Why Is There a Lack of Data on the Burden of HAIs in US Nursing Homes?

Nicola Thompson, PhD, Epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, discusses the lack of data on the burden of healthcare-associated infections in US nursing homes.

Interview Transcript (slightly modified for readability)

“Currently, the national burden of healthcare-associated infections in nursing homes is unknown. There have been burden estimates done in the past. The last publication actually came out in the year 2000 and it was based on a collection of data from separate studies that were conducted between 1978 and 1990. Essentially, what the authors did was group together this information and try to extrapolate out what the national picture might be.

Some of the limitations that the authors acknowledged readily are that there were studies done in different time periods, using different methods and definitions of what an infection is, [and] so the authors concluded that they don’t think that the information they put out there was very accurate, but they did it to raise attention and highlight the fact that there probably is a large burden of infections in the long-term care setting.

The reason that nothing has been done since that time in terms of truly understanding the epidemiology of infections and the burden of infections in nursing homes and long-term care settings is that in general there hasn’t been strong infection prevention and surveillance infrastructure in nursing homes—that includes not having dedicated or trained personnel to fill that role—and there hasn’t been strong surveillance infrastructure available for nursing homes either.

More recently, some of the initiatives that have occurred that have allowed us to start looking at this more closely [was one] in 2012, [where] the CDC developed a Long-Term Care Facility Component for the National Healthcare Safety Network, which is the national system used by healthcare facilities, primarily hospitals, to report infections that occur in the health setting. In 2012, the CDC added a special component suitable for use by long-term care facilities.

There was also the Department of Health and Human Services’ National Action Plan to Prevent HAIs. Initially, that focus was on hospital settings, but gradually [it] moved into looking at what can be done to measure, and then evaluate the effective prevention initiatives in nursing homes.

That big event [also occured] in 2012, and the third was the publication of the revised McGeer definitions for infection surveillance in long-term care facilities. This was a publication that came out in 1990 providing definitions for infection surveillance in nursing homes; those were revised in 2012 as well. Several key pieces that had been missing are now available that allow us to do this work.”