Infection control violations at 15 percent of US nursing homes

ScienceDaily (May 3, 2011) — Fifteen percent of U.S. nursing homes receive deficiency citations for infection control per year, according to a new study published in the May issue of the American Journal of Infection Control, the official publication of APIC -- the Association for Professionals in Infection Control and Epidemiology.

Conducted by a team of researchers at the University of Pittsburgh's Graduate School of Public Health, the study analyzed deficiency citation data collected for the purpose of Medicare/Medicaid certification between 2000 and 2007, representing approximately 16,000 nursing homes per year and a panel of roughly 100,000 observations. The records analyzed represent 96 percent of all U.S. nursing home facilities. The team discovered a strong correlation between low staffing levels and the receipt of an infection control deficiency citation.

Infections are the leading cause of morbidity and mortality in nursing homes, responsible for nearly 400,000 deaths per year. Although this has been the focus of mainstream media attention, very little empirical research has been conducted on the subject.

The Centers for Medicare and Medicaid Services (CMS) requires that nursing homes be certified before receiving reimbursement for Medicare and/or Medicaid residents. As part of this certification process, facilities that do not meet certain standards are issued deficiency citations. This study examined the deficiency citation for infection control requirements known as the F-Tag 441.

"Our analysis may provide some clues as to the reason for the persistent infection control problems in nursing homes," state the authors. "Most significantly, the issue of staffing is very prominent in our findings; that is, for all three caregivers examined (i.e., nurse aides, LPNs and RNs) low staffing levels are associated with F-Tag 441 citations. With low staffing levels, these caregivers are likely hurried and may skimp on infection control measures, such as hand hygiene."

The authors conclude, "The high number of deficiency citations for infection control problems identified in this study suggests the need for increased emphasis on these programs in nursing homes to protect vulnerable elders."

A number of states have enacted legislation that applies to infection prevention practices in long-term care facilities. Illinois is poised to pass legislation requiring an infection preventionist in each skilled nursing facility.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Elsevier Health Sciences, via EurekAlert!, a service of AAAS.

Journal Reference:

Nicholas G. Castle, Laura M. Wagner, Jamie C. Ferguson-Rome, Aiju Men, Steven M. Handler. Nursing home deficiency citations for infection control. American Journal of Infection Control, 2011; 39 (4): 263 DOI: 10.1016/j.ajic.2010.12.010

Note: If no author is given, the source is cited instead.

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HIV infection may be a risk factor for heart failure

ScienceDaily (Apr. 25, 2011) — Patients with HIV infection without a prior history of coronary heart disease may be at a higher risk of developing heart failure, according to a report in the April 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Previous studies have suggested that "class of antiretroviral drugs (particularly protease inhibitors), Human immunodeficiency virus 1 (HIV-1) RNA levels, and low CD4+ lymphocyte counts are each associated with an increased risk of cardiovascular disease events, an important risk factor for heart failure," according to background information in the article. "Heavy alcohol consumption, which is more prevalent among HIV-infected people, is also an established risk factor for heart failure," the authors write. "Other important risk factors for heart failure in the general population include increasing age, hypertension, diabetes mellitus, and obesity, factors that are being seen with increasing frequency among the HIV-infected population," because of improved survival among individuals with the infection.

Adeel A. Butt, M.D. M.S., from the University of Pittsburgh School of Medicine, Pittsburgh and Pittsburgh Healthcare System, and colleagues analyzed data from HIV-infected and HIV-uninfected veterans enrolled in the Veterans Aging Cohort Study Virtual Cohort and the 1999 Large Health Study of Veteran Enrollees from January 1, 2000 to July 31, 2007. The objective of the study was to determine whether HIV infection was independently associated with an increase risk of heart failure (HF).

A total of 8,486 patients were included in the analysis, of whom 2,391 (28.2 percent) were HIV infected and 6,095 (71.8 percent) were HIV uninfected. During the median (midpoint) 7.3 years of follow-up, there were 286 new heart failure events and 1,096 deaths. "Participants with HIV infection were more likely to have hepatitis C virus co-infection (30.5 percent vs. 11.4 percent) and cocaine abuse or dependence (21.9 percent vs. 15.7 percent) and higher reported rate of current smoking (55 percent vs. 45.3 percent), but were less likely to have hypertension (18.7 percent vs. 28.8 percent) or diabetes (16.7 percent vs. 24.8 percent)," the authors report.

Compared with HIV-uninfected veterans, those who were HIV-infected had an increased risk of HF, and this association was also present among veterans who did not have a coronary heart disease event or a diagnosis related to alcohol abuse or dependence before the incident HF event. In addition, the authors report that "Compared with patients without HIV infection, those with HIV infection who had baseline HIV-1 RNA levels of 500 or more copies/mL had a significantly higher risk of HF." Those patients with HIV infection, who had baseline and HIV-1 RNA levels less than 500 copies/mL, did not have an increased risk of heart failure. The authors suggest there could be several mechanisms at work in this relationship between HIV and heart failure, including direct effects of the infection, heavy alcohol consumption, antiretroviral therapy leading to an increased risk of coronary heart disease, nutritional deficiencies, and immunologic damage to the myocardium (heart muscle).

"In conclusion, HIV infection is associated with an increased risk of heart failure after adjusting for traditional risk factors for heart failure. This association persisted even after exclusion of patients with a baseline history of coronary heart disease, heart failure and angina, as well as a coronary heart disease event in the follow-up period prior to the diagnosis of heart failure and a history of alcohol abuse or dependence diagnosis. Ongoing viral replication is associated with a higher risk of heart failure."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

A. A. Butt, C.-C. Chang, L. Kuller, M. B. Goetz, D. Leaf, D. Rimland, C. L. Gibert, K. K. Oursler, M. C. Rodriguez-Barradas, J. Lim, L. E. Kazis, S. Gottlieb, A. C. Justice, M. S. Freiberg. Risk of Heart Failure With Human Immunodeficiency Virus in the Absence of Prior Diagnosis of Coronary Heart Disease. Archives of Internal Medicine, 2011; 171 (8): 737 DOI: 10.1001/archinternmed.2011.151

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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