Severe consequences of healthcare-associated infections among residents of nursing homes: a cohort study

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Summary

The aim of this study was to identify the consequences of healthcare-associated infections in Norwegian nursing homes, to include debilitation, hospital transfer and mortality. We followed the residents of six nursing homes in two major cities in Norway during the period October 2004 to March 2005. For each resident with infection we randomly selected two controls among residents who did not have an infection. Cases and the controls were followed for 30 days as a cohort in order to measure the incidence of complications and risk ratio (RR) in the two groups. The incidence of infection was 5.2 per 1000 resident-days. After 30 days follow-up 10.9% of residents who had acquired infection demonstrated a reduction in overall physical condition compared with 4.8% in the unexposed group (RR: 2.3). Altogether 13.0% of residents with infections were admitted to hospital compared with 1.4% in the unexposed group (RR 9.2), and 16.1% residents with infections died in the nursing home during follow-up compared with 2.4% in the unexposed group (RR: 6.6). Residents with lower respiratory tract infections demonstrated higher morbidity and mortality. In conclusion, healthcare-associated infections cause severe consequences for people living in nursing homes, including debilitation, hospital admission and death.

Introduction

Healthcare-associated infections are common among elderly residents in nursing homes. Only a few European studies have addressed the incidence, risk factors and consequences of such infections.1, 2, 3

Out of a total population of more than 4.7 million (2008) in Norway, 218 594 are aged >80 years and this number has doubled during the last 30 years. Approximately 38 000 persons, with a median age of 84 years, live in nursing homes and ∼75% are female. Almost 90% of residents stay in the nursing home until they die and 40% of all deaths in Norway occur in nursing homes.4 Many residents in nursing homes have complicated medical conditions that require advanced nursing and medical care. One of the reasons for this is the trend towards shorter hospital stays in acute care facilities.

We have recently reported the incidence and associated risk factors for infections among residents of six nursing homes in Norway.3 We found that the incidence of infection was 5.2 per 1000 resident-days and that urinary tract and lower respiratory tract infections were the most common infections. In a case–control study among the residents, we found several factors associated with infection, including chronic heart disease, urinary incontinence, indwelling urinary catheters and skin ulcers. We followed-up infected cases and uninfected controls for 30 days. The purpose of this study was to analyse consequences of healthcare-associated infections in nursing home residents and their subsequent risks for deterioration in overall condition, transfer to hospital and death.

Section snippets

Study design

The design of the initial cohort and case–control study has been described previously.3 Briefly, we followed residents of six long-term care facilities in two major cities in Norway between 1 October 2004 and 31 March 2005 to detect cases of nosocomial infection according to the criteria of McGeer et al.5 We filled a data collection form on potential risk factors for every resident with nosocomial infection and for two controls selected at random among residents who did not have infection at

Participants

Overall, 1411 of the original 1735 cohort members were evaluated after 30 days (Figure 1). There were 613 in the exposed group and 798 in the unexposed group. Reasons for exclusions were: residents who were discharged to home in the follow-up period (N = 72); residents in the unexposed group who had an infection at recruitment (N = 49) or who developed an infection during follow-up (N = 159); and residents in the exposed group who acquired a new infection (N = 29). There were also 15 residents with

Discussion

We found that in Norwegian nursing homes, healthcare-associated infection severely affects the health of the residents in the following 30 day period, leading to a reduction in overall physical condition, hospitalisations and deaths.

Acknowledgements

We thank the physicians and the nursing staff in the participating facilities for their help during this study; also R.M. Nilsen and A. Grjibovski for valuable help during planning this study and with statistical analyses, and K. Svendheim for her help in data collection.

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