Infections in Nursing Homes - How These Infections Happen (2024)

More than 1.5 million Americans reside in about 16,000 nursing facilities in the United States, as indicated by the 2004 National Nursing Home Survey.Infections in Nursing Homes - How These Infections Happen (1)

More than 88 percent of these individuals are over the age of65 and 45 percent are greater than 85 years of age.This number is expected to reach 5.3 million people by the year 2030.

Patients in this population have become sicker over the years and it is estimated that 2 million infections occur in U.S. nursing facilities each year.

Risk factors for infections in the elderly include having indwelling devices, a recent hospital admission, impairments in function, and multiple other illnesses. As an example, residents with feeding tubes are at risk for aspiration pneumonia, skin and soft tissue infections, and other mechanical complications.

Infections and the use of antibiotics are key reasons for the presence of antibiotic-resistant organisms in the nursing home. Common organisms of this classification include methicillin-resistant Staphylococcus aureus (MRSA), resistant Gram-negative bacilli, and vancomycin-resistant enterococci.

Did You Know

Nursing home residents who come from hospitals or are transferred to another nursing home serve as carriers of disease, frequently introducing resistant organisms at their new places of residence.

Risk factors for having resistant organisms include old age, long-term institutionalization, functional status problems, prior antibiotic use, the presence of an indwelling device, and other illnesses.

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Common Infections in Nursing Homes

The most common infections among nursing home residents include:

  • Gastroenteritis
  • Influenza
  • Respiratory infections
  • Skin infections
  • Soft-tissue infections
  • Urinary tract infections

It is impossible to provide precise estimates as to the prevalence and incidence of these types of infections in nursing homes, as there is a great deal of diversity among those infected and the way they are treated.In the 2004 Nursing Home Survey, the rate of pneumonia was 2.3 percent and the rate of UTIs was 5.7 percent among nursing home residents.


Pneumonia and related lower respiratory tract infections are the leading cause of death among nursing home residents. This is also a big reason behind transfers to the hospital.

The incidence of nursing home pneumonia is about 0.3-2.3 episodes per 1,000 resident care days. Residents with feeding tubes carried the highest risk of pneumonia.

Nursing home residents in the U.S. account for 10-18 percent of all people hospitalized for pneumonia, costing about $10,000 per hospital admission.

Pneumonia in the elderly can manifest itself with some atypical symptoms that may challenge the diagnosis of pneumonia in the nursing home setting.

About a quarter of older adults may not develop a fever and are less likely to have chills, pleuritic chest pain, and muscle pain when compared to younger patients. The diagnosis is usually made by blood testing and chest x-rays.

Outbreaks of the seasonal flu are frequently reported. Influenza has been reported among staff members and residents alike who, despite getting flu shots, do not always have the proper preventative careto resist gettinginfluenza.

Nevertheless, it is a good idea to immunize both staff members and residents against influenza. This can also reduce the death rate of older adults if their healthcare workers have also been immunized. Medications can be given to actively fight the flu if providedin a timely fashion.

Aspiration pneumonia is common among the nursing home population and is usually related to difficulties in feeding and regurgitation of gastric contents. Poor oral hygiene also significantly increases the risk of pneumonia. Dental plaque has been looked at as a source of bacteria that later causes pneumonia.

One study showed that 58 percent of nursing home residents had extensive dental needs and 30 percent reported a significant impact of their oral health on their quality of life. These studies highlight the need to provide good oral care to nursing home residents.

Urinary Tract Infections

The UTI is perhaps the most common infection in the nursing home and is the most over-diagnosed infection among nursing home residents. The presence of an indwelling catheter increases the risk of bladder infections and bacterial sepsis from urinary tract organisms.

About 3-7 percent of nursing home residents with an indwelling catheter will get a urinary tract infection with each day that the catheter remains in place. By the 30th day, about 100 percent of residents will have bacteria in the urine.

Half of all nursing home residents will have symptomatic urinary tract infections. The mortality rate for those who have indwelling catheters is higher than for those who do not have a catheter.

Diarrheal Diseases

Bacterial and viral gastroenteritis is the cause of the majority of attacks of diarrhea in the nursing home. Older adults do not produce enough gastric acid and are at a greater risk of developing infectious gastroenteritis.

