Infections in long-term care populations in the United States

Abstract

Objectives: To estimate infection prevalence and explore associated risk factors in nursing home (NH) residents, individuals receiving home health care (HHC), and individuals receiving hospice care.

Design: Cross-sectional.

Setting: Nationally representative samples of 1,174 U.S. NHs in the 2004 National Nursing Home Survey (NNHS) and 1,036 U.S. HHC and hospice agencies in the 2007 National Home and Hospice Care Survey (NHHCS).

Participants: A nationally representative sample of 12,270 NH residents, 4,394 individuals receiving HHC, and 4,410 individuals receiving hospice care.

Measurements: International Classification of Diseases, Ninth Revision, Clinical Modification, codes were used to identify the presence of infection, including community-acquired infection and those acquired during earlier healthcare exposures.

Results: Unweighted response rates were 78% for the 2004 NHHS and 67% for the 2007 NHHCS. Approximately 12% of NH residents and 12% of individuals receiving HHC had an infection at the time of the survey interview, and more than 10% of individuals receiving hospice care had an infection when discharged from hospice care. The most common infections were urinary tract infection (3.0–5.2%), pneumonia (2.2–4.4%), and cellulitis (1.6–2.0%). Short length of care and recent inpatient stay in a healthcare facility were associated with infections in all three populations. Taking 10 or more medications and urinary catheter exposure were significant in two of these three long-term care populations.

Conclusion: Infection prevalence in HHC, hospice, and NH populations is similar. Although these infections may be community acquired or acquired during earlier healthcare exposures, these findings fill an important gap in understanding the national infection burden and may help inform future research on infection epidemiology and prevention strategies in long-term care populations.