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Objectives: To assess the impact of a hygiene-encouragement program on reducing infection rates (primary end point) by 5%., Design: A cluster randomized study was carried out over a 5-month period., Settings and Participants: Fifty nursing homes (NHs) with 4345 beds in France were randomly assigned by stratified-block randomization to either a multicomponent intervention (25 NHs) or an assessment only (25 NHs)., Intervention: The multicomponent intervention was targeted to caregivers and consisted of implementing a bundle of infection prevention consensual measures. Interactive educational meetings using a slideshow were organized at the intervention NHs. The NHs were also provided with color posters emphasizing hand hygiene and a kit that included hygienic products such as alcoholic-based hand sanitizers. Knowledge surveys were performed periodically and served as reminders., Measurements: The primary end point was the total infection rate (urinary, respiratory, and gastrointestinal infections) in those infection cases classified either as definite or probable. Analyses corresponded to the underlying design and were performed according to the intention-to-treat principle. This study was registered (#NCT01069497)., Results: Forty-seven NHs (4515 residents) were included and followed. The incidence rate of the first episode of infection was 2.11 per 1000 resident-days in the interventional group and 2.15 per 1000 resident-days in the control group; however, the difference between the groups did not reach statistical significance in either the unadjusted (Hazard Ratio [HR] = 1.00 [95% confidence interval (CI) 0.89-1.13]; P = .93]) or the adjusted (HR = 0.99 [95% CI 0.87-1.12]; P = .86]) analysis., Conclusion: Disentangling the impact of this type of intervention involving behavioral change in routine practice in caregivers from the prevailing environmental and contextual determinants is often complicated and confusing to interpret the results., (Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)

In France, although there are 445,000 beds in nursing homes (NHs) for elderly people, no studies on the burden of infections in NHs have been published. We sought to estimate the prevalence of infection among the residents and to assess the extent to which infections were associated with the residents' risk factors. We performed a nationwide, multicentre, cross-sectional, clustered period prevalence survey over five one-month periods. Cases of infection were classified as definite or, in the absence of laboratory confirmation, as probable. A total of 44,869 residents in 578 volunteer facilities were enrolled in the survey. The overall prevalence rate of infections was 11.23% [95% confidence interval (CI): 10.50-11.97] and differed significantly (P<0.001) across survey periods (the time of the year the survey was carried out). The rate of definite cases was 4.60% (95% CI: 4.04-5.54) and the rate of probable cases was 6.63% (95% CI: 5.77-7.98). Respiratory tract infections were the most frequent and accounted for 41% of all infections. Infections were significantly associated with age, length of stay, full disability, urinary device, bedsores and the survey period. Only prevention programmes may reduce the impact of infections on this frail population., (Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

A nationwide survey was performed using a two-round web-based Delphi procedure to develop a set of consensus guidelines for preventing infections among residents in nursing homes (NHs). The research group was led by an investigative group of six specialists. Research analysts conducted a literature search and review of practice guidelines, systematic reviews and articles or abstracts published in English and French on the topic of infection prevention. The literature search was examined by 23 specialists (who compiled a preliminary list of 301 recommendations). Using a Delphi survey online instrument, 81 experts from all relevant medical specialties in the fields of infection prevention and control and geriatrics rated their agreement with each of the recommendations using a nine-point scale (1 = strongly disagree, 9 = strongly agree). During the second round, 79 participants received anonymous feedback from the first round and assessed a narrowed list of 130 recommendations. Recommendations were retained and classified according to the overall median score and ratings percentages by stakeholders. A total of 79 raters rated ≥ 10% of items, and 264 recommendations were retained and rated as follows: 240 items reached consensus, 24 items reached near consensus, 37 items were discarded and one recommendation was deleted. Many infections, though not all, can be prevented in the frail elderly. Thus, these guidelines should be adopted by each healthcare professional and facility to implement routine infection control procedures., (Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)