Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain

Abstract

A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a “nosocomiun”, i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

Post-Infection Oscillometry and Pulmonary Metrics in SARS-CoV-2 Patients: A 40-Day Follow-Up Study

“…Infection control measures are emphasized, with strong evidence advocating for comprehensive interventions such as vaccination against influenza, SARS-CoV-2, and pneumococcal disease, as well as the implementation of robust infection control protocols including hand washing, social distancing, and the use of PPE [ 25 , 26 ]. Further studies have delved into the specific factors contributing to outbreaks, including facility size, staffing practices, and the unique environmental characteristics of nursing homes, suggesting the implementation of specific interventions like mass testing, visitor restrictions, and droplet/contact precautions to reduce transmission rates [ 26 , 27 ].…”

“…The effects of gender, chronic illness, and vaccination on COVID-19-related hospitalization and death are detailed, with male sex identified as a particular risk factor [ 29 , 30 ]. Importantly, the need to balance infection prevention with residents’ quality of life is a recurring theme, emphasizing the complexities of managing COVID-19 in these sensitive environments [ 27 ].…”

Antimicrobial Agent Use for Urinary Tract Infection in Long-Term Care Facilities in Spain: Results from a Retrospective Analytical Cohort Analysis

“…Older adults represent a larger proportion of the population, increasing the demand for long-term care facilities. Nursing homes (NHs) are intended to mimic the home environment of residents, but they often become spaces where people with significant underlying conditions live in limited spaces, sharing caregivers in a communal setting [2]. Despite providing less intensive medical care, long-term care facilities have not been immune to healthcare-associated infections, affecting the vulnerable NH population [3,4].…”

“…The aging of the population in NHs has presented a representative change with an increase in complexity, including higher rates of multimorbidity and frailty [18]. This demographic change leads to increased susceptibility to serious complications, especially infectious diseases, highlighting the need for improved antimicrobial stewardship programs and prevention measures for healthcare-associated infections [2].…”

Infection Control Challenges and Solutions in Long-Term Care Facilities

“…Shortages in staffing pose another barrier to infection control within long-term care facilities. Inadequate staffing levels can impede the detection and isolation of cases, leading to rapid disease spread within the facility (8,9). Research emphasizes the significance of staffing for infection prevention and control, stressing the necessity of a trained and adequate workforce to implement proper hygiene practices.…”