Nursing home infection rates climbing: Study

Nursing home infections can be reduced,
researchers say.

Nursing home infection rates are on the rise, a study from Columbia University School of Nursing found, suggesting that more must be done to protect residents of these facilities from preventable complications.

The study, which examined infections in U.S. nursing homes over a five-year period, found increased infection rates for pneumonia, urinary tract infections (UTIs), viral hepatitis, septicemia, wound infections, and multiple drug-resistant organisms (MDROs).

"Infections are a leading cause of deaths and complications for nursing home residents, and with the exception of tuberculosis we found a significant increase in infection rates across the board," said lead study author Carolyn Herzig, MS, project director of the Prevention of Nosocomial Infections & Cost Effectiveness in Nursing Homes (PNICE-NH) study at Columbia Nursing.

"Unless we can improve infection prevention and control in nursing homes, this problem is only going to get worse as the baby boomers age and people are able to live longer with increasingly complex, chronic diseases."

Herzig and a team of researchers from Columbia Nursing and RAND Corporation analyzed infection prevalence from 2006 to 2010, using data that nursing homes submitted to the U.S. Centers for Medicare and Medicaid Services.

While UTIs and pneumonia were the most common, infection prevalence increased the most – 48 percent – for viral hepatitis. Herzig presented findings from the study at IDWeek 2014 in Philadelphia.

More research is needed to determine the exact causes behind the increases in infection prevalence, Herzig said.

But there are several relatively simple interventions that have been proven to help reduce the risk of infection – and that families should look for when selecting a nursing home for a loved one.

UTIs, far and away the most common infection in nursing homes, increased in prevalence by 1 percent, the study found. UTIs can be prevented by reducing the use of urinary catheters and increasing the frequency of assisted trips to the toilet or diaper changes for residents who are unable to use the bathroom.

Families evaluating which nursing home to choose for a loved one should ask what protocols are in place to decrease catheter use, and they should also ask how the staff cares for residents with diapers, Herzig said.

"Nobody wants to think about diapers, but even if your loved one enters the nursing home able to use the bathroom independently, they may need assistance down the line. Seeing how well toileting needs are met is one way to assess infection risk."

Pneumonia climbed in prevalence by 11 percent, the study found. For pneumonia, and other infections that can spread through the air or contact with contaminated surfaces, proper hand hygiene is essential for prevention.

Residents, visitors, and staff should all have easy access to sanitizer or soap and water to clean their hands and be encouraged to do this frequently.

"When you walk into a nursing home for the first time, you should easily spot hand sanitizer dispensers or hand-washing stations," Herzig said. "If you don't see this, it's an indication that infection control and prevention may be lacking at the facility."

MDRO infection prevalence increased 18 percent, the study found. Screening for MDROs is an important tool for reducing the risk of MDROs, Herzig said. Families should ask whether residents are routinely screened for bacteria like C. difficile and methicillin-resistant Staphylococcus aureus (MRSA).

While some nursing homes may only screen residents who are symptomatic or at high risk for infection, routine screening of all residents upon admission is likely to be more effective, Herzig said.

In addition, it's worth asking whether a nursing home has private rooms to allow for isolation if necessary and whether families are consulted when their loved one shares a room with a resident who has an infection.

"Isolation is a common way to contain MRSA and other infections in hospitals, but in nursing homes this isn't as common because these facilities are tailored to residential needs. If the nursing home does have rooms for isolation, it suggests a more robust approach to infection prevention and control."

Source: Columbia University

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Nursing homes benefit from telemedicine

Telemedicine can reduce hospitalizations

Telemedicine used at nursing homes during hours when doctors are not typically present is a viable way to reduce avoidable hospitalizations, according to research published in February's issue of Health Affairs.

Commitment to telemedicine can save
a lot of money at nursing homes.

Hospitalizations of nursing home residents are occurring more frequently, and result in complications, morbidity and expensive Medicare costs.

When a medical issue arises on nights and weekends that cannot be addressed by the on-call physician not present at the facility, the doctor can either travel to the nursing home or recommend that the resident be sent to the hospital emergency room.

Very often, the physician recommends the hospital emergency room.

Researchers David C. Grabowski of Harvard Medical School and A. James O'Malley of The Dartmouth Institute for Health Policy & Clinical Practice at the Geisel School of Medicine designed a study to determine whether nursing home residents who receive off-hour physician coverage by telemedicine experience a lower rate of hospitalizations, thereby generating savings to Medicare in excess of the costs of the telemedicine program.

They studied a Massachusetts for-profit nursing home chain, which had signed a contract with a telemedicine provider to introduce service in 11 nursing homes to cover urgent or emergent calls on weeknights and weekends.

