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Prevalence of Infections in Residential Care Homes for the Elderly in Hong

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Prevalence of Infections in Residential Care Homes for the Elderly in Hong ORIGINAL Prevalence of infections in residential care homes ARTICLE for the elderly in Hong Kong H Chen 陳 虹 Alice PY Chiu 趙珮盈 Objectives To study the prevalence of commonly occurring infections Phoebe SS Lam 林瑞心 among residents of residential care homes for the elderly and WK Poon 潘偉剛 their associated risk factors. SM Chow 周少梅 Design Point prevalence survey. WP Ng 伍惠寶 Setting Residential care homes for the elderly in Hong Kong. Raymond WH Yung 翁維雄 Participants Residential care homes for the elderly were treated as a cluster and about 30% of the residents from each home were selected by systematic sampling with bed numbers ending with the digits of 2, 5, and 8. Selected residents were invited to participate. Results Data from 1603 residents aged 60 years or older from 43 residential care homes for the elderly were analysed. Most (85%) of the residents had underlying medical problems and 55% had more than one problem. The overall prevalence of infection among these residents was 5.7% (95% confidence interval, 4.2- 7.1%). The three most common infections were: common cold or pharyngitis (1.9%; 95% confidence interval, 0.9-3.0%), skin and soft-tissue infections (1.4%; 0.5-2.4%), and symptomatic urinary tract infections (0.6%; 0.2-0.9%). Being ‘bed-ridden’ was a significant risk factor for skin and soft-tissue infections (odds ratio=3.1; 95% confidence interval, 1.4-6.9). Presence of a urinary catheter was a significant risk factor for symptomatic urinary tract infections (odds ratio=62.8; 95% confidence interval, 18.2- 217.0). Chronic obstructive pulmonary disease was a significant risk factor for lower respiratory tract infection (odds ratio=16.5; 95% confidence interval, 3.4-81.2). Conclusions This is the first territory-wide prevalence survey of infections among residents in residential care homes for the elderly in Hong Kong. The data retrieved enable us to target our infection Key words Cross infection; Homes for the aged; control programme in residential care homes for the elderly Institutionalization; Long-term care; to those with a high prevalence. So as to monitor seasonal and Prevalence secular trends, targeted regular surveillance is needed for better profiling of the actual situation. Hong Kong Med J 2008;14:444-50 Introduction Members of the Residential Care Homes for the Aged (RCHE) Prevalence Hong Kong is facing an ageing population. Residential Care Homes for the Elderly (RCHE) Study Group*, Infection Control Branch, Centre for Health Protection, are a heterogeneous group of institutions that provide varying levels of care for aged Department of Health, Hong Kong people, who, for personal, social, health or other reasons, can no longer live alone or H Chen, MB, BS, FHKAM (Paediatrics) with their families.1 As the population continues to age, each year more and more people APY Chiu, MSc, BScH require temporary or permanent placement in RCHE. Many of these residents are frail with PSS Lam, BN, MNurs WK Poon†, RN, PhD different underlying medical problems, which in turn predispose them to increased risk SM Chow, BSc, MHS of infections. Infections lead to increased morbidity, hospital admissions, and mortality. WP Ng, BSc, MNurs Prevention of infection among residents poses a great challenge to health care workers RWH Yung, MB, BS, FRCPath and infection control officers in RCHE. * The RCHE Prevalence Study Group was formed by participants of the action learning Surveillance for infections has been clearly established to be a key to all infection project of the infection control training course control programmes. Overseas studies demonstrated a wide range of overall infections in in long-term care facilitates organised by long-term care facilities; prevalence estimates have varied from 1.6 to 32.7%.2-5 The most Infection Control Branch, Centre for Health 3,6-11 Protection in November 2006 commonly involved sites are: urinary, respiratory, and skin. The prevalence of infection † Current address: Hong Kong Adventist varies with the different institutional environments within which its residents live and Hospital socialise,12 as well as their innate characteristics, such as age, underlying co-morbidities, 6 Correspondence to: Dr RWH Yung mobility, and use of invasive devices (eg urinary catheters). Perceived prevalence also E-mail: [email protected] varies according to the intensity of surveillance carried out.12 444 Hong Kong Med J Vol 14 No 6 # December 2008 # www.hkmj.org # Infections in residential care homes for elderly # There are no territory-wide data regarding the point prevalence of common infections among 香港安老院舍的感染患病率 residents of RCHE in Hong Kong. Our study was designed to determine the same and to identify 目的 研究安老院舍住客常見感染病的患病率，及其風險因 specific risk factors predisposing to such infections. 素。 Hospital surveillance definitions depend 設計 時點患病率調查。 heavily on laboratory data and recorded clinical 安排 香港的安老院舍。 