Usually, the clinical course of these infections is self-limited and no treatment is recommended. Gastroenteritis can be associated with an increase in morbidity and mortality, mainly because these are people who have a greater risk of dehydration.

Did You Know

Studies have shown that nursing home residents are four times more likely to die from gastroenteritis than those older adults residing in the community.

Norovirus remains a common cause of dehydration and gastroenteritis in nursing home residents and is responsible for half of all gastroenteritis outbreaks throughout the world. It has been estimated that about 21 million cases of norovirus occur each year in the U.S. alone.

Norovirus is a very contagious virus and can be transmitted from person to person, and through food and water as well. Nursing homes are frequent sites for outbreaks of these kinds of viruses. About 35 percent of norovirus outbreaks reported by the CDC occur from nursing homes.

Clostridium difficile infections are an emerging cause of infectious diarrhea among nursing home residents. The incidence of colonization in nursing homes varies from 4 to 20 percent.

About 8-33 percent of nursing home residents treated with antibiotics will get a secondary infection with Clostridium difficile. About 10-30 percent of nursing home residents are colonized with the organism at any given time.

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Skin and Soft Tissue Infections

Older nursing home residents are especially predisposed to getting skin and soft tissue infections due to the various changes in the skin as a result of aging.

This includes the atrophy of the dermis and epidermis, decreased resistance to external insults, and prolonged wound healing times. Dry, itchy skin can serve as an entry point for bacteria that can infect the skin.

Typical nursing home skin infections include cellulitis, necrotizing fasciitis, and erysipelas. Chronic wound infections are more common, including infected pressure ulcers, vascular ulcers, and diabetic wound infections. Other types of skin infections include intertrigo, tenia versicolor, herpes zoster, scabies, and herpes simplex.

Pressure ulcers in nursing homes are a frequent phenomenon. Risk factors include immobility, impaired mental capacity, incontinence, impaired nutrition, and a greater degree of other illnesses. Older adults who are frail are at a higher risk of developing pressure ulcers and having these pressure ulcers become infected.

The infections can lead to additional infections in the bone, skin, blood and can result in death. This is why these infections need to be prevented, recognized early, and treated correctly.

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Infections in Nursing Homes - How These Infections Happen (2024)


Infections in Nursing Homes - How These Infections Happen? ›

Older nursing home residents are especially predisposed to getting skin and soft tissue infections due to the various changes in the skin as a result of aging. This includes the atrophy of the dermis and epidermis, decreased resistance to external insults, and prolonged wound healing times.

Why are nursing home residents at more risk of developing an infection? ›

Due to their increased age and decreased immune system, senior nursing home residents often have multiple comorbidities, or multiple diseases at once. The presence of comorbidities weakens the immune system even further, making nursing home residents especially susceptible to infections.

Which type of infection is most closely associated with nursing homes? ›

Nursing home–acquired pneumonia (NHAP) is defined as pneumonia occurring in a resident of a long-term care facility or nursing home. NHAP is one of the most common infectious diseases in long-term care facilities and is a significant cause of mortality and morbidity among residents of such facilities.

What infections are most commonly found in care homes? ›

Common Nursing Home Infections
  • Urinary Tract Infections (UTIs)
  • Pneumonia.
  • Staph.
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Influenza (flu)
  • Bedsores.
  • Clostridium Difficile (C. difficile)
  • Scabies.

What is the most common way infection is transmitted in a facility? ›

Contact transmission is the most common form of transmitting diseases and virus. There are two types of contact transmission: direct and indirect.

Why do infections spread in care homes? ›

Infection outbreaks can occur in care homes because: Infectious agents can survive in and on people, as well as in the environment; Vulnerable residents have frequent contacts with staff, other residents, visitors and the environment; The immune system of vulnerable residents can be easily overwhelmed.

What are the 2 most common types of bacteria in a care home? ›

Most Environment-Related Infection

The most common pathogens are Group A Streptococcus (GAS) and Methicillin-resistant Staphylococcus aureus (MRSA). GAS and MRSA can lead to severe and invasive infections involving multiple internal organs.

How can you reduce the risk of infection in a care home? ›

  1. Wash hands thoroughly, and at the right time. Every caregiver will understand the importance of hand hygiene; however, in order for this to be effective, hands must be washed at the right time, and in the right way. ...
  2. Use the correct PPE. ...
  3. Manage linen appropriately. ...
  4. Educate visitors. ...
  5. Dispose of human waste appropriately.

