scholarly journals Paramyxovirus Outbreak in a Long-Term Care Facility: The Challenges of Implementing Infection Control Practices in a Congregate Setting

2017 ◽  
Vol 38 (4) ◽  
pp. 399-404 ◽  
Author(s):  
Steven Schaeffer Spires ◽  
H. Keipp Talbot ◽  
Carolyn A. Pope ◽  
Thomas R. Talbot
Keyword(s):  
Infection Control ◽  
Older Adult ◽  
Adult Population ◽  
Care Facility ◽  
Control Measures ◽  
Nasopharyngeal Swab ◽  
Term Care ◽  
Infection Control Measures ◽  
First Case ◽  
Older Adult Population

OBJECTIVEWe report an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) infections in a dementia care ward containing 2 separately locked units (A and B) to heighten awareness of these pathogens in the older adult population and highlight some of the infection prevention challenges faced during a noninfluenza respiratory viral outbreak in a congregate setting.METHODSCases were defined by the presence of new signs or symptoms that included (1) a single oral temperature ≥ 37.8°C (100.0°F) and (2) the presence of at least 2 of the following symptoms: cough, dyspnea, rhinorrhea, hoarseness, congestion, fatigue, and malaise. Attempted infection-control measures included cohorting patients and staff, empiric isolation precautions, and cessation of group activities. Available nasopharyngeal swab specimens were sent to the Tennessee Department of Health for identification by rT-PCR testing.RESULTSWe identified 30 of the 41 (73%) residents as cases over this 16-day outbreak. Due to high numbers of sick personnel, we were unable to cohort staff to 1 unit. Unit B developed its first case 8 days after infection control measures were implemented. Of the 14 cases with available specimens, 6 patients tested positive for RSV-B, 7 for HMPV and 1 patient test positive for influenza A. Overall, 15 cases (50%) required transfer to acute care facilities; 10 of these patients (34%) had chest x-ray confirmed pulmonary infiltrates; and 5 residents (17%) died.CONCLUSIONSThis case report highlights the importance of RSV and HMPV in causing substantial disease in the older adult population and highlights the challenges in preventing transmission of these viruses.Infect Control Hosp Epidemiol 2017;38:399–404

scholarly journals An outbreak of norovirus infection in a long-term care facility in Brazil

2010 ◽  
Vol 8 (4) ◽  
pp. 410-413 ◽  
Author(s):  
Fernando Gatti de Menezes ◽  
Vanessa Maria da Silva de Poli Correa ◽  
Fábio Gazelato de Mello Franco ◽  
Miriam Ikeda Ribeiro ◽  
Maria Fátima dos Santos Cardoso ◽  
...  
Keyword(s):  
Infection Control ◽  
Long Term Care ◽  
Control Strategies ◽  
Care Facility ◽  
Control Measures ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Infection Control Measures

ABSTRACT Objective: To describe a norovirus outbreak in a Brazilian long-term care facility from July 8 to 29, 2005. Methods: In the first 48 to 72 hours after onset of symptoms in inpatients and employees, the main infection control strategies were staff education, emphasis on hand washing, implementing contact precautions up to 48-72 hours after resolution of symptoms, complete cleaning of the rooms and exclusion of symptomatic employees from work until 48-72 hours after resolution of their symptoms. Epidemiological and clinical characteristics of the norovirus infections were described based on chart review. Results: The incidence among inpatients and employees was 41.3% and 16.25%, respectively. The main symptom was diarrhea, affecting 100% of inpatients and employees. Forty-four percent of specimens were positive by RIDASCREEN® Norovirus analyses, and identified as norovirus genogroup GII. Seventy percent of inpatients were women and their age range was 51-98 years. Inpatients had in average two comorbid conditions – 87.3% with cardiovascular or chronic pulmonary condition and 47.6% with dementia. There was not relapse or death. Conclusions: The early infection-control measures associated to surveillance are required to keep long-term care facilities free of noroviruses and to protect those who are most vulnerable.

