In long-term care facilities (LTCF) the first line of infection detection more often than not is a nurses’ aide, who must determine that there is a problem with the resident and then promptly reports it to the nurse in charge. Moreover, physician visits are infrequent, and on-site diagnostic testing is uncommon. For the above reasons, the diagnosis of infections in LTCF is mainly based on clinical grounds.
The previous HALT project collected information on the occurrence of all healthcare associated infections (HAI) based on definitions developed by McGeer et al (1991) for infection surveillance in nursing homes. These McGeer definitions were slightly modified as access to microbiological and laboratory tests is more limited in European LTCFs in comparison with Canadian institutions. For this reason, an additional criterion (“diagnosed by the attending physician”) was added. Only infections not already present or in incubation at the time of admission or readmission (after hospitalization or community visit) to the LTCF had to be considered.
Infection criteria were collected through a checklist of signs and symptom. Decision algorithms were applied during data analysis in order to decide whether or not enough signs/symptoms were present to consider the infection as “confirmed”. The checklist is a part of the resident questionnaire (see Manuals & Tools). The questionnaire only had to be completed for residents with signs/symptoms of an infection (and/or residents receiving an antimicrobial).
During the course of the HALT-2 project, the data collection method on HAI will be revised and case definitions for HAI will be validated.