Clostridium difficile Infections in Veterans Health Administration Long-Term Care Facilities

2015 ◽  
Vol 37 (3) ◽  
pp. 295-300 ◽  
Author(s):  
Jeffrey S. Reeves ◽  
Martin E. Evans ◽  
Loretta A. Simbartl ◽  
Stephen M. Kralovic ◽  
Allison A. Kelly ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Care Facilities ◽  
Onset Rate ◽  
Admission Prevalence

OBJECTIVEA nationwide initiative was implemented in February 2014 to decrease Clostridium difficile infections (CDI) in Veterans Affairs (VA) long-term care facilities. We report a baseline of national CDI data collected during the 2 years before the Initiative.METHODSPersonnel at each of 122 reporting sites entered monthly retrospective CDI case data from February 2012 through January 2014 into a national database using case definitions similar to those used in the National Healthcare Safety Network Multidrug-Resistant Organism/CDI module. The data were evaluated using Poisson regression models to examine infection occurrences over time while accounting for admission prevalence and type of diagnostic test.RESULTSDuring the 24-month analysis period, there were 100,800 admissions, 6,976,121 resident days, and 1,558 CDI cases. The pooled CDI admission prevalence rate (including recurrent cases) was 0.38 per 100 admissions, and the pooled nonduplicate/nonrecurrent community-onset rate was 0.17 per 100 admissions. The pooled long-term care facility–onset rate and the clinically confirmed (ie, diarrhea or evidence of pseudomembranous colitis) long-term care facility–onset rate were 1.98 and 1.78 per 10,000 resident days, respectively. Accounting for diagnostic test type, the long-term care facility–onset rate declined significantly (P=.05), but the clinically confirmed long-term care facility–onset rate did not.CONCLUSIONSVA long-term care facility CDI rates were comparable to those in recent reports from other long-term care facilities. The significant decline in the long-term care facility-onset rate but not in the clinically confirmed long-term care facility–onset rate may have been due to less testing of asymptomatic patients. Efforts to decrease CDI rates in long-term care facilities are necessary as part of a coordinated approach to decrease healthcare-associated infections.Infect. Control Hosp. Epidemiol. 2016;37(3):295–300

scholarly journals Determinants of Hospital Length of Stay among Patients with Pneumonia Admitted to a Large Canadian Hospital from 1991 to 2001

2005 ◽  
Vol 12 (7) ◽  
pp. 365-370 ◽  
Author(s):  
Margaret J McGregor ◽  
J Mark FitzGerald ◽  
Robert J Reid ◽  
Adrian R Levy ◽  
Michael Schulzer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Long Term Care ◽  
Care Facility ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Care Facilities

BACKGROUND: Pneumonia is a common reason for hospital admission, and the cost of treatment is primarily determined by length of stay (LOS).OBJECTIVES: To explore the changes to and determinants of hospital LOS for patients admitted for the treatment of community-acquired pneumonia over a decade of acute hospital downsizing.METHODS: Data were extracted from the database of Vancouver General Hospital, Vancouver, British Columbia, on patients admitted with community-acquired pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 481.xx, 482.xx, 483.xx, 485.xx and 486.xx) from January 1, 1991 to March 31, 2001. The effects of sociodemographic factors, the specialty of the admitting physician (family practice versus specialist), admission from and/or discharge to a long-term care facility (nursing home) and year of admission, adjusted for comorbidity, illness severity measures and other potential confounders were examined. Longitudinal changes in these factors over the 10-year period were also investigated.RESULTS: The study population (n=2495) had a median age of 73 years, 53% were male and the median LOS was six days. Adjusted LOS was longer for women (10% increase, 95% CI 3 to 16), increasing age group (7% increase, 95% CI 4 to 10), admission under a family physician versus specialist (42% increase, 95% CI 32 to 52) and admission from home with subsequent discharge to a long-term care facility (75% increase, 95% CI 47 to 108). Adjusted hospital LOS decreased by an estimated 2% (95% CI 1 to 3) per annum. The mean age at admission and the proportion admitted from long-term care facilities both increased significantly over the decade (P<0.05).CONCLUSIONS: Results suggest that the management of hospitalized patients with pneumonia changed substantially between 1991 and 2001. The interface of long-term care facilities with acute care would be an important future area to explore potential efficiencies in caring for patients with pneumonia.

scholarly journals BETTER LIVING THROUGH TECH: TECHNOLOGY-MEDIATED RECREATION AND LONG-TERM CARE FACILITY RESIDENTS’ QUALITY OF LIFE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S442-S442
Author(s):  
Ethan A McMahan ◽  
Marion Godoy ◽  
Abiola Awosanya ◽  
Robert Winningham ◽  
Charles De Vilmorin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Data Set ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Care Facilities

