We have all witnessed residents with a significant change in condition, residents with an onset of new behaviors, unsteady gait, lethargy, loss of appetite and more. How do our caregivers respond when they notice these sometimes subtle changes in condition? Are caregivers trained to observe for changes or is your home experiencing a higher than average re-hospitalization rate? How are your caregivers identifying acute infections and will your infection control surveillance program withstand a regulatory review?
The McGeer criteria for classifying nosocomial infections was originally adapted from the acute care setting and considered the “gold standard” in long-term care since 1992. At that time there was no evidence-based information available and the criteria were never validated. Long-term care has evolved over the years and we are providing higher levels of care. As such, the Society for HealthCare Epidemiology of America (SHEA) has updated the McGeer criteria to be more specific to our settings.
Urinary Tract Infections represent the largest percentage of nosocomial infections in long-term care facilities. Surveillance definitions for urinary tract infections vary widely from the original McGeer criteria and now include:
- Leukocytosis – An increase in white cells (neutrophils) in the peripheral blood. As a result it will usually be necessary to obtain a complete blood count (CBC) when diagnosing a urinary tract infection.
- Bacterial colony counts – Colony counts were not used in the original McGeer’s criteria because it was felt that their use would lead to over-counting and over-treating “asymptomatic bacterurias”. In the new guidelines there are two colony count ranges depending on whether or not the resident has a catheter.
This information is important as it may change the way we report suspected infection rates in our homes. Although the use of indwelling urinary catheters has decreased since 1992 the new criteria address colony counts in two distinct ways, one with and one without the use of a catheter. There are other changes to the criteria and the information can be accessed at:
Remember, it may not be possible to prevent all nosocomial infections however we must be alert to early signs and symptoms of infections in an effort to avoid unnecessary re-hospitalizations! If you should have any questions or need assistance with your infection control program please contact your HealthCap risk manager!