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In 2012, the Maryland (MD) Emerging Infections Program (EIP) participated in the Centers for Disease Control and Prevention’s PISToL project (Piloting Infection Surveillance Tools in Long Term Care). The project allowed long term care facilities (LTCFs) to pilot a new National Healthcare Safety Network (NHSN) component designed to introduce standardized healthcare-associated infection (HAI) surveillance into the LTC setting.
METHODS:
Maryland recruited eight LTCFs to pilot the surveillance component for three months. LTCFs were directed to use NHSN surveillance definitions to identify urinary tract infection (UTI) events and laboratory-identified Clostridium difficile infection (LabID-CDI) events. LTCFs were then asked to submit completed event forms as well as denominator data (residence-days, urinary catheter-days, and new admissions) on a monthly basis. The MD PISToL Coordinator performed site visits at three LTCFs at the conclusion of the project to conduct validation.
RESULTS:
Four of eight LTCFs did not complete the project, most citing time and resource constraints. Four LTCFs completed three months of UTI surveillance; three LTCFs completed three months of LabID-CDI surveillance. A total of 81 UTI events were reported during the surveillance period by the four fully participating LTCFs. Of these, 42 (52%) met surveillance definitions for UTI events. 14 total LabID-CDI events were reported by three facilities during the surveillance period; all met the LabID-CDI event surveillance definition. LTCF staff reported spending between four and eighteen hours per month on surveillance and data collection activities. Obtaining surveillance forms from LTCFs at the end of each month required multiple contact attempts by the MD PISToL Coordinator. Data validation confirmed discrepancies in application of UTI surveillance definitions due either to misunderstanding or inattention to the protocol; validation activities also identified LTCF laboratory testing and prescribing practices which could potentially affect surveillance methodologies that rely on laboratory-confirmed infections.
CONCLUSIONS:
The LTC setting differs significantly from the acute care setting, where most standardized HAI surveillance has taken place to date. Lack of time to devote to infection surveillance and lack of training in the basics of surveillance methodology are major sources of concern for expanding surveillance in this setting. NHSN web-based surveillance tools may assist LTCF staff with learning to use surveillance definitions, but these require web access and skills which may currently be deficient. Whether they choose to use NHSN or another format, LTCF leadership will likely need to invest in additional staff and training to meet the challenge of implementing HAI surveillance in their facilities.