Infection control in long-term care facilities

Infections are common in long-term care facilities. The most frequent endem ic infections are urinary infection, respiratory infection, and skin and so ft tissue infections. Outbreaks also occur frequently, and some facilities have a high prevalence of colonization of residents with antimicrobial-resi stant organisms. Our understanding of infections and the development of inf ection-control programs for long-term care facilities have progressed great ly over the past 15 years. Whereas the occurrence of infections has been de scribed and specific guidelines for infection-control programs in long-term care facilities have been developed, there is still limited evaluation of the effectiveness of programs or specific interventions to support prioriti zation of infection-control resources. In addition, the spectrum of patient s and care delivered in longterm care facilities continues to evolve. Incre asingly, chronic care patients, including those requiring chronic respirato r therapy, dialysis, or percutaneous feeding tubes, are cared for in these facilities. Our understanding of prevention of infection in these patients remains limited. Important questions include what interventions may prevent endemic infections, what are the most effective means to identify outbreak s early, and what interventions may minimize the prevalence of antimicrobia l-resistant organisms. Programs to optimize antimicrobial use need to be de veloped. Thus, although progress in understanding and practice has been mad e, important questions remain.