Healthcare-associated Infection in Irish Long-term Care Facilities

A study was carried out 2011, to highlight the prevalence of HCAI and the antimicrobial use in Irish long-term care facilities (LTCF). This was conducted to inform national LTCD policy and to plan for the future of HCAI schemes. With earlier discharges being carried out and societal changes, there is an increasing number of people being cared for in LTCF. Although, this study was not predominately centred that of elderly people. LTCF residents vary in age, length of stay and associated illness. LTCF may be based in an individual’s home. In the Republic of Ireland there is a mixture of both public and private healthcare systems – 75% private and 25% public.

There are few research studies on HCAI from Irish LTCFs and those that are available show the heavy link with multi-drug resistant organisms and these facilities. The results of this study showed that the most common HCAI was urinary tract infections. In a study conducted between 1994-1995 evaluating six different elderly nursing homes in the west of Ireland, the results showed that of 56 residents, 26 reportedly acquired MRSA from within the nursing home. This suggested that the infection control interventions were likely to have an impact on MRSA prevalence. The ESAC (European Surveillance of Antimicrobial Consumption) conducted studies to calculate the antibiotic use. In April of 2009 304 LTCFs from twenty different countries (including 18 Irish LTCFs) participated. It was found that antibiotic prescribing was higher in Ireland with a percentage of 10. 5%, in comparison with the European overall percentage of 5. 9%. These studies stress the evident link between LTCF’s and HCAI. These infections are a major threat to patient safety as it exposes people to further health issues. Approximately 7% of European patients contract HCAI which causes the burden of roughly 1-11 billion pounds for Britain. There are approaches to address this problem. The British Medical association (BMI) published recommendations on ways to tackle this problem of HAI and to distinguish a new plan of action to counter this problem.

The principal changes that were made in the guidelines, centred around policies dealing with micro-organisms (particularly methicillin resistant staphylococcus aureus and Clostridium difficile) to policies which targeted to decrease rates of HAI (e. g. surgical site infections, ventilator associated pneumonia and UTI’s) and changing behaviour. The guidelines that were released by the BMA suggested a wide variety of behavioural and organisational interventions, which cover topics such as antimicrobial prescribing, hand hygiene, screening and isolation, bed occupancy and workload. These behavioural factors include, the closely antimicrobial prescribing centred around human, veterinary and agriculture anti-microbial use. Improvement of hand hygiene standards by system switch and culture change, established on the WHO guidelines which focus’s on hand hygiene. The use of indwelling devices which have multimodal uses that have proved effective interventions for example these “care bundles” been used to reduce bloodstream infections that are related to catheters. There are organisational factors which can address the issue of HCAI’s such as dress code and the use of personal protective equipment are vital in the support of excellent hygienic standards, this includes no sleeves, no jewellery and the use of disposable protective clothing.

The use of effective screening policies and adequate isolation protocols would control the contraction of microorganisms which are multidrug resistant. Performance standards should be reached by guaranteeing access to service and meeting nationally agreed performance targets. The leaders of healthcare are pivotal to achieving a change in culture in which no compliancy is deemed unacceptable. The maintenance of appropriate staffing levels with reasonable workloads would in term combat HCAI as it allows for better infection control practice. Wider policy initiatives: the constant surveillance of HAI is vital in improving the quality of care to patients. In order for the system to get better, adequate monitoring must be conducted as well as prioritizing research to study the best methods to reduce and control HAI’s.