Persistence of Fluoroquinolone-Resistant, Multidrug-ResistantStreptococcus pneumoniaein a Long-Term–Care Facility Efforts to Reduce Intrafacility Transmission

2005 ◽  
Vol 26 (3) ◽  
pp. 239-247 ◽  
Author(s):  
Alicia M. Fry ◽  
Chi Chi N. Udeagu ◽  
Montse Soriano-Gabarro ◽  
Scott Fridkin ◽  
Diana Musinski ◽  
...  
Keyword(s):  
Infection Control ◽  
Long Term Care ◽  
Care Facility ◽  
Control Measures ◽  
Nasopharyngeal Carriage ◽  
Outbreak Strain ◽  
Term Care ◽  
Long Term Care Facility ◽  
Infection Control Measures

AbstractObjective:We describe an effort to reduce transmission of a multidrug-resistantStreptococcus pneumoniae(MDRSP) in a long-term-care facility (LTCF).Design:Longitudinal cross-sectional study.Setting:An LTCF in New York City with ongoing disease due to an MDRSP strain among residents with AIDS since a 1995 outbreak. The MDRSP outbreak strain was susceptible to vancomycin but not to other antimicrobials tested, including fluoroquinolones.Participants:Residents and staff members of the LTCF during 1999 through 2001.Intervention:Implementing standard infection control measures, and developing and implementing "enhanced standard" infection control measures, modified respiratory droplet prevention measures to reduce inter-resident transmission.Results:Before the intervention, nasopharyngeal carriage of the MDRSP outbreak strain was detected in residents with AIDS and residents with tracheostomies who were not dependent on mechanical ventilation. The prevalence of nasopharyngeal carriage of the MDRSP outbreak strain was 7.8% among residents who had AIDS and 14.6% among residents with tracheostomies. After training sessions on standard and enhanced standard infection control measures, the staff appeared to have good knowledge and practice of the infection control measures. After the intervention, new transmission among residents with tracheostomies was prevented; however, these residents were prone to persistent tracheal carriage and needed ongoing enhanced standard infection control measures. Ongoing transmission among residents with AIDS, a socially active group, was documented, although fewer cases of disease due to the outbreak strain occurred.Conclusions:Infection control contributed to less transmission of MDRSP in the LTCF. Additional strategies are needed to reduce transmission and carriage among certain resident populations.

Tightly Clustered Outbreak of Group A Streptococcal Disease at a Long-Term Care Facility

2006 ◽  
Vol 27 (12) ◽  
pp. 1377-1384 ◽  
Author(s):  
Kathryn E. Arnold ◽  
Jody L. Schweitzer ◽  
Barbara Wallace ◽  
Monique Salter ◽  
Ruth Neeman ◽  
...  
Keyword(s):  
Infection Control ◽  
Long Term Care ◽  
Care Facility ◽  
Control Measures ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Infection Control Measures ◽  
Group A

Objective.To describe investigation of a tightly clustered outbreak of invasive group A streptococcal (GAS) disease associated with a high mortality rate in a long-term care facility (LTCF).Design.Cross-sectional carriage survey and epidemiologic investigation of LTCF resident and employee cohorts.Setting.A 104-bed community LTCF between March 1 and April 7, 2004.Patients.A cohort of LTCF residents with assigned beds at the time of the outbreak.Interventions.Reinforcement of standard infection control measures and receipt of chemoprophylaxis by GAS carriers.Results.Four confirmed and 2 probable GAS cases occurred between March 16 and April 1, 2004. Four case patients died. The final case occurred during the investigation, before the patient was determined to be a GAS carrier. No case occurred during the 6 months after the intervention. Disease was caused by typeemm3GAS; 16.5% of residents and 2.4% of employees carried the outbreak strain. Disease was clustered in 1 quadrant of the LTCF and associated with nonintact skin. GAS disease or carriage was associated with having frequent personal visitors.Conclusions.Widespread carriage of a virulent GAS strain likely resulted from inadequate infection control measures. Enhanced infection control and targeted prophylaxis for GAS carriers appeared to end the outbreak. In addition to employees, regular visitors to LTCFs should be trained in hand hygiene and infection control because of the potential for extended relationships over time, leading to interaction with multiple residents, and disease transmission in such residential settings. Specific attention to prevention of skin breaks and proper wound care may prevent disease. The occurrence of a sixth case during the investigation suggests urgency in addressing severe, large, or tightly clustered outbreaks of GAS infection in LTCFs.

