The reported number of lower respiratory tract infections (LRTIs) and influenza-like illnesses (ILIs) increased by six percent and 28 percent respectively in Pennsylvania nursing homes in 2011 compared to 2010, according to a report published in the December 2011 Pennsylvania Patient Safety Advisory.
Targeted strategies to prevent LRTIs and ILIs must take into consideration increased risk factors associated with elderly LTC residents, such as swallowing difficulties, smoking, immobility, poor oral care and lack of influenza and pneumococcal vaccination.
"Pneumonia cases can be decreased over 20 percent with adequate oral care and swallowing difficulty interventions," said Sharon Bradley, RN, CIC, senior infection prevention analyst from the Pennsylvania Patient Safety Authority. "Mandatory vaccination programs also can reduce influenza virus by 60 percent when 100 percent of staff are vaccinated."
In Pennsylvania nursing homes, the Authority identified that those implementing a mandatory staff vaccination program had a 21.5 percent lower combined seasonal LRTI/ILI infection rate from October 2010 through March 2011. Further, facilities with mandatory vaccination programs have 42 percent lower mortality rates than nursing homes without mandatory programs.
The analysis comes from the Authority's 2010 annual survey to assess the effect of healthcare worker vaccination on the reduction of LRTI and ILI in Pennsylvania nursing homes. Eighteen of the 221 nursing homes that responded to the survey reported having mandatory annual healthcare worker vaccination programs in place.
Patients who have difficulty swallowing (dysphagia) carry a sevenfold increased risk of aspiration pneumonia, according to the Authority. Nursing-home acquired aspiration pneumonia has the highest mortality rate of any healthcare-acquired infection. It is estimated that 30 percent of pneumonia in long-term care facilities is caused by aspiration.
Several components crucial to structuring a targeted prevention program are detailed in the Advisory article, including an effective oral hygiene program, reducing dysphagia and aspiration risk factors and implementing a mandatory staff vaccination program.