Hostname: page-component-7479d7b7d-pfhbr Total loading time: 0 Render date: 2024-07-15T23:00:08.822Z Has data issue: false hasContentIssue false
  • English
  • Français

Infection Prevention and Control in the Long-Term-Care Facility

Published online by Cambridge University Press:  02 January 2015

Philip W. Smith  and
Patricia G. Rusnak
Philip W. Smith*
Affiliation:
SHEA Long-Term-Care Committee and APIC Guidelines Committee
Patricia G. Rusnak*
Affiliation:
SHEA Long-Term-Care Committee and APIC Guidelines Committee
*
The Society for Healthcare Epidemiology of America, 875 Kings Hwy, Suite 200, Woodbury, NJ 08096
The Society for Healthcare Epidemiology of America, 875 Kings Hwy, Suite 200, Woodbury, NJ 08096
Get access Rights & Permissions [Opens in a new window]

Abstract

More than 1.5 million residents reside in US nursing homes. In recent years, the acuity of illness of nursing home residents has increased. Long-term-care facility residents have a risk of developing nosocomial infection that is similar to acute-care hospital patients. A great deal of information has been published concerning infections in the long-term-care facility, and infection control programs are nearly universal.

This position paper reviews the literature on infections and infection control programs in the long-term-care facility, covering such topics as tuberculosis, bloodborne pathogens, epidemics, isolation systems, immunization, and antibiotic-resistant bacteria. Recommendations are developed for long-term-care infection control programs based on interpretation of currently available evidence. The recommendations cover the structure and function of the infection control program, including surveillance, isolation, outbreak control, resident care, and employee health. Infection control resources also are presented.

Type
SHEA/APIC Position Paper
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 12 , December 1997 , pp. 831 - 849
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals . Am J Epidemiol 1985;121:182–205 CrossRefGoogle ScholarPubMed
2. Haley, RW, Culver, DH, White, JW, et al. The nationwide nosocomial infection rate-a new need for vital statistics. Am J Epidemiol 1985;121:159–167.CrossRefGoogle ScholarPubMed
3. Smith, PW, Daly, P, Roccaforte, JA. Current status of nosocomial infection control in extended care facilities. Am J Med 1991;91 (suppl 3B):281–285.CrossRefGoogle ScholarPubMed
4. Smith, PW. Infection in long-term care facilities. Infect Centrol 1985:6:435,436.Google ScholarPubMed
5. US Senate Special Committee on Aging: Aging America-Trends and Projections. Washington, DC: US Department of Health and Human Services, 1988.Google Scholar
6. American Medical Association White Paper on Elderly Health. Arch Intern Med 1990;150:2459–2472.CrossRefGoogle Scholar
7. Verghese, A, Berk, SL, Introduction and epidemiologie considerations. In: Verghese, A, Berk, SL, eds. Infections in Nursing Homes and Long-Term Care Facilities. Basel, Switzerland: Karger; 1990.Google Scholar
8. Smith, PW, Rusnak, PG. Guideline for infection prevention and control in the long-term care facility . Am J Infect Control 1991;19:198–215.CrossRefGoogle ScholarPubMed
9. Schneider, EL. Infectious diseases in the elderly. Ann Intern Med 1983;98:395–400.CrossRefGoogle ScholarPubMed
10. Garibaldi, RA, Nurse, BA. Infections in the elderly. Am J Med 1986;81(suppl):53–58.CrossRefGoogle ScholarPubMed
11. Yoshikawa, TT. Geriatric infectious diseases: an emerging problem. J Am Geriatr Soc 1983;31:34–38.CrossRefGoogle Scholar
12. Norman, DC, Yoshikawa, TT Clinical features of infection and the significance of fever in the elderly nursing home patient. In: Verghese, A, Berk, SL, eds. Infections in Nursing Homes and Long-Term Care Facilities. Basel, Switzerland: Karger; 1990.Google Scholar
13. Saltzman, RL, Peterson, PK. Immunodeficiency of the elderly. Reviews of Infectious Diseases 1987;9:1127–1137.CrossRefGoogle ScholarPubMed
14. Smith, PW, Roccaforte, JS, Daly, PB. Infection and immune response in the elderly. Epidemiol 1992;2:813–822.Google ScholarPubMed
15. Jackson, MM, Fierer, J. Infections and infection risk in residents of long-term care facilities: a review of the literature, 1970-1984. Am.J Infect Control 1985;13:63–77.CrossRefGoogle ScholarPubMed
