Guidelines for infection control in nursing homes: a Delphi consensus web-based survey

Summary

A nationwide survey was performed using a two-round web-based Delphi procedure to develop a set of consensus guidelines for preventing infections among residents in nursing homes (NHs). The research group was led by an investigative group of six specialists. Research analysts conducted a literature search and review of practice guidelines, systematic reviews and articles or abstracts published in English and French on the topic of infection prevention. The literature search was examined by 23 specialists (who compiled a preliminary list of 301 recommendations). Using a Delphi survey online instrument, 81 experts from all relevant medical specialties in the fields of infection prevention and control and geriatrics rated their agreement with each of the recommendations using a nine-point scale (1 = strongly disagree, 9 = strongly agree). During the second round, 79 participants received anonymous feedback from the first round and assessed a narrowed list of 130 recommendations. Recommendations were retained and classified according to the overall median score and ratings percentages by stakeholders. A total of 79 raters rated ≥10% of items, and 264 recommendations were retained and rated as follows: 240 items reached consensus, 24 items reached near consensus, 37 items were discarded and one recommendation was deleted. Many infections, though not all, can be prevented in the frail elderly. Thus, these guidelines should be adopted by each healthcare professional and facility to implement routine infection control procedures.

Introduction

Endemic and epidemic infections with distinct epidemiology in the current fast-growing elderly population are a major issue in nursing homes (NHs).¹ Indeed, residents in NHs are uniquely vulnerable to infection risk because of the long-term-confined environment in which they socialise and live, colonisation by multidrug-resistant micro-organisms (MDROs), physiological changes, underlying diseases, invasive devices, polypharmacy and loss of independence.² In addition, cross-infections within facilities are promoted by the difficulty of diagnosing infections because of atypical clinical presentation and cognitive impairment in the elderly, limited access to laboratories or radiology, low levels of physician input or unfavourable nurse:patient ratios. Moreover, the transfer of residents between acute care and NHs contributes to the transmission of healthcare-associated infections (HAIs).³ As a result, infections in these settings contribute to high morbidity and mortality rates, increased hospital transfers, outbreaks, antimicrobial use and additional costs.⁴

Evidence concerning infection control principles in NHs proved to be scanty or lacking, which may usually be ascribable to studies’ feasibility. Hospital infection control guidelines are difficult to apply to NHs in view of the differences between these settings.³ Thus, using a web-based Delphi technique, we aimed to collect opinions of a panel of experts to establish and widely disseminate consensus recommendations for infection control in elderly people living in NHs.⁵