Influenza-Like Illnesses in Nursing Homes Requires Implementation of Structured Prevention Programs

Pneumonia and other lower respiratory tract infections are the second most common infections among nursing home residents and the leading cause of death from infections in the long-term care setting.

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 data, emphasizing the need for structured prevention programs, according to information published in the December 2011 Pennsylvania Patient Safety Advisory.

Specifically, from January through June 2011, the monthly average number of LRTIs increased by 6.4 percent, and the number of ILIs increased by 28.2 percent compared to the first six months of 2010.

Targeted strategies to prevent LRTIs and ILIs must take into consideration increased risk factors associated with elderly long-term care residents, such as swallowing difficulties, smoking, immobility, poor oral care and lack of influenza and pneumococcal vaccination.

"Pneumonia cases can be decreased over twenty percent with adequate oral care and swallowing difficulty interventions," says 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.

Bradley added that comparing data between nursing homes with a mandatory program and those without, a projection of 616 potential respiratory tract infections could have been prevented among the remaining 203 facilities that responded.  She said further statewide analysis shows that mandatory staff vaccination could have prevented up to 1,991 respiratory tract infections among all Pennsylvania nursing homes.

Patients who have difficulty swallowing (dysphagia) carry a sevenfold increased risk of aspiration pneumonia. Aspiration pneumonia is inflammation of the lungs and airways to the lungs (bronchial tubes) from breathing in foreign material. 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.

"Identifying and implementing aspiration-prevention strategies is important because patients who have difficulty swallowing are at such an increased risk for aspiration-pneumonia," Bradley adds.

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.