A National Survey of Infection Control and Antibiotic Stewardship Structures in Irish Long-Term Care Facilities

Background: Essential components of the prevention and control of healthcare associated infection (HCAI) and antimicrobial resistance (AMR) in long term care facilities (LTCF) include staff education, antimicrobial stewardship, infection control policies and HCAI/AMR surveillance. At present, there is limited information available from Irish LTCFs.

Objective: The aim was to evaluate medical care, infection control and antibiotic stewardship practices and protocols in Irish LTCFs.

Methods: Sixty-nine Irish LTCFs completed a questionnaire detailing information on staffing and bed capacity, provision of medical care and infection control and antibiotics stewardship practices.

Results: LTCF size ranged from ten to 382 beds (median 47 beds) with the proportion of single rooms per 100 beds ranging from 0 – 87% (median = 17%). Median bed occupancy was 93% (68.8 - 100). Twenty-four hour nursing care was available in all LTCF.  Medical care was provided by primary care practitioners (GPs) in 51%, a physician employed by the facility in 35% and both in 14%. Coordination of medical activity was provided in 45% (n=31) of LTCFs by either a designated GP (13%, n = 9), a designated physician employed by the LTCF (28%, n = 19) or an external physician (4%, n = 3). There was no coordination of medical activity in 53.6% (n=37).  The coordinating physician was responsible for infection control and/or antimicrobial stewardship in only 19% of LTCFs, though responsible for coordination of vaccinations in 74%.

 In 81% (n = 56) of LTCFs, a person with training in infection prevention and control (IPC) (nurse 87.5% (n = 49), doctor 3.6% (n = 2), unknown 8.9% (n = 5)) was in charge of IPC.  IPC activities included education and training (86%), outbreak management (83%) and development of care protocols (75%). Only 20% (n = 14) of the LTCFs had a HCAI surveillance programme, though the majority (99%, n = 68) had a hand hygiene protocol and 88.4% (n = 61) provided hand hygiene training in the year prior to the survey.

 Antibiotics were prescribed by a range of medical practitioners including GPs (60%) and LTCF doctors (33%). Antimicrobial stewardship activities included: availability of local antimicrobial guidelines (28%), antimicrobial consumption surveillance (16%), AMR surveillance (12%) and prescribers education (7%).

Conclusions: This study provides an important baseline on infection control and antimicrobial stewardship activities in Irish LTCFs. The variation in medical care and potential antibiotic prescribers among LTCFs highlights the need for national antimicrobial stewardship initiatives specifically for LTCF.  Likewise improving infection control awareness and staff education in this setting will reduce HCAI.