We've blogged before about
LTACHs (long-term acute care hospitals) and the role they play in amplifying and disseminating multi-drug resistant pathogens. A recent
report in Clinical Infectious Diseases describes an LTACH outbreak of group A streptococcus, which is arguably one of the most antibiotic susceptible (though highly virulent) pathogens. In this 57-bed facility there were 11 cases, 8 of which were bacteremic, and of which 2 died. The outbreak continued for 4 months. The report notes poor infection control practices and a delayed recognition of an outbreak by infection prevention personnel in the facility. The
editorial accompanying the paper is also worth reading. Given what we know about LTACHs and their patient population, it may be wise for acute care hospitals who receive transfers from LTACHs to initiate empiric contact precautions for these patients until the patients can be fully evaluated (and those of you who know my feelings about contact precautions know that I
almost never argue in support of contact precautions).
Remember you are talking about a primarily for-profit environment. I'm afraid that until infection preventionists are legislated in a meaningful fashion, that this pattern will continue. Some LTC and LTACs' idea of infection preventionist is adding this to the director of nursing or assistant director of nursing's job description with no special training. There are some interesting disincentives for recognizing and tracking infections in LTC and LTACs as well. Staffing and access to supplies in some of these care facilities is a paradigm unto itself, making it almost impossible for even caring staff to do a good job, and there are caring individuals in these facilities. Dialog with these facilities is difficult, but important.
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