16. Mcolle, LE, Garibaldi, RA. Infection control in long-term care facilities. Infect Control Hosp Epidemiol 1995;16:348–353.Google Scholar
17. Garibaldi, RA, Brodine, S, Matsumiya, S. Infections among patients in nursing homes-policies, prevalence, and problems. N Engl J Med 1981;305:731–735.CrossRefGoogle ScholarPubMed
18. Jackson, MM, Fierer, J, Barrett-Connor, E, et al. Intensive surveillance for infections in a three-year study of nursing home patients. Am J Epidemiol 1992;135:685–696.CrossRefGoogle Scholar
19. Sager, MA Easterling, DV, Kindig, DA, Anderson, OW. Changes in the location of death after passage oí Medicare's prospective payment system. N Engl j Med 1989;320:433–439.CrossRefGoogle Scholar
20. Scheckler, WE, Peterson, PJ. Infections and infection control among residents of eight rural Wisconsin nursing homes. Arch Intern Med 1986;146:1981–1984.CrossRefGoogle ScholarPubMed
21. Price, LE, Sarubbi, FA Jr, Rutala, WA Infection control programs in twelve North Carolina extended care facilities, Infect Control 1985;6:437–441.CrossRefGoogle ScholarPubMed
22. Cohen, ED, Hierholzer, WJ, Schilling, CR, Snydman, DR. Nosocomial infections in skilled nursing facilities: a preliminary survey. Public Health Rep 1979;94:162–166.Google ScholarPubMed
23. Magnussen, MH, Robb, SS. Nosocomial infections in a long-term care facility. Am J Mect Control 1980;8:12–17.CrossRefGoogle Scholar
24. Gambert, SR, Duthie, EH Jr, Priefer, B, Rabinowtch, RA. Bacterial infections in a hospital-based skilled nursing facility. Journal of Chronic Diseases 1982;35:787–786.CrossRefGoogle Scholar
25. Farber, BF, Brennen, C, Punteren, AJ, Brody, JE A prospective study of nosocomial infections in a chronic care facility. J Am Geriatr Soc 1984;32:499–502.CrossRefGoogle Scholar
26. Nicolle, LE. McIntyre, M, Zacharias, H, MacDonell, JA. Twelve month surveillance of infections in institutionalized elderly men. J Am Geriatr 1984;32:513–519.CrossRefGoogle ScholarPubMed
27. Standfast, SJ, Michelsen, PB, Baltch, AL, et al. A prevalence survey of infections in a combined acute and long-term care hospital, Infect Control 1984;5:177–184.CrossRefGoogle Scholar
28. Setia, U, Serventi, I, Lorenz, P Nosocomial infections among patients in a long-term care facility: spectrum, prevalence, and risk factors. Am J Infect Control 1985;13:57–62.CrossRefGoogle Scholar
29. Franson, TR, Duthie, GH Jr, Cooper, JE, Oudenhoven, EV, Hoffmann, RC. Prevalence survey of infections and their predisposing factors at a hospital-based nursing home care unit. J Am Geriatr Soc 1986;34:95–100.CrossRefGoogle Scholar
30. Vlahov, D, Tenney, JH, Cervino, KW, Shamer, DK. Routine surveillance for infections in nursing homes: experience at two facilities. Am J Infect Control 1987;15:47–53.CrossRefGoogle ScholarPubMed
31. Alvarez, S, Shell, CG, Woolley, TW Berk, SL, Smith, JK. Nosocomial infections in long-term facilities. J Gerontol 1988;43:M9–M17.CrossRefGoogle ScholarPubMed
32. Hoffman, N, Jenkins, R, Putney, K. Nosocomial iniection rates during a one-year period in a nursing home care unit of a Veterans' Administration hospital . Am J Infect Control 1990;18:55–63.CrossRefGoogle Scholar
33. Jacobson, C, Strausbaugh, LJ. Incidence and impact of infection in a nursing home care unit. Am J Infect Control 1990;18:151–159.CrossRefGoogle Scholar
34. Darnowski, SB. Gordon, M. Simor, AE. Two years of infection surveillance in a geriatric long-term care facility. Am J Infect Control 1991;19:185–190.CrossRefGoogle Scholar
35. Magaziner, J, Tenney, JH, DeForge, B, Hebei, R, Muncie, HL, Warren, JW. Prevalence and characteristics of nursing home acquired infections in the aged. J Am Geriatr Soc 1991;39:1071–1078.CrossRefGoogle ScholarPubMed
36. Steinmiller, AM, Robb, SS, Muder, RR. Prevalence of nosocomial infection in long-term-care Veterans' Administration medical centers. Am J Infect Control 1991;19:143–146.CrossRefGoogle Scholar
37. Beck-Sague, C, Villarino, E, Giuliano, D, et al. Infectious diseases and death among nursing home residents: results of surveillance in 13 nursing homes. Infect Control Hosp Epidemiol 1994;15:494–496.CrossRefGoogle ScholarPubMed
