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Non-respiratory infections – specific considerations in care homes

By Victoria Ewan and Adam Gordon


This review provides an update on current evidence surrounding the epidemiology, treatment and prevention of non-respiratory infections in care homes. It covers urinary tract infection (UTI), methicillin-resistant staphylococcus aureus (MRSA), decubitus ulcers, scabies, tinea infections and viral and bacterial gastroenteritis. The care home sector provides a unique ecological niche for infections, housing frail older people with multiple co-morbidities and frequent contact with healthcare services in a semi-closed environment. This leads to differences in the diagnosis and management of infections – particularly of outbreaks – when compared with community-dwelling counterparts. It is essential that care home staff play a role in the early recognition, isolation and treatment of infections but they are often not trained as healthcare professionals – this presents a challenge to systematised response. Effective interface between care homes, public health and infection control services are essential to the delivery of care, yet it is not clear how most-effectively to structure such links

Publisher: Cambridge University Press
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Provided by: Nottingham ePrints

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  1. A method comparison study to assess the reliability of urine collection pads as a means of obtaining urine specimens from non-toilet-trained children for microbiological examination.
  2. (2004). A national census of care home residents. Age Ageing. doi
  3. (1992). A prospective study of pressure sore risk among institutionalized elderly.
  4. A severe outbreak of Escherichia coli O157:H7--associated hemorrhagic colitis in a nursing home.
  5. Acute Bloody Diarrhea: A Medical Emergency for Patients of All Ages. doi
  6. (2008). Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Cochrane Database of Systematic Reviews.
  7. (2004). Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database of Systematic Reviews.
  8. (2003). Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database Syst Rev.
  9. (1999). Antimicrobial resistance patterns in urinary isolates from nursing home residents. Fifteen years of data reviewed.
  10. Asymptomatic Bacteriuria and Inflammatory Response to Urinary Tract Infection of Elderly Ambulatory Women in Nursing Homes - molecular pathogenesis and clinical management.
  11. (2002). Asymptomatic bacteriuria in a population of elderly in municipal institutional care. Scandinavian Journal of Primary Health Care.
  12. (1992). Bacteremia in a long-term-care facility: a fiveyear prospective study of 163 consecutive episodes. Clinical Infectious Diseases.
  13. (2009). Care of Elderly: UK Market Survey. London: Laing and Buisson
  14. (2009). Clinical features to identify urinary tract infection in nursing home residents: a cohort study.
  15. Clostridium difficile: An Emerging Epidemic in Nursing Homes. Geriatric Nursing. doi
  16. Clustering and Risk Factors of Methicillin-Resistant Staphylococcus aureus Carriage in Two Italian Long-Term Care Facilities.
  17. (2003). Comparison of Mortality Associated with Methicillin Resistant and Methicillin Susceptible Staphylococcus aureus Bacteremia: A Meta-analysis. Clinical Infectious Diseases.
  18. Controlling Scabies in Institutional Settings: A Review of Medications, Treatment Models, and Implementation.
  19. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women.
  20. Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature.
  21. (1997). Deaths after ivermectin treatment. The Lancet.
  22. (1997). Deaths associated with ivermectin for scabies. The Lancet.
  23. (1997). Deaths associated with ivermectin treatment of scabies. The Lancet.
  24. (2000). Department of Health. Care Standards Act
  25. Dermatophytosis in institutions for the elderly.
  26. Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol.
  27. Diagnosis of UTI. Quick reference guide for primary care2009: Available from:
  28. Effect of exclusion policy on the control of outbreaks of suspected viral gastroenteritis: Analysis of outbreak investigations in care homes. doi
  29. Epidemiological trends in skin mycoses worldwide.
