Nursing home policies and practices for healthcare acquired infections: Results from a national survey

Currently, there is no national-level data on the prevalence of healthcare-acquired infections (HAIs) in nursing homes (NHs) and policies/practices they adopt. In 2012, we conducted a national survey of NHs, focusing on the most common HAIs: methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C diff), and Extended Spectrum Beta-Lactamase producers (ESBLs). The survey included questions regarding prevalence, admission and screening policies, contact precautions, decolonization, and cleaning practices. 1,002 surveys were returned. For MRSA, carrier prevalence was 4.04% (SD=6.00%) and infection was 0.71% (SD=1.41%). 14.2% of NHs were less likely to accept residents with MRSA. The principal reason for denying admission was lack of single/cohort rooms. Majority of NHs (96.4%) did not perform routine admission screening because: it was not required by regulatory agencies (56.2%); would not change care provision (30.7%); and due to screening costs (17.5%). Isolation strategies differed widely - 50.6% adhered to national guidelines by using contact precautions for infected patients with draining wounds while 39.0% went beyond guidance. Despite no guidance for differential cleaning of MRSA carriers' rooms, 59.3% reported increased cleaning, including more frequent cleaning (21.8%) or cleaning more items (44.6%) per room. Similar information about prevalence, policies and practices with respect to Cdiff and ESBL will be presented.HAIs are frequently found in NHs, but policies denying admission to HAI carriers do not appear to be common. NHs lack standardized approaches to infection prevention, and large variations in practices exist. Many facilities have adopted isolation, decolonization and cleaning practices that extend beyond current guidance.