38. Warren, JE Catheter-associated bacteriuria in long-term care facilities. Infect Control Hosp Epidemiol 1994;15:557–562.CrossRefGoogle ScholarPubMed
39. Ouslander, JG, Greengold, B, Chen, S. External catheter use and urinary tract infections among incontinent male nursing home patients. J Am Geriatr Soc 1987;35:1063–1070.CrossRefGoogle ScholarPubMed
40. Ouslander, JG, Schnelle, JE Incontinence in the nursing home. Ann Intern Med 1995;122:438–449.CrossRefGoogle ScholarPubMed
41. Nicolle, LE. Henderson, E, Bjornson, J, McIntyre, M, Harding, GKM, MacDonell, JA. The association of bacteriuria with resident characteristics and survival in elderly institutionalized men. Ann Intern Med 1987;106:682–686.CrossRefGoogle ScholarPubMed
42. Warren, JW, Steinberg, L, Hebel, JR, Tenney, JH. The prevalence of urethral catheterization in Maryland nursing homes. Arch Intern Med 1989;149:1535–1537.CrossRefGoogle ScholarPubMed
43. Kunin, CM, Douthitt, S, Dancing, J, Anderson, J, Moeschberger, M. The association between the use of urinary catheters and morbidity and mortality among elderly patients in nursing homes. Am J Epidemiol 1992;135:291–301.Google ScholarPubMed
44. Ribeiro, BJ, Smith, SR Evaluation of urinary catheterization and urinary incontinence in a general nursing home population. J Am Geriatr Soc 1985;33:479–482.CrossRefGoogle Scholar
45. Nicolle, LE. Urinary tract infections in long-term care facilities. Infect Control Hosp Epidemiol 1993;14:220–225.CrossRefGoogle ScholarPubMed
46. Warren, JW, Tenney, JH, Hoopes, JM, Muncie, HL, Anthony, WC. A prospective microbiologic study of bacteriuria in patients wim chronic indwelling urethral catheters. J Infect Dis 1982;146:719–723.CrossRefGoogle Scholar
47. Daly, PB, Smith, PW, Rusnak, PG, Woods, CL. A microbiologic survey of long term care urinary catheters. Nebr Med J 1991;76:161–165.Google ScholarPubMed
48. Nicolle, LE, Mayhew, WJ, Bryan, L. Prospective randomized comparison of therapy and no therapy lor asymptomatic bacteriuria in institutionalized elderly women. Am J Med 1987;83:27–33.CrossRefGoogle Scholar
49. Wong, ES, Hooten, TM. Guideline for prevention of catheter-associated urinary tract infections. Infect Control 1981;2:125–130.CrossRefGoogle Scholar
50. Ministry of National Health and Welfare. Canadian Infection Control Guidelines for Long Term Care Facilities. Ottawa, Ontario. Canada: Ministry of National Health and Welfare; 1994.Google Scholar
51. Garofalo, K. Home health. In: APIC Infection Control and Applied Epidemiology: Principles and Practice. St Louis. MO: Mosby-Year Book, Inc; 1996.Google Scholar
52. Falsey, AR. Noninfluenza respiratory virus infection in long-term care facilities. infect Control Hosp Epidemol 1991;12:602–608.CrossRefGoogle ScholarPubMed
53. Garb, JL, Brown, RB, Garb, JT, Tuthill, RW. Differences in etiology of pneumonias in nursing home and community patients. JAMA 1978;240:2169–2172.CrossRefGoogle ScholarPubMed
54. Marrie, TJ, Durant, H, Kwan, C. Nursing home-acquired pneumonia: a case control study. J Am Geriatr Soc 1986;34:697–702.CrossRefGoogle ScholarPubMed
55. Peterson, PK, Stein, D, Guay, DRP et al. Prospective study of lower respiratory tract infections in an extendedcare nursing home program: potential role of oral ciprofloxacin. AM J Med 1988;85:164–171.CrossRefGoogle Scholar
56. Crossley, KB, Thum, KR. Nursing home-acquired pneumonia. Semin Respir Infect 1994;96:313–320.Google Scholar
57. Koivula, I, Sten, M, Makela, PH. Risk factors for pneumonia in the elderly Am J Med 1994;96:313–320.CrossRefGoogle ScholarPubMed
58. Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention. Guideline for prevention of nosocomial pneumonia. Infect Control Hosp Epidemiol 1994;15:587–627.CrossRefGoogle Scholar
59. Butler, JC, Breiman, RF, Campbell, JF, lipman, HB, Broome, CV, Facklam, RR. Pneumococcal polysaccharide vaccine efficacy-an evaluation of current recommendations. JAMA 1993;270:1826–1831.CrossRefGoogle Scholar
60. Fine, MJ, Smith, MA, Carson, CA, et al. Efficacy of pneumococcal vaccination in adults-a meta-analysis of randomized controlled trials. Arch Intern Med 1994;154:2666–2677.CrossRefGoogle ScholarPubMed