  30. (2009). Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) among residents of nursing homes in Belgium. J Antimicrob Chemother.
  31. (1986). Escherichia coli O157:H7 diarrhea in a nursing home: clinical, epidemiological, and pathological findings. J Infect Dis. doi
  32. Escherichia coli O157:H7 infection in nursing homes: review of literature and report of recent outbreak. doi
  33. Essential Infectious Disease Topics for Primary Care2008.
  34. Explaining the national differences in pressure ulcer prevalence between the Netherlands and Germany adjusted for personal risk factors and institutional quality indicators. doi
  35. Fluoroquinolone-resistant Escherichia coli in the long-term care setting.
  36. (2002). Health Survey for England 2000: Characteristics of Care Homes and Their Residents. London: The Stationary Office;
  37. Hemorrhagic colitis in a nursing home in Ontario.
  38. Hospital-acquired infections in Norwegian long-term-care institutions. A three-year survey of hospital-acquired infections and antibiotic treatment in nursing/residential homes,including 4500 residents in Oslo.
  39. Indwelling Device Use and Antibiotic Resistance in Nursing Homes: Identifying a High-Risk Group.
  40. (1994). Infection caused by Escherichia coli O157:H7 in Alberta, Canada, and in Scotland: a five-year review, 1987-1991. Clin Infect Dis. doi
  41. Infection control in a skilled nursing facility: a 6-year survey.
  42. (2000). Infection Control in Long Term Care Facilities. Clinical Infectious Diseases. doi
  43. (2008). Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people. Cochrane Database Syst Rev.
  44. (1996). Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev.
  45. (1993). Infectious diseases and mortality among US nursing home residents.
  46. (2007). Interventions for treating scabies. Cochrane Database Syst Rev.
  47. Laboratory investigation of outbreak of hemorrhagic colitis caused by Escherichia coli O157:H7.
  48. length of stay, and proton pump inhibitors: key factors in Clostridium difficile-associated disease in nursing home patients. doi
  49. López-Areal JdlL, Martinez CA. Scabies in the elderly.
  50. Management of hospital outbreaks of gastroenteritis due to small roundstructured viruses. doi
  51. Management of suspected bacterial urinary tract infection in adults. A national clinical guideline2006: Available from:
  52. (1999). Management of Urinary tract infections in the nursing home elderly: a proposed algorithmic approach.
  53. Medical services for older people in nursing homes — Comparing services in England and The Netherlands. doi
  54. (2001). Methicillin Resistant Staphylococcus aureus in Geriatric Patients: Usefulness of Screening in a Chronic Care Setting. Infection Control and Hospital Epidemiology.
  55. (1997). Methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes in a major UK city: an anonymized point prevalence survey. Epidemiology and Infection. doi
  56. (2004). Methicillin-resistant Staphylococcus aureus in hospitals and the community: Stealth dynamics and control catastrophes. doi
  57. Methicillin-resistant Staphylococcus aureus in long-term-care facilities. Clinical Microbiology and Infection.
  58. Methicillin-resistant Staphylococcus aureus: : Long-term care concerns.
  59. (1991). Methicillin-resistant Staphylococcus aureus: Colonization and Infection in a Long-term Care Facility. Annals of Internal Medicine.
  60. Mortality due to gastroenteritis of unknown etiology in the United States. doi
  61. (1999). Multiple Antibiotic-Resistant Klebsiella and Escherichia coli in Nursing Homes. doi
  62. Norovirus excretion in an aged-care setting.
  63. Norovirus outbreaks in nursing homes. doi
  64. (1994). Norwalk virus infection of volunteers: new insights based on improved assays. J Infect Dis. doi
  65. (1997). Nursing Homes in 10 Nations: A Comparison Between Countries and Settings. Age Ageing. doi
  66. (2005). of Clinical Excellence. CG29 - The management of pressure ulcers in primary and secondary care: a clinical practice guideline. London: National Insitute of Clinical Excellence/Royal College of Nursing;
  67. Outbreaks of gastroenteritis due to infections with Norovirus doi
  68. Pneumonia and influenza: specific considerations in care homes. Reviews in Clinical Gerontology. doi
  69. Preparedness of Residential and Nursing Homes for Pandemic Flu. doi