Abstract Empirical research on long-term care facility resident engagement has consistently indicated that increased engagement is associated with more positive clinical outcomes and increased quality of life. The current study adds to this existing literature by documenting the positive effects of technologically-mediated recreational programing on quality of life and medication usage in aged residents living in long-term care facilities. Technologically-mediated recreational programming was defined as recreational programming that was developed, implemented, and /or monitored using software platforms dedicated specifically for these types of activities. This study utilized a longitudinal design and was part of a larger project examining quality of life in older adults. A sample of 272 residents from three long-term care facilities in Toronto, Ontario participated in this project. Resident quality of life was assessed at multiple time points across a span of approximately 12 months, and resident engagement in recreational programming was monitored continuously during this twelve-month period. Quality of life was measured using the Resident Assessment Instrument Minimum Data Set Version 2.0. Number of pharmacological medication prescriptions received during the twelve-month study period was also assessed. Descriptive analyses indicated that, in general, resident functioning tended to decrease over time. However, when controlling for age, gender, and baseline measures of resident functioning, engagement in technologically-mediated recreational programming was positively associated with several indicators of quality of life. The current findings thus indicate that engagement in technology-mediated recreational programming is associated with increased quality of life of residents in long-term care facilities.

Dirty laundry? Evaluation of Clostridium Difficile Contamination in the Laundry at a Long-Term Care Facility

2012 ◽  
Vol 40 (5) ◽  
pp. e172
Author(s):  
Marguerite O'Donnell ◽  
Marguerite O'Donnell ◽  
Jennifer Cadnum ◽  
Brett M. Sitzlar ◽  
Curtis J. Donskey
Keyword(s):  
Clostridium Difficile ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

Clostridium difficile Infection in a Department of Veterans Affairs Long-Term Care Facility

2011 ◽  
Vol 32 (5) ◽  
pp. 513-515 ◽  
Author(s):  
Dubert M. Guerrero ◽  
Michelle M. Nerandzic ◽  
Lucy A. Jury ◽  
Shelley Chang ◽  
Robin L. Jump ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Long Term Care ◽  
Medical Center ◽  
Care Facility ◽  
Healthcare Facility ◽  
Veterans Affairs ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

In a Veterans Affairs medical center, 39% of healthcare facility–onset, healthcare facility-associated Clostridium difficile infections had their onset in the affiliated long-term care facility (LTCF). Eighty-five percent of LTCF-onset patients had been transferred from the hospital within the past month. Delays in diagnosis and treatment were common for LTCF-onset patients.

Opioid underuse in terminal care of long-term care facility residents with pain and/or dyspnoea: A cross-sectional PACE-survey in six European countries

2020 ◽  
Vol 34 (6) ◽  
pp. 784-794 ◽  
Author(s):  
Marc Tanghe ◽  
Nele Van Den Noortgate ◽  
Luc Deliens ◽  
Tinne Smets ◽  
Bregje Onwuteaka-Philipsen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Terminal Care ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Opioid Prescription ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Care Facilities

Background/objectives: Opioids relieve symptoms in terminal care. We studied opioid underuse in long-term care facilities, defined as residents without opioid prescription despite pain and/or dyspnoea, 3 days prior to death. Design and setting: In a proportionally stratified randomly selected sample of long-term care facilities in six European Union countries, nurses and long-term care facility management completed structured after-death questionnaires within 3 months of residents’ death. Measurements: Nurses assessed pain/dyspnoea with Comfort Assessment in Dying with Dementia scale and checked opioid prescription by chart review. We estimated opioid underuse per country and per symptom and calculated associations of opioid underuse by multilevel, multivariable analysis. Results: Nurses’ response rate was 81.6%, 95.7% for managers. Of 901 deceased residents with pain/dyspnoea reported in the last week, 10.6% had dyspnoea, 34.4% had pain and 55.0% had both symptoms. Opioid underuse per country was 19.2% (95% confidence interval: 12.9–27.2) in the Netherlands, 25.2% (18.3–33.6) in Belgium, 29.3% (16.9–45.8) in England, 33.7% (26.2–42.2) in Finland, 64.6% (52.0–75.4) in Italy and 79.1% (71.2–85.3) in Poland ( p < 0.001). Opioid underuse was 57.2% (33.0–78.4) for dyspnoea, 41.2% (95% confidence interval: 21.9–63.8) for pain and 37.4% (19.4–59.6) for both symptoms ( p = 0.013). Odds of opioid underuse were lower (odds ratio: 0.33; 95% confidence interval: 0.20–0.54) when pain was assessed. Conclusion: Opioid underuse differs between countries. Pain and dyspnoea should be formally assessed at the end-of-life and taken into account in physicians orders.

Sign in / Sign up

Export Citation Format

Share Document