61. Centers for Disease Control. Recommendations of the Immunization Practices Advisory Committee. Pneumococcal polysaccharide vaccine. MMWR 1989;38:64–75.Google Scholar
62. Centers for Disease Control and Prevention. Prevention and control of influenza-recommendations of the Advisory Committee on Immunization Practices. 1996;45:1–24.Google Scholar
63. Goodman, RA, Orenstein, WA Munro, TF, Smith, SC, Sikes, RK. Impact of influenza A in a nursing home. JAMA 1982;247:1451–1453.CrossRefGoogle ScholarPubMed
64. Kohn, MA, Farley, TA, Sundin, D, Tapia, R, McFarland, LM, Arden, NH. Three summertime outbreaks of influenza type A. J Infect Dis 1995;172:246–249.CrossRefGoogle ScholarPubMed
65. Gravenstein, S, Miller, BA, Drinka, P Prevention and control of influenza outbreaks in long term care facilities. Infect Control Hosp Epidemiol 1992;13:49–54.CrossRefGoogle ScholarPubMed
66. Patriarca, PA, Weber, JA, Parker, RA, et al. Efficacy of influenza vaccine in nursing homes-reduction in illness and complications during an influenza A (H3N2) epidemic. JAMA 1985;253:1136–1139.CrossRefGoogle ScholarPubMed
67. Gross, PA, Hermogenes, AW, Sacks, HS, et al. The efficacy of influenza vaccine in elderly persons-a meta-analysis and review of the literature. Arm Intern Med 1995;123:518–527.Google ScholarPubMed
68. Gross, PA, Quinnan, GV, Rodstein, M, et al. Association of influenza immunization with reduction in mortality in an elderly population. Arch Intern Med 1988;148:562–565.CrossRefGoogle Scholar
69. Patriarca, PA, Arden, NH, Kopian, JP, Goodman, RA. Prevention and control of type A influenza infection in nursing homes-benefits and costs of four approaches using vaccinations and amantadine. Ann Intern Med 1987;107:732–740.CrossRefGoogle ScholarPubMed
70. Saah, AJ, Neufeld, R, Rodstein, M, et al. Influenza vaccine and pneumonia mortality in a nursing home population. Arch Intern Med 1986;146:2353–2357.CrossRefGoogle Scholar
71. Mast, EE, Harmon, MW, Gravenstein, S, et al., Emergence and possible transmission of amantadine־resistant viruses during nursing home outbreaks of influenza A (H3N2). Am J Epidemiol 1991;134:988–997.CrossRefGoogle Scholar
72. Arden, NH, Kendal, AP, Patriarca, PA. Managing an Influenza Vaccination Program in the Nursing Home. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control; 1987.Google Scholar
73. Gomolin, IH, Leib, HB, Arden, NH, Sherman, FT. Control of influenza outbreaks in the nursing home guidelines for diagnosis and management. J Am Geriatr Soc 1995;43:71–74.CrossRefGoogle ScholarPubMed
74. Stead, WW, Lofgren, JP, Warren, E, Thomas, C. Tuberculosis as an epidemic and nosocomial infection among the elderly in nursing homes. N Engl J Med 1985;312:1483–1487.CrossRefGoogle Scholar
75. Narain, JP, Lofgren, JP, Warren, E, Stead, WW. Epidemic tuberculosis in a nursing home: a retrospective cohort study. J Am Geriatr Soc 1985;33:258–263.CrossRefGoogle Scholar
76. Bentley, DW. Tuberculosis in long-term care facilities. Infect Control Hosp Epidemiol 1990;11:42–46.CrossRefGoogle ScholarPubMed
77. Price, LE, Rutala, WA. Tuberculosis screening in the long-term care setting. Infect Control 1987;8:353–356.CrossRefGoogle ScholarPubMed
78. Committee on Public Health Issues, American College of Chest Physicians. Public health issues in control of tuberculosis-surveillance techniques and the role of health care providers (a national consensus statement). Chest 1985;87(suppl):135–138.CrossRefGoogle Scholar
79. Centers for Disease Control. Prevention and control of tuberculosis in facilities providing long-term care to the elderly-recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR 1990;39(RR-10):7–20.Google Scholar
80. Centers for Disease Control and Prevention. Guidelines for preventing transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;45:1–132.Google Scholar
81. Stern, JK, Smith, PW, Tuberculosis in the long-term care facility. Geriatrie Focus on Infectious Diseases 1991;1:6–10.Google Scholar
82. Naglie, G, McArthur, M, Simer, A, et al. Tuberculosis surveillance practices in long-term care institutions. Infect Control Hosp Epidemiol 1995;16:148–151.CrossRefGoogle ScholarPubMed
