Rosie Lyles

We’ve seen a number of serious infection scares with an outbreak of the Enterovirus-D68 (EV-D68) and several cases of Ebola in the United States this year. As the U.S. response to the current Ebola situation and other emerging infection risks continues to evolve, it is important for facilities across the spectrum of care to take stock of their existing infection prevention and control protocols and consider where there might be knowledge gaps or areas for improvement – not only in the context of viruses like Ebola but perhaps more importantly as they apply to everyday practice.

Infectious diseases remain a significant cause of morbidity and mortality among hospitalized patients and residents of long-term care facilities. According to the Centers for Disease Control and Prevention, an estimated 1 to 3 million serious infections occur annually in long-term care facilities, and as many as 380,000 people die of infections in these facilities every year. Chief among them are familiar foes such as influenza, bacterial pneumonia and gastroenteritis. 

In the face of both familiar threats such as the flu and new challenges posed by the emergence and spread of multidrug-resistant organisms like methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae and klebsiella pneumoniae carbapenemase (KPC)-producing bacteria, it has become increasingly important for long-term care providers to look beyond conventional pathogen-specific prevention strategies in favor of more comprehensive approaches to combat infection.

The recently published “Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates” series led by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America, focused on acute care. But several reviewers raised an important question that also has applications for long-term care settings: What is the relative effectiveness (and cost-effectiveness) of vertical versus horizontal approaches to infection prevention? 

The reviewers suggest that in recent years, approaches to combatting healthcare-associated infections (HAIs) have taken two conceptually different paths: Vertical approaches which focus on specific pathogens and horizontal approaches that aim to reduce the risk of infection caused by a wide range of pathogens. The former relies on surveillance and patient-specific measures designed to prevent further transmission once a case is confirmed, while the later takes a facility-wide approach focusing on the population as a whole, rather than a single patient with prevention strategies such as enhancing hand hygiene, improving environmental cleaning, and promoting antimicrobial stewardship.

Today’s growing concerns surrounding infectious risks such as Ebola, EVD-68, and flu are excellent examples of why proactive horizontal approaches to infection prevention and implementing proven prevention practices on a daily basis are so important, because the reality is that long-term care facilities and the populations they serve are at inherently increased risk of infection.

Regular interpersonal contact and contact with objects and surfaces in the environment is an integral part of residential care, but it is also a primary risk factor for acquiring and spreading pathogens. Along the same lines, decreased immune function is a normal part of the aging process, but in long-term care facilities, frequent comorbidities, increased incontinence, memory loss and dementia and decreased skin integrity can make elderly populations especially vulnerable to infection.

Another challenge is that clinical staff in long-term care facilities cannot rely on isolation precautions to the same extent that they are commonly used in acute-care settings, because of the negative affect isolation can have on residents’ well-being. This makes horizontal approaches to infection prevention and overall facility cleanliness especially important not only during flu season or in light of recent infection scares but on an everyday basis.

Rosie D. Lyles, M.D., is the Head of Clinical Affairs at Clorox Professional Products Company. Lyles is a physician-scientist with more than a decade of experience studying the epidemiology and prevention of multidrug-resistant organisms (MDROs) and infections such as C. difficile, MRSA and CRE. For more influenza and norovirus prevention tips, visit