Owing to the ageing of the population the number of elderly people in need of care in Long-Term Care Facilities (LTCF) across Europe and indeed elsewhere continues to increase markedly. Residents of these facilities often have a high risk for the acquisition and development of healthcare associated infections (HAI) and antimicrobial resistant micro-organisms. They are more vulnerable because of immunosenescence brought on by natural age advancement and may have underlying conditions (e.g. diabetes, dementia) and physiological limitations. In addition, they often receive antimicrobial therapy for acute and chronic infections and have multiple admissions to acute care hospitals, which increases the risk of import of resistant micro-organisms to the LTCF.
Furthermore, living in these ‘homelike facilities’ poses a particular challenge in the prevention and control of healthcare associated infections and antimicrobial resistance, because the vulnerable residents live together in close proximity and share common social contacts. In these settings, a ‘hospital-like’ approach for infection control is often compromised or ignored, because such measures would be perceived as lowering the quality of life of the residents.
The continuous promotion of effective prevention and infection control measures faces many constraints as LTCF often lack sufficient certified nurses, have high workloads and devote insufficient time to training (especially in infection control). In addition, medical care in LTCF is most often provided by the classic, individual ‘GP to patient’ relationship, which sometimes pays insufficient attention to the ‘public health’ aspects of medical care in institutions for collective living. Attention to clinical care, including preventive and control measures (e.g. infection control arrangements, care protocols, vaccination, antibiotic therapy) is thus often given a low priority.
From 2009-2011, the European Centre for Disease Prevention and Control (ECDC) funded the HALT project (Healthcare Associated infections in Long-Term care facilities). The aim of this project was to develop and implement a protocol for surveillance of HAI, antimicrobial use and resistance in European LTCFs in order to establish baseline rates and identify priorities for improvement. A very successful point prevalence survey (PPS) was conducted in 722 LTCFs across 25 European countries. In late 2011, ECDC awarded the HALT-2 team the contract to repeat a HAI and antimicrobial prevalence study in mid 2013.