scholarly journals A novel influenza A (H1N1) outbreak experience among residents of a long term-care facility in Saudi Arabia during 2010 seasonal flu circulation

2012 ◽  
Vol 4 (1) ◽  
pp. 23 ◽  
Author(s):  
Raouf M. Afifi ◽  
Sherif Omar ◽  
Ahmed El Raggal
Keyword(s):  
Saudi Arabia ◽  
Influenza A ◽  
Long Term Care ◽  
Care Facility ◽  
Control Measures ◽  
Term Care ◽  
Long Term Care Facility ◽  
Infection Control Measures ◽  
Influenza A H1n1

The aim of this work was to describe and analyze an outbreak of novel 2009 influenza A (H1N1) among residents of a long-term care facility (LTCF) in Prince Mansour Military Hospital (PMMH), Taif, Saudi Arabia. These patients had been admitted to the LTCF months or years before the outbreak for several reasons, e.g. cerebral palsy, neurological deficits due to road traffic accidents with resultant handicap, chronic diseases associated with old age. An observational study was carried out to demonstrate and analyze the epidemiological characteristics (demographic factors, risk factors, and outcomes) associated with the outbreak in order to clarify which prevention and control measures had been taken and which recommendations were followed. During the period October 28 to November 11 2010, 21 LTCF residents were suspected to be clinically involved: fever ≥38ºC with influenza-like illness (ILI). Age ranged from 9-91 years (mean 46±24.13); 62% were males. Among them, 12 (57%) were influenza A (H1N1) positive by reverse transcription polymerase chain reaction (RTPCR). Mortality involved 2 (17%) of the A (H1N1) laboratory confirmed individuals. Implementation of the recommended infection control measures mitigated the transmission of infection to new individuals. The fulfillment of strict infection control measures could limit H1N1 infection among LTCFPMMH patients. Routine influenza, including specific H1N1 immunization of all LTCF residents together with their healthcare staff, should be mandatory in those settings serving immunocompromised patients.

Zanamivir Use During Transmission of Amantadine-Resistant Influenza A in a Nursing Home

2000 ◽  
Vol 21 (11) ◽  
pp. 700-704 ◽  
Author(s):  
Christine Lee ◽  
Mark Loeb ◽  
Anne Phillips ◽  
Judy Nesbitt ◽  
Karen Smith ◽  
...  
Keyword(s):  
Nursing Home ◽  
Influenza A ◽  
Nursing Home Residents ◽  
Care Facility ◽  
Respiratory Illness ◽  
The Elderly ◽  
Control Measures ◽  
Term Care ◽  
Long Term Care Facility ◽  
Infection Control Measures