83. McGowan, GE Jr. The booster effect-a problem for surveillance of tuberculosis in hospital employees. Infect Control 1980;1:147–149.CrossRefGoogle ScholarPubMed
84. Menzies, D, Fanning, A, Yuan, L, Fitzgerald, M. Tuberculosis among health care workers. N Engl J Med 1995;332:92–98.CrossRefGoogle ScholarPubMed
85. Winters, RE. Guidelines for preventing the transmission of tuberculosis: a better solution? Clin Infect Dis 1994;19:309,310.CrossRefGoogle ScholarPubMed
86. Smith, DM. Pressure ulcers in the nursing home. Ann Intern Med 1995;123:433–442.CrossRefGoogle ScholarPubMed
87. Brandeis, GH, Morris, JN, Nash, DJ, Upsitz, LA The epidemiology and natural history of pressure ulcers in elderly nursing home residents. JAMA 1990;204:2905–2909.CrossRefGoogle Scholar
88. Bryan, CS, Dew, CE, Reynolds, KL. Bacteremia associated with decubitus ulcers. Arch Intern Med 1983;143:2093–2095.CrossRefGoogle ScholarPubMed
89. Allman, RM. Pressure sores among the elderly. N Engl J Med 1989;320:850–853.Google ScholarPubMed
90. Auerbach, SB, Schwartz, B, Williams, D, et al. Outbreak of group A streptococcal infections in a nursing home-lessons on prevention and control. Arch Intern Med 1992;152:1017–1022.CrossRefGoogle Scholar
91. Schwartz, B, Ussery, XT Group A streptococcal outbreaks in nursing homes. Infect Control Hosp Epidemiol 1992;13:742–747.CrossRefGoogle Scholar
92. Degglau, J. Scabies in long-term facilities. Infect Control Hosp Epidemiol 1992;13:421–425.CrossRefGoogle Scholar
93. Estes, SA, Estes, J. Therapy of scabies-nursing homes, hospitals and the homeless. Semin Dermatol 1993;12:2&33.Google ScholarPubMed
94. Rodriguez, EM, Parrott, C, Rolka, H, et al. An outbreak of viral gastroenteritis in a nursing home: importance of excluding ill employees. Infect Control Hosp Epidemiol 1996;17:587–595.CrossRefGoogle Scholar
95. Ryan, CA. Tauxe, RV, Hosek, GW, et al. Escherichia coli 0157:H7 diarrhea in a nursing home: clinical, epidemiological and pathological findings . J Infect Dis 1986;154:631–638.CrossRefGoogle Scholar
96. Carter, AO, Borczyk, AA, Carlson, JAK, et al, A severe outbreak of Escherichia coli 0157:H7-associated hemorrhagic colitis in a nursing home. N Engl J Med 1987;317:1496–1500.CrossRefGoogle Scholar
97. Bentley, DW: Clostridium difficile -associated disease in long-term care facilities. Infect Control Hosp Epidemiol 1990;11:434–438.CrossRefGoogle ScholarPubMed
98. Simor, AE, Yake, SL, Tsimidis, K. Infection due to Clostridium difficile among elderly residents of a long-term care facility. Clin Infect Dis 1993;17:672–678.CrossRefGoogle ScholarPubMed
99. White, KE, Hedberg, CW, Edmonson, LM, Jones, DBW, Osterholm, MX MacDonald, KL. An outbreak of giardiasis in a nursing home with evidence for multiple modes of transmission. J Infect Dis 1989;160:298–304.CrossRefGoogle Scholar
100. Bennett, RG. Diarrhea among residents of long-term care facilities. Infect Control Hosp Epidemiol 1993;14:397–404.CrossRefGoogle ScholarPubMed
101. Levine, WC, Smart, JF, Archer, D, Bean, NH, Tauxe, RV. Foodborne disease outbreaks in nursing homes, 1975 through 1987. JAMA 1991;266:2105–2109.CrossRefGoogle ScholarPubMed
102. Setia, U, Serventi, I, Lorenz, P Bacteremia in a long-term care facility-spectrum and mortalityty. Arch Intern Med 1984:1633–1635.CrossRefGoogle Scholar
103. Muder, RR, Brennen, C, Wagener, MM, Goete, AM. Bacteremia in a long-term care facility: a five year prospective study of 163 consecutive episodes. Clin Infect Dis 1992;14:647–654.CrossRefGoogle Scholar
104. Centers for Disease Control and Prevention. Guideline for prevention of intervascular device-related infections. Am J Infect Control 1996;24:262–293.CrossRefGoogle Scholar
105. Boustcha, E, Nicolle, LE. Conjunctivitis in a long-term care facility. Infect Control Hosp Epidemiol 1995;16:210–216.CrossRefGoogle Scholar
106. Centers for Disease Control. Surveillance for epidemics-United States. MMWR 1989;38:694–696.Google Scholar
107. Standaert, SM, Hutcheson, RH, Schaffer, W. Nosocomial transmission of Salmonella gastroenteritis to laundry workers in a nursing home. Infect Control Hosp Epidemiol 1994;15:22–26.CrossRefGoogle ScholarPubMed