observations.13 In RCHE, radiology and microbiology 參與者 把香港的安老院舍組成聯網，然後系統抽樣每間院舍 data are not readily available. In this survey, the 的床位編號最後數字為2、5、及8的住客，即邀請約 diagnosis of infection was made following modified 30%院舍住客參與本研究。 long-term care facilities specific surveillance criteria developed by a Canadian consensus conference.14 結果 共分析43間安老院舍及1603位60歲或以上的院舍 This definition was intended specifically for residents 住客的數據。大多數住客（85%）有潛藏的毛病， of elderly residential homes and was mainly based on 55%有多於一種的身體毛病。研究對象的總患病率 acute symptoms. 為5.7%（95%置信區間：4.2-7.1%）。三種最常見 的感染分別為：普通傷風或咽炎（1.9%；95%置信 區間：0.9-3.0%），皮膚及軟組織感染（1.4%；0.5- Methods 2.4%），及症狀性尿道感染（0.6%；0.2-0.9%）。 We conducted a territory-wide point prevalence 「臥床」是皮膚及軟組織感染的顯著風險因素（風險 survey of common infections among residents of 比值=3.1，95%置信區間：1.4-6.9）；導尿管是症狀 RCHE in Hong Kong on a single day in December 性尿道感染的顯著風險因素（風險比值=62.8，95%置 2006. 信區間：18.2-217.0）；慢性阻塞性肺部疾病則是下 呼吸道感染的顯著風險因素（風險比值=16.5，95%置 信區間：3.4-81.2）。 Study design 結論 作為首個對香港安老院舍的地方性感染病的患病率研 Our target population included residents in all types 究，得出的數據有助制定針對有高感染率的安老院舍 of RCHE throughout the territory. The updated list 的防疫措施。要監控季節性和長期感染病，及掌握到 of all such homes was obtained from the Licensing 較佳的實際情況，針對性的常年監測是必要的。 Office of Residential Care Homes of the Social Welfare Department. Stratified cluster sampling was employed within regions (Hong Kong Island, Kowloon, and New Territories) and for types of members of the RCHE Prevalence Study Group, homes (private and non-private). Selected RCHE with the assistance of the RCHE staff or residents’ were invited to participate and a training workshop relatives. for staff was organised. Acute symptoms were recorded and the The recruited home was treated as a cluster diagnosis of infection was subsequently made and about 30% of the residents from each home were following modified long-term care facilities specific selected by systematic sampling with bed numbers surveillance criteria, developed by a Canadian ending in digits of 2, 5, and 8. Selected residents consensus conference (Appendix).14 Symptoms were invited to participate and verbal consents were were checked by interviewing the residents or their obtained. Consenting residents were interviewed on relatives with the help of RCHE staff. A brief physical the survey day. examination was carried out if feasible. Medical In November 2006, a RCHE Prevalence Study records were reviewed after the interview. Infections Group was formed by participants of the infection were identified when symptoms or signs fulfilled the control training course in long-term care facilities. above surveillance criteria, or were diagnosed by They were health care workers (mainly doctors the attending physician or nurses (as stated in the and nurses) looking after elderly patients in public medical record), or when the resident was still on hospitals or in the community. They visited the antibiotics prescribed for a specific condition. The recruited homes and interviewed consenting prevalence of each infection was determined and residents on the survey day. associated risk factors were identified. A survey form (divided into two parts) was The survey was conducted in an anonymous designed for data collection. The first part collected manner; residents were identified only if follow-up demographic data on the residents and their action was needed. If the resident was admitted to a underlying medical conditions. The second part was hospital, consulted a doctor, or had a specimen sent a checklist of acute symptoms of common infections. for culture within 24 hours following recruitment, The form was in Chinese and distributed to the the patient’s outcome was traced by reviewing the homes before the survey. The forms were filled by hospital discharge summary and culture results. Hong Kong Med J Vol 14 No 6 # December 2008 # www.hkmj.org 445 # Chen et al # average cluster size of 31.61 (ie the average number 50 of residents sampled per home with 30% selection). 45 Assuming a response rate of 95%, the final sample size 40 needed for stratified cluster sampling was estimated 35 to be 1580. 30 25 20 Statistical analysis % of residents 15 For statistical analyses, the software programs used 10 were: SPSS (version 12.0 for Windows), Stata (version 5 7.0), and Epi-Info (version 3.3.2). The point prevalence 0 of residents with infection in RCHE was defined as 60-69 70-79 80-89 90-99 ≥100 the number of residents with infection/number of Age-group (years) residents surveyed. Generalised estimating equations were used to identify possible risk factors for different FIG 1. Age distribution of residents in residential care homes for the elderly types of infections. All analyses took account of the stratified cluster sampling frame. Stata’s survey mean function (svymean) and Epi-Info’s complex survey mean function were used to produce standard errors for the clustered data. 40 35 Results 30 A total of 43 RCHE were visited. There were 4645 25 residents and 289 staff in these facilities, with a staff- 20 to-resident ratio of 1:16.
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