AbstractObjective:To describe the use of zanamivir during an influenza A outbreak.Population:Residents of a 176-bed long-term-care facility for the elderly in Newmarket, Ontario, Canada, 90% of whom received influenza vaccine in the fall of 1998.Outbreak:When respiratory illness due to influenza A was confirmed, infection control measures and amantadine prophylaxis were initiated. Despite these measures, transmission of influenza A continued.Intervention:Zanamivir inhalations, 10 mg daily for prophylaxis and 10 mg twice daily for treatment of influenza.Results:There were 13 definite and 66 probable outbreak-associated cases of influenza A. Twelve (15%) cases developed pneumonia, 7 (9%) were hospitalized, and 2 (2.6%) died. All 12 culture-positive cases yielded influenza A/Sydney/H3N2/05/97-like virus, a 1998/99 vaccine component. The three isolates obtained prior to the initiation of amantadine were amantadine-susceptible; all nine obtained after prophylaxis was instituted were amantadine-resistant. One hundred twenty-nine (92%) of 140 residents who were offered zanamivir accepted it and were able to attempt inhalations. Of these 129, 78% (100) had no difficulty in complying with inhalations. Difficulty with inhalations was associated with decreased functional and mental status. Fifteen (58%) of 26 residents fully dependent in activities of daily living had difficulty compared to 14 (14%) of 100 others (P<.001). Twenty-two (45%) of 49 residents not oriented to person, place, or time had difficulty compared to 7 (10%) of 77 others (P<001). In the 2 weeks after zanamivir prophylaxis, only 2 new cases of respiratory illness occurred, neither confirmed as influenza. No side effects were identified in 128 zanamivir-treated residents.Conclusion:A minority of nursing home residents have difficulty following instructions for zanamivir inhalations. Zanamivir was well tolerated, and its use was temporally associated with termination of an outbreak that amantadine had failed to control.

Lack of Transmission of Vancomycin-Resistant Enterococci in Three Long-Term–Care Facilities

1999 ◽  
Vol 20 (05) ◽  
pp. 341-343 ◽  
Author(s):  
Christina A. Greenaway ◽  
Mark A. Miller
Keyword(s):  
Infection Control ◽  
Long Term Care ◽  
Point Prevalence ◽  
Control Measures ◽  
Term Care ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Care Facilities ◽  
Vancomycin Resistant

Abstract Three patients colonized with vancomycin-resistant Enterococcus were admitted to one or more of three long-term-care facilities. Six point-prevalence surveys revealed no transmission of vancomycin-resistant Enterococcus after a total of 234 days of exposure during which moderately strict infection control measures were implemented. Four of 116 environmental cultures were positive.

scholarly journals In the Eye of the COVID-19 Storm: An Ethical Analysis on Aging, End of Life, and Recovery

2021 ◽  
Vol 9 (5) ◽  
Author(s):  
Al Giwa
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Elder Abuse ◽  
Adult Population ◽  
Severe Disease ◽  
Multiple Chronic Conditions ◽  
Geriatric Population ◽  
Term Care ◽  
Medical Response ◽  
Older Adult Population

Early into the COVID pandemic, epidemiologists and infectious disease experts warned that older adults were among those most vulnerable to the disease, as multiple studies from China, Italy, Washington State, and New York City showed that age greater than 65 significantly increased the risk of severe disease and/or death from the novel 2019 coronavirus. Centers for Disease Control data through June 2020 show that nearly 81% of deaths due to COVID-19 are of people 65 years of age and older. These breakdowns indicate that, primarily, persons with advanced age and most, often, those with multiple chronic conditions are those who have died. The effects of the virus led to public health measures aimed at reducing exposures of older people and other vulnerable populations. The disease was amplified in rehabilitation centers, skilled nursing facilities, assisted living centers, group homes, and other long-term care facilities serving a primarily geriatric population. Even as parts of the country are opening up, the death toll is still climbing and affecting the older adult population disproportionately. Duty to care, autonomy and self-determination, non-judgmental regard, justice, and futility are all significant ethical principles and constructs that have arisen in the intense and real-time application of healthcare as we continue to face the present global pandemic. We use an ethical lens to examine the medical response of the SARS-CoV-2 pandemic on the older adult population and explore if society is doing enough to protect older adults, or rather, engaging in and furthering collective and systematic elder abuse.

scholarly journals 208 - Person-centred infection prevention and control during a pandemic: The Dementia Isolation Toolkit

2021 ◽  
Vol 33 (S1) ◽  
pp. 11-11
Author(s):  
Andrea Iaboni ◽  
Hannah Quirt ◽  
Steven Stewart ◽  
Alisa Grigorovich ◽  
Claudia Barned ◽  
...  
Keyword(s):  
Infection Control ◽  
Online Survey ◽  
Moral Distress ◽  
Well Being ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Care Plans ◽  
Infection Control Measures ◽  
People With Dementia