108. Shlaes, DM, Lehman, MH, Currie-McCumber, CA, Kim, CH, Floyd, R Prevalence of colonization with antibiotic resistant gram-negative bacilli in a nursing home care unit: the importance of cross-colonization as documented by plasmid analysis. Infect Control 1986;7:538–545.CrossRefGoogle Scholar
109. John, JF, Ribner, BS. Antibiotic resistance in long-term care facilities. Infect Control Hosp Epidemiol 1991;12:245–250.CrossRefGoogle ScholarPubMed
110. Muder, RR, Brennen, C, Wagener, MM, Vickers, RM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med Med 1991;114:107–112.CrossRefGoogle Scholar
111. Bradley, SF, Terpenning, MS, Ramsey, MA, Zarins, LT, et al, Methicillin-resistant Staphylococcus aureus- colonization and infection in a long-term care facility. Am Intern Med 1991;115:417–422.CrossRefGoogle Scholar
112. Strausbaugh, LJ, Jacobson, C, Sewell, DL, Potter, S, Ward, IT Methicillin-resistant Staphylococcus aureus in extended care facilities-experiences in a Veterans' Affairs Nursing Home and a review of the literaure. Infect Control Hosp Epidemiol 1991;12:36–45.CrossRefGoogle Scholar
113. Boyce, JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities-microbiology, epidemiology and preventive measures. Infect Control Hosp Epidemiol 1992;13:725–737.CrossRefGoogle ScholarPubMed
114. American Hospital Association MRSA Task Force. Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infecí Control Hosp Epidemiol 1994:15:105–115.CrossRefGoogle Scholar
115. Floumoy, DJ. Antimicrobial susceptibilities of bacteria from nursing home residents in Oklahoma. Gerontology 1994;40:53–56.Google Scholar
116. Crossley, KB, Irvine, P, Kaszar, DJ, Loewenson, RB. Infection control practices in Minnesota nursing homes. JAMA 1985;254:2918–2921.CrossRefGoogle ScholarPubMed
117. Khabbaz, RF, Tenney, JH. Infection control in Maryland nursing homes. Infect Control Hosp Epidemiol 1988;9:159–162.CrossRefGoogle ScholarPubMed
118. Pearson, DA, Checko, PJ, Hierholzer, WJ Jr, Jekel, JF. Infection control practitioners and committees in Connecticut's skilled nursing facility. Am J Infect Control 1990;18:167–175.CrossRefGoogle Scholar
119. Pearson, DA, Checko, PJ, Hierholzer, WJ Jr, Jekel, JF Infection control practices in Connecticut's skilled nursing facilities. Am J Infect Control 1990;18:269–276.CrossRefGoogle ScholarPubMed
120. Goldrick, B, Larson, E. Assessment of infection control programs in Maryland skilled-nursing long-term care facilities. Am J Infect Control 1994;22:83–89.CrossRefGoogle ScholarPubMed
121. Strausbaugh, LJ, Joseph, C. Epidemiology and prevention of infections in residents of long-term care facilities. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore. MD: Williams & Wilkins; 1996.Google Scholar
122. Rusnak, PG. Long temi care . In: APIC Infection Control and Applied Epidemiology: Principles and Practice. St Louis, MO: Mosby-Year Book, Inc; 1996.Google Scholar
123. Omnibus Budget Reconciliation Act of 1987. Pub L No. 100203, December 22, 1987, subtitle C, part 1, § 4201, pages 160–170.Google Scholar
124. US Department of Health and Human Services, Health Care Financing Administration. Medicare and Medicaid requirements for long term care facilities. Federal Register 09 26,1991;56:48826–48879.Google Scholar
125. Health Care Financing Administration Long Term Care Survey Process Training Manual. National Technical Information Service, 1986. Springfield, VA: US Department of Commerce; 1986.Google Scholar
126. Medicare guidelines: requirements for states and long term care facilities. 42 CFR 5483.1483.75.Google Scholar
127. Department of Labor, Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens: final rule. Federal Register 12 6, 1991;56(235):64004–64182.Google Scholar
128. Decker, MD. The OSHA bloodborne hazard standard. Infect Control Hosp Epidemiol 1991;13:407-417.Google Scholar
129. American Institute of Architects. Guidelines for Construction and Equipment of Hospital and Medical Facilities. Washington DC: AIA 1996.Google Scholar
130. The Joint Commission on Accreditation of Healthcare Organizations. Comprehensive Accreditation Manuals for Long Term Care. Chicago, IL: Joint Commission on Accreditation of Healthcare Organizations, 1996.Google Scholar
131. Crossley, K, Nelson, L, Irvine, P. State regulations governing infection control issues in long-term care. J Am Geriatr Soc 1992;40:251–254.CrossRefGoogle ScholarPubMed