What are factors that put patients at risk for infection? ›

Having other medical conditions such as diabetes, chronic obstructive pulmonary disease (COPD), autoimmune disease, among others. If you have other medical conditions, ask your doctor if they put you at increased risk for infection. Other factors, such as poor nutrition, stress, or lack of sleep.

Which client is most susceptible to infection? ›

Some people are more vulnerable than others, including:
  • premature babies.
  • very sick children.
  • elderly people.
  • frail people.
  • people with certain medical conditions, such as diabetes.

What are 4 common types to get healthcare associated infections? ›

The most common infections associated with healthcare facilities include catheter-associated urinary tract infections; central line-associated bloodstream infections, surgical site infections, and pneumonia.

What is the most common infection transmitted to healthcare workers to a patient? ›

Varicella is one of the most common hospital-acquired diseases among HCWs. It is a highly contagious disease and exposure to the virus is common in the healthcare setting. Most persons with a clear history of chickenpox in childhood are probably immune.

What is the most common diagnosis in nursing homes? ›

The top condition on our list is essential (primary) hypertension, with 3.30% of claims. This makes sense since nearly one in two adults in the U.S. has hypertension.

What poor practices may lead to the spread of infection? ›

Poor practices that may lead to infection

Poor practice, e.g. coughing and sneezing without covering mouth, poor personal hygiene, not washing hands between contact with individuals.

What are the 3 main ways infection is transmitted in the workplace? ›

Transmission of infection
  • breathing in airborne germs – coughs or sneezes release airborne pathogens, which are then inhaled by others.
  • touching contaminated objects or eating contaminated food – the pathogens in a person's faeces may be spread to food or other objects, if their hands are dirty.

What is the number one cause of infection transmission among patients? ›

Contact transmission

This is the most important and frequent mode of transmission in the health care setting. Organisms are transferred through direct contact between an infected or colonized patient and a susceptible health care worker or another person.

How does infection spread in assisted living? ›

How Do Infections Spread? Germs can be found on the hands or gloves of health care workers, on surfaces in the facility, and on medical equipment. If these are not properly cleaned and disinfected, the germs may spread to other people and the environment.

What is the most common bacterial infection in elderly? ›

Bacteremia is often associated with a central line in the hospitalized elderly patients and methicillin-resistant Staphylococcus aureus is the most common pathogen in this cohort (12). Sepsis is also more frequently observed in the elderly.

What is the most common bacteria found in the home? ›

What Type of Bacteria Are the Most Common in A Home? There are four types of bacteria that are extremely common within a household. Staphylococcus, Micrococcus, Pseudomonas, and Bacillus are the most common types. Micrococcus is spherical, and can be found in meat products, in water, and in your soil.

Where is bacteria most commonly found in a house? ›

Kitchen rags, towels and sponges are notorious for bacterial contamination. The sink drain, sink and countertops are also frequently contaminated. Cutting boards, coffee filters, the dishwasher and fridge seals are also top locations for contamination.

What is the best way to minimize infection? ›

Use soap and water or an alcoholbased hand rub to clean your hands. It only takes 15 seconds to practice hand hygiene. to practice hand hygiene. Your doctors and nurses should practice hand hygiene every time they enter your room.

What are the causes of infection? ›

Three things are necessary for an infection to occur: Source: Places where infectious agents (germs) live (e.g., sinks, surfaces, human skin) Susceptible Person with a way for germs to enter the body. Transmission: a way germs are moved to the susceptible person.

What are five ways to prevent the spread of infection? ›

Tips to prevent the spread of disease

Wash your hands for at least 20 seconds with soap and water before and after handling raw meats, fruits and vegetables. Wash and disinfect surfaces before and after use. Keep chilled food chilled. Keep heated food heated.

What are the 7 causes of infection? ›

Infectious diseases can be caused by:
  • Bacteria. These one-cell organisms are responsible for illnesses such as strep throat, urinary tract infections and tuberculosis.
  • Viruses. Even smaller than bacteria, viruses cause a multitude of diseases ranging from the common cold to AIDS.
  • Fungi. ...
  • Parasites.