  70. Pressure ulcer prevalence in Europe: a pilot study. doi
  71. (1995). Pressure Ulcers in the Nursing Home. Annals of Internal Medicine.
  72. Prevalence of Methicillin Resistant Staphylococcus aureus Colonization Among Older Residents of Care Homes in the United Kingdom. Infection Control and Hospital Epidemiology.
  73. Prevalence of methicillin-resistant Staphylococcus aureus and factors associated with colonization among residents in community longterm-care facilities in Spain. Clinical Microbiology and Infection.
  74. Prevalence of methicillin-resistant Staphylococcus aureus colonization in residents and staff in nursing homes in Northern Ireland.
  75. (2002). Prevalence of nosocomial infections and use of antibiotics in long-term care facilities in Norway,
  76. (2008). Prevalence of nursing home-associated infections in the Department of Veterans Affairs nursing home care units.
  77. Prospective randomized double-blind trial of racecadotril compared with loperamide in elderly people with gastroenteritis living in nursing homes. doi
  78. (2005). Prospective surveillance for healthcare-associated infections in German nursing home residents. J Hosp Infect.
  79. Protracted outbreak of S. Enteritidis PT 21c in a large Hamburg nursing home. doi
  80. Recurrent urinary tract infections in older people: the role of cranberry products.
  81. (2007). Recurring norovirus outbreaks in a long-term residential treatment facility -
  82. (1999). Residential care and the elderly: the burden of infection. J Hosp Infect.
  83. Risk factors for colonization with methicillin-resistant Staphylococcus aureus among nursing home residents.
  84. Risk Factors for Methicillin Resistant Staphylococcus aureus Carriage in Residents of German Nursing Homes. Infection Control and Hospital Epidemiology.
  85. Rotavirus detection and characterisation in outbreaks of gastroenteritis in aged-care facilities. doi
  86. (2000). Scabies and pediculosis. The Lancet.
  87. (1992). Scabies in Chronic Health Care Institutions. Arch Dermatol.
  88. Scabies Outbreaks in Nursing Homes for the Elderly: Recognition, Treatment Options and Control of Reinfestation.
  89. serotypic, and enterotoxin analysis of Bacillus cereus in an outbreak setting.
  90. Survival and infectivity of Sarcoptes scabiei var. canis and var. hominis.
  91. (2000). The burden of infection in long-term care. Infect Control Hosp Epidemiol.
  92. The community prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in older people living in their own homes: implications for treatment, screening and surveillance in the UK.
  93. The frequency of a Norwalklike pattern of illness in outbreaks of acute gastroenteritis.
  94. The Lancet.
  95. The Nottingham Staphylococcus aureus population study: prevalence of MRSA among the elderly in a university hospital.
  96. The prevalence of asymptomatic bacteriuria in long term care facility residents in Shiraz, Southwest Iran: a cross-sectional study.
  97. The prevalence of infections in nursing homes in Belgium.
  98. The prevalence of methicillin-resistant Staphylococcus aureus among the residents of six nursing homes for the elderly.
  99. (1995). The Treatment of Scabies with Ivermectin.
  100. (1941). Transmission of Scabies. Br Med
  101. Trichophyton violaceum infection occurring in a nursing home. Nippon Ishinkin Gakkai Zasshi.
  102. Two epidemiologic patterns of norovirus outbreaks: surveillance in England and wales, 1992-2000. Emerg Infect Dis. doi
  103. (2009). Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Treatment of pressure ulcers: Quick Reference Guide. Washington DC: National Pressure Ulcer Advisory Panel; doi
  104. Understanding gastroenteritis in elderly residents of agedcare facilities.
  105. (2000). Urinary tract infection in old age: over-diagnosed and over-treated. Age Ageing.
  106. (2005). Urine collection pads: are samples reliable for urine biochemistry and microscopy? Pediatric Nephrology.
  107. Validity of the Minimum Data Set in Identifying Urinary Tract Infections in Residents of Long-Term Care Facilities.
  108. (2000). Widespread environmental contamination with Norwalk-like viruses (NLV) detected in a prolonged hotel outbreak of gastroenteritis. Epidemiology and Infection.

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