132. Smith, PW, editor. Infection Control in Long-Term Care Facilities. 2nd ed. Albany, NY: Delmar Publishers Inc, 1994.Google Scholar
133. American Health Care Association. Infection Prevention and Control for Long-Term Care Facilities-Handbook and Instructor's Guide. AHCA, Washington, DC: 1995.Google Scholar
134. Satterfield, N. Infection control in long-term care facilities: the hospital-based parctitioner's role. Infect Control Hosp Epidemiol 1993;14:40–47.CrossRefGoogle ScholarPubMed
135. Gamer, JS, Jarvis, WR. Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988:16:128–140.Google Scholar
136. Smith, PW. Infection surveillance in long-term care facilities. Infect Control Hosp Epidemiol 1991;12:55–58.CrossRefGoogle ScholarPubMed
137. McGeer, AR, Campbell, B, Emori, TG, et al. Consensus conference on nosocomial infections in long-term care facilities. Am J Infect Control 1987;15:97–100.Google Scholar
138. McGeer, A, Campbell, B, Emori, TG, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991:19:1–7.CrossRefGoogle ScholarPubMed
139 Centers for Disease Control. Guidelines for investigating clusters of health events. MMWR 1990;39:1–23.Google Scholar
140. Gamer, JS, Simmons, BP Guideline for isolation precautions in hospitals . Infect Control 1983;4:245–325.Google Scholar
141. Lynch, E Cummings, MJ, Roberts, PL, Herriott, MJ, Yates, B, Stamm, WE. Implementing and evaluating a system of generic infection precautions: body substance isolation. Am J Infect Control 1990;18:1–12.CrossRefGoogle ScholarPubMed
142. Centers for disease Control. Recommendations for prevention of HIV transmission in health care settings. MMWR 1987;36:18–188.Google Scholar
143. Centers for Disease Control. Update: Universal Precautions for prevention of transmission of human immunodeficiency virus, hepatitis B, and other bloodbome pathogens in healthcare settings. MMWR 1988;37:377–387.Google Scholar
144. Garner, JS, the Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996:17:5–80.CrossRefGoogle ScholarPubMed
145. Thompson, BL, Dwyer, DM, Ussery, XT, et al. Handwashing and glove use in a long-term-care facility. Infect Control Hosp Epidemiol 1997;18:97–103.CrossRefGoogle Scholar
146. Centers for Disease Control. Handwashing and glove use in a long-term-care facility, Maryland, 1992. MMWR 1992;42:672–675.Google Scholar
147. Larson, E. Guideline for use of topical antimicrobial agents. Am J Infect Control 1988;16:253–266.CrossRefGoogle ScholarPubMed
148. Larson, EL. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–269.CrossRefGoogle ScholarPubMed
149. Irvine, PW, VanBuren, N, Crossley, K Causes for hospitalization of nursing home residents: the role of infection. J Am Geriatr Soc 1984;32:103–108.CrossRefGoogle ScholarPubMed
150. Richardson, JP. Tetanus and tetanus immunization in long-term care facilities. Infect Control Hosp Epidemiol 1993;14:591–594.CrossRefGoogle ScholarPubMed
151. Richardson, JP, Knight, AL. The prevention of tetanus in the elderly. Arch Intern Med 1991;151:17l2–17l7.CrossRefGoogle ScholarPubMed
152. Gardner, P, Eickhoff, T, Poland, G, et al. Adult immunizations. Ann Intern Med 1996:12:35–40.CrossRefGoogle Scholar
153. Sepkowitz, KA. Occupationally acquired infections in health care workers. Ann Intern Med 1996;125:826–834 and 1996;125:917-928.CrossRefGoogle ScholarPubMed
154. Diekema, DJ, Doebbeling, BN. Employee health and infection control. Med Control Hosp Epidemiol 1995;16:292–301.CrossRefGoogle Scholar
155. Centers for Disease Control and Prevention. Update: provisional publie health service recommendations for chemoprophylaxis after occupationally acquired exposure to HIV. MMWR 1996;45:468–472.Google Scholar
156. Leinbach, RM. English, AJ. Training needs of infection control professionals in long-term care facilities in Virginia. Am J Infect Control 1995;23:73–77.CrossRefGoogle ScholarPubMed
157. Smith, PW, Daly, PB, Rusnak, PG, Roccaforte, JS. Design and dissemination of a multiregional long-term care infection control training program. Am J Infect Control 1992;20:275–277.CrossRefGoogle ScholarPubMed