What are common causes of infection in elderly care settings? ›

Common Infections in Nursing Homes
  • Gastroenteritis.
  • Influenza.
  • Respiratory infections.
  • Skin infections.
  • Soft-tissue infections.
  • Urinary tract infections.
Sep 29, 2021

Why are elderly more at risk of infection? ›

As we age, our immune system weakens. This makes us more vulnerable to infections of all types. And any sort of challenge to the body can do more damage. When the immune system gears up in older people, there is also a higher likelihood of a phenomenon called a cytokine storm.

What are five 5 factors that can increase a client's susceptibility to infection? ›

Multiple innate factors (e.g., age, nutritional status, genetics, immune competency, and pre-existing chronic diseases) and external variables (e.g., concurrent drug therapy) influence the overall susceptibility of a person exposed to a virus.

What are 6 most common hospital acquired infections? ›

These infections include catheter-associated urinary tract infections, central line-associated bloodstream infections, surgical site infections, ventilator-associated pneumonia, hospital-acquired pneumonia, and Clostridium difficile infections.

What is the biggest infection control risk in healthcare? ›

Hand washing. Twenty six percent of practices visited did not provide staff with hand washing training. Effective hand washing prevents the transmission of micro-organisms to yourself and others – it's the single most important procedure for infection control.

How common are UTIs in nursing homes? ›

Urinary tract infections (UTIs) are one of the most common infections in older persons living in nursing homes (NHs). It is estimated that the error rate of a UTI diagnosis based solely on clinical criteria is 33% in a general population [1].

Which of the following are common problems in nursing home patients? ›

14 Common Nursing Home Problems
  • Increased Costs. Nursing homes generally cost more than in-home care or assisted living facilities. ...
  • Smaller Living Arrangements. ...
  • Living Among Other Residents. ...
  • Fewer Chances to Go Out. ...
  • Boredom and Isolation. ...
  • Disregarding Preferences. ...
  • Less Say in the Care Plan. ...
  • Restricted Visiting Hours.
Jan 17, 2022

What is a high risk nursing diagnosis? ›

A risk nursing diagnosis is “a clinical judgment concerning the vulnerability of an individual, family, group, or community for developing an undesirable human response to health conditions/life processes.” A risk nursing diagnosis must be supported by risk factors that contribute to the increased vulnerability.

How can you prevent the spread of infection in a care home? ›

  1. Wash hands thoroughly, and at the right time. Every caregiver will understand the importance of hand hygiene; however, in order for this to be effective, hands must be washed at the right time, and in the right way. ...
  2. Use the correct PPE. ...
  3. Manage linen appropriately. ...
  4. Educate visitors. ...
  5. Dispose of human waste appropriately.

How can you reduce the spread of infection in a care setting? ›

Regular cleaning or decontamination requirements will reduce the number of pathogens present in the environment and on equipment. Isolation or distancing, keeping away from others when infectious, reduces the opportunity for the pathogen to find a new host (reservoir).

Why do elderly keep getting infections? ›

Seniors are much more prone to developing skin infections because of their skin's declining ability to heal itself and resist disease. Common skin infections in elderly patients include: Bacterial or fungal foot infections, which can be more common in those with diabetes. Cellulitis.

What are the 4 factors that make a person more susceptible to infection? ›

Multiple innate factors (e.g., age, nutritional status, genetics, immune competency, and pre-existing chronic diseases) and external variables (e.g., concurrent drug therapy) influence the overall susceptibility of a person exposed to a virus.

What are the best practices to reduce healthcare associated infections? ›

Strategies to Prevent Healthcare-Associated Infections
  • Hand hygiene.
  • Maintaining a safe, clean, hygienic hospital environment.
  • Screening and categorizing patients into cohorts.
  • Public health surveillance.
  • Antibiotic stewardship.
  • Following patient safety guidelines.
Sep 28, 2020

Who is most at risk from hospital acquired infections? ›

Anyone getting medical care is at some risk for an HAI; however, some people are at higher risk than others, including the following: Very young people – premature babies and very sick children. Very old people – the frail and the elderly. People with certain medical conditions – such as diabetes.

How infection can spread from nurses to patients? ›

Even if gloves are changed between rooms, there are still several ways to transmit germs. For example, nurses might pick up pens, flashlights or other objects to use with gloved hands. Touching these objects later without gloves can transmit harmful microorganisms to that nurse's skin.

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