Objectives:People working in long-term care homes (LTCH) face ethical dilemmas about how to minimize the risk of spread of COVID-19, while also minimizing psychological hardship and other harms of infection control measures on residents. The Dementia Isolation Toolkit (www.dementiaisolationtoolkit.com; DIT) was developed to address the gap in ethical guidance for LTCH on how to safely and effectively isolate people with dementia while supporting the personhood and well-being of residents. In this presentation, we will present the DIT and report on the results of a survey of LTCH staff in Ontario, Canada on their experiences isolating residents in LTCH and the use of the DIT in supporting person-centred isolation care.Methods:A link to an online survey was distributed to LTCH staff through provincial organizations and agencies as well as through social media and the DIT website. Inclusion criteria were LTCH staff working on-site at a LTCH since March 1, 2020, who had direct or indirect experience with the isolation/quarantine of LTCH residents. Results were summarized descriptively.Results:A broad sample of LTCH staff (n=207) participated in the survey, most of whom had experienced an outbreak in their LTCH. Dementia (96%) was the most important barrier to implementation of infection control measures in LTCH, followed by staff distress about the effects of isolation on residents (61%). Important facilitators for isolation included delivery of 1:1 activities in the resident’s room (81%) and designating essential caregivers to provide support (67%), while inadequate staffing levels were reported as a barrier (55%). 65% of respondents indicated some familiarity with the DIT, and of those who had used the toolkit, 62% found it helpful in supporting isolation care, particularly in developing care plans and making and communicating decisions. Of those who had used the DIT, 48% found it fairly or very helpful at reducing their level of distress.Conclusions:Isolation as an infection control and prevention (ICP) measure in LTCH environments can be harmful to residents and create moral distress in staff. ICP guidance and support of LTCH needs to address how to minimize these harms by providing dementia-specific guidance such as in the DIT.

scholarly journals Clinical and Demographic Characteristics of Patients With a New Diagnosis of Carriage or Clinical Infection With Carbapenemase-Producing Enterobacterales: A Retrospective Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Assaf Adar ◽  
Hiba Zayyad ◽  
Maya Azrad ◽  
Kozita Libai ◽  
Ilana Aharon ◽  
...  
Keyword(s):  
Antibiotic Susceptibility ◽  
Medical Center ◽  
Resistance Mechanism ◽  
Care Facility ◽  
Control Measures ◽  
Clinical Infection ◽  
Term Care ◽  
Long Term Care Facility ◽  
Infection Control Measures ◽  
New Diagnosis

Background: To examine the clinical, demographic, and microbiologic characteristics of new rectal carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) carriers vs. those with a clinical infection, hospitalized at Padeh-Poriya Medical Center between 2014 and 2017 and to examine the susceptibility profiles of isolates from clinical infections.Methods: In this retrospective, chart analysis, demographic and clinical data were collected from medical charts of 175 adult patients with either new- onset carbapenemase-producing Enterobacterales (CPE) carriage or clinical CPE infection. Collected data included age, ethnic group, place of residence, hospitalizations in the past 90 days, and 30-day mortality. Microbiological analyses considered bacterial genus, molecular resistance mechanism and antibiotic susceptibility.Results: A significantly higher percentage (42.4%) of CPE carriers were long-term care facility residents, and had been recently hospitalized (56.3%), as compared to patients with clinical CPE infection (29.2 and 45.9%, respectively). Additionally, we noted a high (58.3%) acquision of CPE in our hospital. The most common bacterial isolate was K. pneumoniae and the most common resistance mechanism was Klebsiella pneumoniae (K. pneumoniae) carbapenemases (KPC). High susceptibility rates to amikacin and chloramphenicol were also noted.Conclusions: This study reaffirmed the importance of CPE screening and infection control measures. The observed antibiotic susceptibility profile suggests amikacin and chloramphenicol as potential treatments for CPE infection.

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