158. Daly, PB, Smith, PW, Rusnak, PG, Jones, MB, Guiliano, D. Impact of knowledge and practice of a multiregional long-term care facility infection control training program. Am J Infect Control 1992;20:225–233.CrossRefGoogle ScholarPubMed
159. Zimmer, JG, Bentley, DW, Valenti, WM, Watson, NM. Systemic antibiotic use in nursing homes-a quality assessment. J Am Geriatr Soc 1986;34:703–710.CrossRefGoogle Scholar
160. Jones, SR, Parker, DF, Liebow, ES. Kimbrough, RC III, Frear, RS. Appropriateness of antibiotic therapy in long-term care facilities. Am J Med 1987;83:499–502.CrossRefGoogle ScholarPubMed
161. Warren, JW, Palumbo, FB, Fitterman, L, Speedie, SM. Incidence and characteristics of antibiotics use in aged nursing home patients. J Am Geriatr Soc 1991;39:963–972.CrossRefGoogle ScholarPubMed
162. Katz, PR, Beam, TR Jr, Brand, F, Boyce, K. Antibiotic use in the nursing home-physician practice patterns. Arch Intern Med 1990;150:1465–1468.CrossRefGoogle ScholarPubMed
163. Nicolle, LE, Bentley, D, Garibaldi, R, Neuhaus, E, Smith, P, SHEA long-tern-care committee. Antimicrobial use in long-term-care facilities. Infect Control Hosp Epidemiol 1996;17:119–128.CrossRefGoogle Scholar
164. Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance. Federal Register 05 17, 1994;59:25758–25763.Google Scholar
165. Strausbaugh, U, Crossley, KB, Nurse, BA, Thrupp, LD, SHEA long-term care committee. Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol 1996;17:140.CrossRefGoogle Scholar
166. Department of Labor Joint Advisory Notice. Protection against occupational exposure to hepatitis B virus and human immunodeficiency virus. Federal Register 10 30, 1987;52:41818–41824.Google Scholar
167. Bentley, DW, Cheney, L. AIDS and long-term care facilities. Infect Control Hosp Epidemiol 1990;11:202–206.CrossRefGoogle ScholarPubMed
168. Crossley, K, Willenbring, K, Thurn, J. Needlestick injuries and needle disposal in Minnesota nursing homes. J Am Geriatr Soc 1990;38:793–796.CrossRefGoogle ScholarPubMed
169. Gwartney, DL, Daly, PB Roccaforte, JS, Smith, PW. Persons with AIDS in the long term care facility: attitudes, policies, and preparations. AIDS Patient Care 1992;6:15–18.CrossRefGoogle Scholar
170. Rusnak, PG, Boehle, MC. Regulations, policies and procedures. In: Smith, PW, ed. Infection Control in Long Term Care. Facilities. 2nd ed. Albany, NY: Delmar Publishers Inc; 1994.Google Scholar
171. Joint Committee on Healthcare Laundry Guidelines. Guidelines for healthcare linen service, 1993. Chicago, IL: American Society for Healthcare Environmental Services of the American Hospital Association; 1993.Google Scholar
172. Centers for Disease Control. Disinfection of hydrotherapy pools and tanks. Atlanta, GA: CDC; 1972.Google Scholar
173. Linnemann, CC Jr. Nosocomial infections associated with diysical therapy, including hydrotherapy. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Vilkins; 1996.Google Scholar
174. Haberstich, NJ. Infection control measures : the environmental reservoir. In: Smith, PW, ed. Infection Control in Long-Term Care Facilities. 2nd ed. Albany, NY: Delmar Publishers, Inc; 1994.Google Scholar
175. Rutala, WA APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313–342.CrossRefGoogle ScholarPubMed
176. Weatherly, KS, Kenwood, L, Hlusko, DL, Franklin, KG. Product evaluation process-a systems approach to controlling health care costs. AORNJ 1994;59:489–498.Google ScholarPubMed
177. Rutala, WA, Mayhall, CG, the Society for Hospital Epidemiology of America. Medical waste. Infect Control Hosp Epidemiol 1992;13:38–48.CrossRefGoogle ScholarPubMed
178. Environmental Protection Agency, Standards for the tracking and management of medical waste. Federal Register 03 24, 1989,54:12326–12395.Google Scholar
179. Crede, W, Hierholzer, WJ. Linking hospital epidemiology and quality assurance: seasoned concepts in a new role. Infect Control Hosp Epidemiol 1988;9:42–44.Google Scholar
180. Simmons, BP, Kritchevsky, SB. Epidemiologic approaches to quality assessment. Infect Control Hosp Epidemiol 1995;16:101–104.CrossRefGoogle ScholarPubMed
181. Gross, PA, Barrett, TL, Dellinger, EP, et al. Consensus development of quality standards. Infect Control Hosp Epidemiol 1994;15:180,181.CrossRefGoogle ScholarPubMed