Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Feb 14;20(1):59.
doi: 10.1186/s12877-020-1467-6.

Developing evidence-based guidance for assessment of suspected infections in care home residents

Carmel Hughes  1 , David R Ellard  2   3 , Anne Campbell  4 , Rachel Potter  2 , Catherine Shaw  5 , Evie Gardner  6 , Ashley Agus  6 , Dermot O'Reilly  7 , Martin Underwood  2   3 , Mark Loeb  8 , Bob Stafford  9 , Michael Tunney  5
Affiliations
Review

Developing evidence-based guidance for assessment of suspected infections in care home residents

Carmel Hughes et al. BMC Geriatr. .

Abstract

Background: The aim of this study was to update and refine an algorithm, originally developed in Canada, to assist care home staff to manage residents with suspected infection in the United Kingdom care home setting. The infections of interest were urinary tract infections, respiratory tract infections and skin and soft tissue infection.

Method: We used a multi-faceted process involving a literature review, consensus meeting [nominal group technique involving general practitioners (GPs) and specialists in geriatric medicine and clinical microbiology], focus groups (care home staff and resident family members) and interviews (GPs), alongside continual iterative internal review and analysis within the research team.

Results: Six publications were identified in the literature which met inclusion criteria. These were used to update the algorithm which was presented to a consensus meeting (four participants all with a medical background) which discussed and agreed to inclusion of signs and symptoms, and the algorithm format. Focus groups and interview participants could see the value in the algorithm, and staff often reported that it reflected their usual practice. There were also interesting contrasts between evidence and usual practice informed by experience. Through continual iterative review and analysis, the final algorithm was finally presented in a format which described management of the three infections in terms of initial assessment of the resident, observation of the resident and action by the care home staff.

Conclusions: This study has resulted in an updated algorithm targeting key infections in care home residents which should be considered for implementation into everyday practice.

Keywords: Algorithm; Care homes; Infections; Older people; Prescribing.

PubMed Disclaimer

Conflict of interest statement

Carmel Hughes is a member of the Health Services & Delivery Research Commissioned Panel (National Institute for Health Research-NIHR), Martin Underwood is a member of NIHR Journals Library Editors Group and Mark Loeb has worked for the World Health Organisation as a consultant to develop antibiotics for essential list of medicines and algorithms for appropriate antibiotic use.

Figures

Fig. 1
Fig. 1
Outline of the consensus meeting
Fig. 2
Fig. 2
PRISMA diagram outlining the review process for identification of new evidence
Fig. 3
Fig. 3
Revised and adapted version of the algorithm
See this image and copyright information in PMC

References

    1. Hughes CM, Tunney MM. Improving prescribing of antibiotics in long-term care: resistant to change? JAMA Intern Med. 2013;173:682–683. doi: 10.1001/jamainternmed.2013.4077. - DOI - PubMed
    1. Daneman N, Bronskill SE, Gruneir A, et al. Variability in antibiotic use across nursing homes and the risk of antibiotic-related adverse outcomes for individual residents. JAMA Intern Med. 2015;175:1331–1339. doi: 10.1001/jamainternmed.2015.2770. - DOI - PubMed
    1. McClean P, Hughes C, Tunney M, et al. Antimicrobial prescribing in European nursing homes. J Antimicrob Chem. 2011;66:1609–1616. doi: 10.1093/jac/dkr183. - DOI - PubMed
    1. McClean P, Tunney M, Gilpin D, et al. Antimicrobial prescribing in residential homes. J Antimicrob Chem. 2012;67:1781–1790. doi: 10.1093/jac/dks085. - DOI - PubMed
    1. Department of Health, Social Services and Public Safety . Strategy for tackling antimicrobial resistance (STAR) 2012-2017. Belfast: DHSSPSNI; 2012.

Publication types

MeSH terms

LinkOut - more resources