3.4 Infectious Illnesses

Prevention and control of infection and the reduction of antibiotic resistant strains of bacteria are important in any institutionalized setting. Infection with antibiotic resistant strains requires more complex treatment regimens. When an individual with a resistant organism is treated with an ineffective antibiotic, the organism continues to infect the patient, could potentially spread to other patients, and further compounds the resistance problem (Tenover, 2008). Infectious illnesses have the potential to affect many individuals in communal living environments, like nursing facilities. The spread of infectious illnesses is especially concerning when infected individuals are frail or medically compromised (Strausbaugh, 2003).

Types and Rates of Infection in Nursing Facilities

Results from the NFQR resident assessment indicate that the proportion of residents with an infectious illness, including single or multiple infections in a single individual, has steadily increased since 2006. In 2008, 13% of residents living in nursing facilities had an infection in the past seven days (Figure 3.4):

Proportion of residents with an infectious illness in the past 7 days

2006 — 10%
2007 — 11%
2008 — 13%

Infectious illnesses occur frequently in nursing facilities. Typical infections include urinary tract infections, skin and soft tissue infections, or pneumonia (Nicolle, 1996). The NFQR resident assessment indicates a slight increase in urinary tract infections, skin infections, pneumonia, diarrhea, and fever in 2008 compared to 2006 and 2007:

Proportion of residents with infectious illness
	2006	2007	2008
Urinary tract infection	4.0%	4.0%	5.0%
Skin infection	2.0%	2.0%	3.0%
Pneumonia	0.7%	0.9%	2.0%
Diarrhea and fever	0.0%	0.1%	0.3%
Other infection	4.0%	5.0%	4.0%

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Resistant Infectious Agents

The use of broad spectrum antibiotics has been attributed to antibiotic-resistant microorganisms (Weiner, 1999). "Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections" (CDC, 2008). Two of the most prevalent bacteria exhibiting antibiotic resistance are Methicillin Resistant Staphylococcus Aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE). These types of resistant infections are most commonly found in skin infections, deep tissue wounds, or abscesses. This year, reported cases of antibiotic-resistant illnesses increased compared to previous years (Figure 3.4):

Antibiotic-resistant infection
	2006	207	2008
MRSA Infection	0.4%	0.3%	0.4%
VRE Infection	0.1%	0.0%	0.4%

Significantly more VRE infections were reported for residents in 2008 compared to 2007 (7).

Figure 3.4 – Infectious Illnesses

Did the resident have an infection in the past seven days?

Yes — 13%
No — 87%

Had a urinary tract infection [Q4.1] — 5%
Had a skin infection [Q4.2] — 3%
Had pneumonia [Q4.3] — 2%
Had diarrhea and fever [Q4.4]0.— 3%
Had "other" infection [Q4.5] — 4%

Antibiotic resistance

Infectious agents are becoming increasingly resistant to antibiotics; two of the most prevalent are:

Methicillin-Resistant Staphylococcus Aureus (MRSA)
Vancomycin-Resistant Enterococcus (VRE)

How many infections were MRSA? [Q4.1–4.3 and 4.5]

2006 — 0.4%
2007 — 0.3%
2008 — 0.4%

How many infections were VRE? [Q4.1–4.3 and 4.5]

2006 — 0.1%
2007 — 0.0%
2008 — 0.4%

Survey conducted: February – July 2008 [Q#.#] = Survey question number (Appendix A) Survey sample: 2,129 from 128,971 residents (Medicare, Medicaid, or any other payer source) living in the 1,044 Medicaid certified nursing facilities in Texas. For further information, contact the NFQR Project Lead at 512-438-3472.

Footnotes

7. Statistically significant at p<.01.

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Updated: June 8, 2010