The telemedicine service consisted of two-way video conferencing with a high-resolution camera, allowing nursing home residents to be examined remotely by a physician. For the period of October 2009 through September 2011, the nursing home chain staggered its telemedicine introduction. Six of the 11 nursing homes in the chain were randomized to initiate the telemedicine service while the five remaining nursing homes served as the control group.

The researchers found that four of the six treatment facilities were responsible for most of the telemedicine calls. Across all calls, the rate of hospitalizations declined 5.3 percent for the control group and 9.7 percent for the treatment group. This effect was largely concentrated in the four "more engaged" nursing homes, whose rate of hospitalization declined 11.3 percent.

"We did not observe a statistically significant effect of the telemedicine intervention on hospitalizations," the researchers wrote.

However, when they compared the four more-engaged nursing homes with the two less-engaged ones, they found a significant decline in the hospitalization rate at the more engaged facilities. A secondary finding of the analysis is that the hospitalization rate for non-engaged intervention facilities was very close to that of the control facilities.

"According to these estimates, a nursing home that typically had 180 hospitalizations per year and that was more engaged with telemedicine could expect to see a statistically significant reduction of about 15.1 hospitalizations per year" than a facility that was less engaged, the researchers said. The average Medicare savings would be roughly $150,000 per nursing home per year.

The annual cost of the telemedicine service in this study was $30,000 per nursing home, implying a net savings of roughly $120,000 per nursing home per year in the more engaged facilities, the researchers said.

The researchers say engagement is the key to the use of telemedicine preventing hospitalizations. Simply making it available does not guarantee its use by nursing home staff. Telemedicine providers and nursing home leaders will have to take additional steps to encourage buy-in among nursing home administrators, front-line staff members, and physicians.

Additional research will be needed to test models that encourage stronger engagement on the part of providers, as well as examine the implications of new policies that incentivize increased adoption, they said.

Source: The Dartmouth Institute for Health Policy & Clinical Practice 

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Dangerous chemicals applied in Indiana workplaces

Dangerous chemicals found inside Indiana restaurants, nursing homes, hotels and health clinics

Restaurants, hotels and health care
facilities might have been treated with
harmful pesticides.

Products such as Fipronil, more well known by its brand name Termidor, arrived on the market nearly a decade ago, and have since been adapted to a number of uses, including commercial and agricultural pesticides. It’s even used in very low doses in some pet flea treatments, including the brand name Frontline.

Used safely, as directed, Fipronil can be a game changer in the elimination of pests, especially ants.

The product works so well that it has to be diluted and combined with water when its sprayed as Termidor. It also comes with a long list of use restrictions backed by federal law.

The U.S. Environmental Protection Agency (EPA) lists Fipronil as a "possible human carcinogen," meaning it has the potential to cause cancer.

Termidor is only approved for outdoor use in areas far away from humans and animals. Using it indoors around children whose immune systems are still developing is of particular concern, the EPA noted.

But, in early 2012, state regulators began getting tips from whistle blowers alleging that wasn't what was happening in the field, and that the pesticides were being used indoors.

Last summer, investigators from the Office of the Indiana State Chemist (OISC), based at Purdue University, opened their first Fipronil case file, and began gathering samples across the state.

Swabs were taken inside restaurant kitchens and retirement homes, churches and health clinics, hotels and even grocery stores.

From Mooresville to Muncie, Bloomington, Greenwood, Indianapolis and dozens of other Central Indiana cities, nearly every test so far has come back positive for Fipronil.

OISC and the EPA are still gathering evidence on the effects of long term exposure to Fipronil, but both agencies are concerned by their findings so far.

The state fined one company, Ecolab, $18,000 for violations of Fipronil use. A settlement was recently reached requiring the company to pay $9,000 of that fine.

But Ecolab isn't the only company now accused of illegally applying Fipronil indoors.

State investigators are now tracking at least three additional active cases.

Investigators are also asking for the public’s help. Those looking to hire a pest control company should

• ask if they are licensed with the state and the appropriate agency
• get two or three references and use them
• check the accuracy of what they have been told

The state’s ultimate goal is to cut the risk of indoor Fipronil use to zero.

Editor's note: This article has been edited for length.

Source: WishTV

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Nursing home cited for workplace hazards

OSHA fines New Jersey nursing home for exposing workers to excessive heat and health hazards

CARNEYS POINT, N.J. – The U.S. Department of Labor's Occupational Safety and Health Administration has cited Carneys Point Care Center for 10 alleged serious violations and one other-than-serious violation found at the nursing home in Carneys Point.

