveyed; 1664 (40%) males and 2506 (60%) females. The most common HCAI risk factors included; incontinence (n = 2530, 61%), disorientation (n = 2110, 50.6%), bedridden (n = 2101, 50.4%), age over 85 years (n = 1430, 34.3%) and urinary catheter use (n = 234, 5.6%). One hundred and two (2.4%) HCAIs were identified as strictly defined by the McGeer definitions, and 156 (3.7%) when physician diagnosis was included as a criterion in all the McGeer definitions.¹ The most common HCAIs were urinary tract (n = 62, 39.7%), respiratory (n = 44, 28.2%) and skin infections (n = 31, 19.9%). 

Of the 426 (10.2%) residents on antibiotics, 25 (6%) were prescribed two or more antibiotic types.  Antibiotics were prescribed for treatment of infection (n = 262, 57.8%) and prophylaxis (n = 182, 40.2%). The most common indications for therapy included respiratory tract (35.1%), urinary tract (32.1%) and skin infections (21.8%).  Prophylactic antibiotics were predominantly prescribed for prevention of urinary tract infection with trimethoprim most frequently prescribed. Seventeen (10.7%) residents on UTI prophylaxis had a urinary catheter in situ.

Conclusions: This study provides the first national data on HCAI prevalence in Irish LTCFs. HCAI prevalance is lower than that reported in previous national surveys, especially when the McGreer definitions were rigorously applied.¹  While the use of inexperienced, albeit trained data collectors may account for this finding, the benefits of increasing local staff knowledge and awareness of HCAI proved the real benefit of participation in the study.  The frequency of antimicrobial prescribing for prophylactic use noted in this survey underlines the importance of antimicrobial stewardship in this setting.

¹Mc Geer et al . Am J Infect Control, 1991; 19(1), 1-7.