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March 20, 2018

Can Infection Prevention Programs in Hospitals and Nursing Facilities Be Integrated?From Silos to Partners

Author Affiliations
  • 1Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
  • 2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 3VA Ann Arbor Healthcare System, Ann Arbor, Michigan
  • 4Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
  • 5Department of Infection Prevention and Epidemiology, Michigan Medicine, Ann Arbor
  • 6Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
JAMA. 2018;319(11):1089-1090. doi:10.1001/jama.2018.0060

Dissemination and implementation of evidence-based interventions have successfully reduced central line–associated bloodstream infections, surgical site infections, and Clostridium difficile in many acute care hospitals partly as a result of resourceful, diverse, and proficient hospital infection prevention teams. However, infection prevention programs in nursing facilities are less well developed.

Contemporary nursing facilities are composed of 2 distinct populations: patients who require skilled nursing and rehabilitation care after a hospital stay (postacute care) and long-term care residents who permanently reside at these facilities. Nursing facilities encounter many challenges in effectively implementing and maintaining infection prevention programs. First, both patients receiving postacute care and long-term residents frequently visit common areas including dining rooms, rehabilitation areas, and family visitation rooms, increasing the risk of pathogen transmission. Second, nursing facilities lack in-house diagnostic testing and rely on offsite physicians, leading to delays in the evaluation and management of individuals with acute infections. Third, the postacute care population has inherently more active medical problems, with more devices, wounds, recurrent hospital stays, and high antibiotic use compared with long-term care residents. Most important, nursing facilities lack adequate resources to support the increasingly complicated infection prevention mandates such as infection surveillance, staff education, and implementation of antimicrobial stewardship programs. However, we believe the transition toward integrated health care systems provides a unique opportunity to collaborate with a shared goal of reducing infections and enhancing quality of care.