Definitions of infection for surveillance in long-term care facilities.

In the last decade, increasing attention has focused on the practice of infection control in long-term care facilities. It has become clear that much more data on rates, risk factors, and management of infections in residents of such facilities are needed if the quality of resident care and the cost-effectiveness of infection control programs are to be optimized. It is also clear that the standard definitions of nosocomial infections developed for use in acute care hospitals are not applicable in most long-term care facilities. Standard definitions of infections for use in long-term care facilities would be helpful, both as guidelines for surveillance and as outcome measures for studies of infections and infection control in these facilities. This set of definitions was developed at a consensus conference held in January 1989 and subsequently revised by a modified Delphi technique involving consensus conference participants. Discussion at the conference was based on definitions developed at Yale University (Checko P, et al., unpublished manuscript) and revised by the Co-operative Infection Control Committee and on detailed reviews of these definitions written by a sample of 62 infectious disease physicians, geriatricians, infection control practitioners from long-term care facilities, and authors of published research in the field. They are intended specifically for use in facilities that provide homes for elderly residents who require 24-hour personal care under professional nursing supervision. The majority of these residents will have some degree of cognitive impairment. All will require some assistance with activities of daily living, and some may require urinary catheters, sterile dressings, and/or tube feedings. However, neither intravenous therapy nor laboratory/radiology facilities will usually be available on the premises. We have no data as yet on the reliability or validity of these definitions, although they are the subject of an ongoing study. We hope, however, that they will stimulate thought and research, and we look forward to the development of uniform definitions and of infection surveillance and control programs in long-term care facilities.