OSHA's May inspection was initiated as part of the agency's national emphasis program for nursing and residential care facilities.

Nursing facilities can harbor many
health hazards.

"The increasing rate of injuries and illnesses among hospital and health care workers underscores OSHA's concern about the safety and health of these workers," said Paula Dixon-Roderick, director of OSHA's Marlton Area Office.

"The workers that care for our loved ones deserve a safe workplace. OSHA is committed to ensuring effective hazard prevention measures nationwide."

Among the serious violations cited involves OSHA's general duty clause because workers in the laundry department were exposed to excessive levels of heat. OSHA proposed a fine of $6,300 for this violation.

Serious violations, carrying $42,300 in proposed penalties, include

• failing to ensure workers wore appropriate eye protection; 
• ensure easy access to a sharps container; 
• correct exposed wires from an industrial washer; 
• provide suitable eyewash facilities, bloodborne pathogen training, Hepatitis B vaccines and effective information and training on hazardous chemicals in the workplace; 
• properly use flexible electrical cords and label hazardous chemical containers; 
• develop a written hazard communication program; and 
• have material safety data sheets and safety data sheets for each hazardous chemical used in the workplace. 

A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.

To ask questions, obtain compliance assistance, file a complaint, or report workplace hospitalizations, fatalities or situations posing imminent danger to workers, the public should call OSHA's toll-free hotline at 800-321-OSHA (6742).

Source: OSHA

Protect nursing home workers and patients

The indoor air quality in a nursing home can suffer from airborne chemicals, certain odors, bacteria, viruses, mold, particles, dust and other contaminants.

A well-placed air purifier
helps provide cleaner and
healthier air in rooms and
gathering places.

With strict source control, proper ventilation and the right air cleaning system, staff and patients will be able to breathe healthier air.

Electrocorp has developed a range of indoor air purifiers for nursing homes, hospitals and health care settings that feature a highly efficient activated carbon and HEPA filter system plus optional UV germicidal filtration.

Activated carbon (or charcoal) is the best way to remove airborne chemicals, odors, volatile organic compounds and gases, while HEPA traps particles and dust. UV helps neutralize biological contaminants such as bacteria, viruses and mold, so that they won't affect human health anymore.

For more information and a free IAQ consultation, contact Electrocorp today.

Retirement homes: For a greener future

Seniors are at greater risk for
respiratory and auto-immune diseases

As people live longer, the need for retirement homes, nursing homes and adult congregate living facilities increases.

To date, approximately 10 million seniors in the United States are or will live in one of these types of homes.

For the average healthy person, exposure to harmful chemicals found in cleaning products, furniture and paints may not have immediate or long-term effects. Seniors, however, are particularly at risk.

As we age, our immune systems become less effective, making us more vulnerable to disease and infection. As a result, autoimmune diseases and cancers are more prevalent, as are cardiovascular and respiratory diseases.

What the experts suggest

Indoor environmental experts have come up with three important elements necessary for ensuring good indoor air quality:         

• Source control
• Ventilation
• Air cleaning

Source Control

Source control is the process of eliminating the causes of air pollution at the source, such as in building materials. The EPA agrees that source control is the only way to eliminate indoor air pollution, but it is impossible to completely rid the air of contaminants. As a result, it is suggested that buildings are outfitted with furniture, paint and cleaning products that are low in volatile organic compounds. It is also important to regularly test for high humidity. This is a sure-fire way of detecting early signs of mold. By starting as simply as that, the quantity of pollutants will be reduced.

Ventilation

A good HVAC ventilation system will allow for a constant flow of air to pass. It can also aid in minimizing the threat of mold. But an HVAC system alone is not enough. It can bring in pollutants, such as pollen and dust from the outside as well as circulate pollutants that are already indoors. Ensuring a regular cleaning of the filters in the HVAC system will aid greatly in reducing built-up contaminants indoors.

Air Cleaning

A good ventilation system is incomplete without an air cleaning solution. Because HVACs are limited in their capacity to rid the air of allergens and pollutants, air cleaners will pick up the slack. These cleaning units will adsorb airborne chemicals with activated carbon filters. HEPA filters will trap particles and the need for constant cleaning will be significantly reduced.

Source: GREENGUARD

Electrocorp’s air cleaners

Electrocorp's air filtration systems can outfit retirement homes with air cleaners that will help reduce the risk of illness through airborne chemicals. With options for HEPA filters, activated carbon filters, and even UV germidical lamps, Electrocorp can provide cleaner air solutions for seniors.

Do you or someone you know live in a retirement home, nursing home or adult congregate living facility? Tell us your indoor air quality stories.

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To learn more about Electrocorp’s products, contact us through our website.