Preventing Infectious Diseases in Long-Term Care Settings

Interim Charge on Long-term Care Settings by Liam M. Fry, MD, FACP, CMD 

Senate Health and Human Services

Feb. 18, 2016 

Good day, Chair Schwertner and members of the committee. I am Liam Fry, MD, CMD, FACP, a physician practicing internal medicine in Austin, with a focus on geriatric medicine. I am board certified in internal medicine, geriatrics, and hospice and palliative care. I am here on behalf of the Texas Medical Association, representing more than 48,000 physicians and medical students. 

I appreciate the opportunity to share our comments on this charge to this committee. Thank you for highlighting the issues around quality, and thank you for the opportunity to testify. I will identify some opportunities to strengthen our efforts to prevent the spread of infectious diseases specifically through vaccination, responding to outbreaks, and infection control in long-term care facilities.

Improving vaccination 

Vaccines play a key role in prevention for both residents and their caretakers. Vaccines such as pneumococcal vaccines protect vulnerable populations like older adults from serious diseases. In addition, vaccines such as influenza vaccines and others protect by helping reduce the likelihood a caregiver could transmit the disease to vulnerable residents or contribute to a flu outbreak. 

We know we can improve our vaccine coverage among residents and health care personnel. Nationally, about 64 percent of health care personnel report receiving a flu vaccine[ 1 ]  though coverage varies by work setting. For example, flu vaccination coverage is lowest among health care personnel working in long-term care settings.[ 2 ]  Yet nearly three-quarters of residents age 65 or older are more likely to be vaccinated for influenza (71.5 percent in 2013-14). And many in these settings cannot be vaccinated because of medical contraindications. Pneumococcal disease is another for which we should encourage vaccination. Nationally, more than one-third of older adults have not been vaccinated against the disease.

Measuring and reporting vaccine coverage should be an important part of a vaccination strategy. Facilities should know the coverage within their resident and staff population. This information should also be posted at the facility and submitted to ImmTrac, the statewide immunization registry. Having this information would be a critical tool for local health officials when responding to a potential outbreak. It also would be helpful for consumers and their families in making decisions about placement. 

Strengthening tools to respond to potential outbreaks 

Infections like influenza can spread easily in long-term care settings. And older patients are at higher risk of developing severe complications from influenza. In addition to annual vaccination, facilities should implement consistent procedures involving testing, surveillance, and reporting. When we are able to recognize a potential outbreak early, we are able to offer evidence-based interventions that are effective in managing it.

In the event of a potential outbreak at a long-term care facility, a relationship between local public health resources and individual facilities is critical. For example, local health officials are important partners and can help identify and contain possible outbreaks of influenza. Developing a relationship with public health entities is crucial for long-term care facilities, especially when it comes to controlling and preventing infectious diseases, as public health entities have numerous tools to assist in prevention and disease response. 

Controlling and preventing infection

Patient Transfers. Controlling multidrug resistant organisms (MDROs) is a serious concern in health care facilities, and long-term care centers face special challenges due to limited resources and their residents’ complex medical needs. For residents who may transfer between long-term care and/or acute-care facilities, we support strategies to better communicate the status of a resident of a long-term care facility known to be colonized or infected with a MDRO. 

Staff also should have some minimum guidance on how best to prepare and carry out transfers of patients with MDRO including documentation of the MDRO. 

Antimicrobial Stewardship. As antibiotics are among the most frequently prescribed medications in nursing homes, these settings can play a key role in the national effort to reduce the threat of antibiotic resistance. We need to help by making sure facilities’ infection control programs have the resources to appropriately use antimicrobials to treat infections while at the same time reducing microbial resistance. 

In addition to resources, facilities also must have the tools and education on how to apply antimicrobial stewardship activities in Texas facilities. National recommendations from sources such as the Centers for Disease Control and Prevention do exist. However, implementing strategies and activities can depend on resources and staffing.  

Thank you again for the opportunity to highlight these important quality issues related to preventing infectious diseases in long-term care settings. We stand by ready to assist the committee.  

[1]  Williams WW, Lu P, O’Halloran A, et al. Surveillance of Vaccination Coverage Among Adult Populations — United States, 2014. MMWR Surveill Summ 2016;65:1–36. DOI:

[2]  CDC. Health care personnel and flu vaccination, internet panel survey, United States, November 2015. Accessed online at

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June 30, 2016