As populations across OECD countries continue to age, an increasing number of people will require support from long-term care (LTC) services, including nursing homes and LTC living facilities (see indicator on “Recipients of long-term care”). Providing safe care for these patients is a key challenge for OECD health systems, as residents of LTC facilities are more frail and sicker, and present a number of other risk factors for the development of patient safety events, including healthcare-associated infections (HAIs) and pressure ulcers (OECD/European Commission, 2013[1]).
HAIs can lead to significant increases in patient morbidity, mortality and cost for the health system. In the acute care sector, HAIs alone are estimated to make up 3-6% of hospital budgets (Slawomirski et al., 2017[2]). These infections are also generally considered to be preventable through standard prevention and hygiene measures. The most commonly occurring HAIs in LTC facilities include urinary tract infections, lower respiratory tract infections, skin and soft tissue infections (Suetens et al., 2018[3]).
In 2016-17, the average prevalence of HAIs among LTC facility residents in OECD countries was 3.8% (Figure 11.14). This proportion was lowest in Lithuania, Hungary, Sweden, Germany, and Luxembourg (less than 2%), and highest in Denmark, Portugal, Greece and Spain (over 5%).
The impact of HAIs is increased by the rise of antibiotic-resistant bacteria, which can lead to infections that are difficult or even impossible to treat. Figure 11.15 shows the proportions of bacteria isolated from LTC residents that are resistant to antibiotics. On average, over one quarter of isolates were resistant to antibiotics. This is nearly equivalent to levels seen in acute care hospitals, where antibiotic resistance is considered a major threat.
Pressures ulcers are another important patient safety concern in LTC facilities. A pressure ulcer is an injury to the skin or underlying tissue resulting from sustained pressure; they occur frequently in patients with limited mobility. Pressure ulcers can lead to complications including infections, and cost up to EUR 170 per patient per day in LTC settings (Demarré et al., 2015[4]).
Across OECD countries on average, the observed prevalence rate of pressure ulcers in selected LTC facilities was 5.35 (Figure 11.16). The highest rates of pressure ulcer prevalence were observed in Spain, Italy and Portugal, at nearly twice the OECD average, while Lithuania, Hungary and Luxembourg reported the lowest rates at under 3%.
