Nursing home-associated infections in Department of Veterans Affairs community living centers.
BACKGROUND
Little is known about factors contributing to nursing home-associated infections (NHAIs). We conducted a survey of residents in 133 Department of Veterans Affairs community living centers to determine the roles of indwelling device use, bed locations, and treatment codes on NHAIs.


METHODS
A Web-based point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections was conducted on November 14, 2007.


RESULTS
Among 10,939 residents, 575 had at least one NHAI, for a point prevalence rate of 5.3%. Urinary tract infection, skin infection, asymptomatic bacteriuria, and pneumonia were the most prevalent NHAIs. A total of 2687 residents had one or more indwelling devices; 290 of these also had an NHAI, for a prevalence of 10.8%. In contrast, the prevalence of NHAIs in residents without indwelling devices was 3.5% (P < .0001). Indwelling urinary catheters, percutaneous gastrostomy tubes, peripherally inserted central catheters, and suprapubic urinary catheters were the most commonly used devices. There were 4027 residents in designated units and 6912 residents in dispersed units. The rate of device use was 21.4% in the designated units and 26.4% in the dispersed units (P < .0001). The prevalence of NHAIs was 4.5% in the designated units and 5.7% in the dispersed units (P < .001). Rates of NHAIs and device use varied greatly among the various treatment codes; however, there was a positive correlation between the rates of NHAIs and device use. Stepwise logistic regression analysis of data from long-stay and short-stay skilled nursing care residents revealed that only the presence of an indwelling device, not length of stay or bed location, affected the rate of NHAIs.


CONCLUSIONS
Indwelling device use, but not bed location or treatment code, was found to be associated with increased rate of NHAIs.
Tsan
Linda
L
Department of Veterans Affairs Central Office, Washington, DC, USA. vlinda.w.tsan@va.gov
Langberg
Robert
R
Davis
Chester
C
Phillips
Yancy
Y
Pierce
John
J
Hojlo
Christa
C
Gibert
Cynthia
C
Gaynes
Robert
R
Montgomery
Ona
O
Bradley
Suzanne
S
Danko
Linda
L
Roselle
Gary
G
D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000453:epidemiology; D002404:Catheterization / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D009735:Nursing Homes; D015995:Prevalence; D012307:Risk Factors; D014728:Veterans