1. Alison Keyser Metobo, MPH +
Population- based Surveillance of Reportable Diseases in Nursing Home Facilities in Nebraska
Manjiri Joshi, MPH+
Alison Keyser Metobo, MPH +
+Epidemiology Surveillance Response Coordinator

2. Overview Background Objective Methods Results Next Steps
Nursing home increased risk for infection
Health outcomes in nursing home residents
Baseline for Nebraska cases
Objective
Methods
Estimated incidence rates in nursing home residents
Comparing estimated incidence rates in nursing home residents and non-nursing home cases
Results
Next Steps

3. Background

4. Nursing Home residents are at increased risk for infection
Advanced Age
Group Living
Comorbidities
Compromised Immunity
Need for hospitalization

5. Health outcomes for nursing home residents
Clostridium Difficile infections
Influenza
Methicillin Resistance Staphylococcus Aureus
Vancomycin resistance Enterococci

6. Compared Nebraska incidence rates with national incidence rates
Establish baseline in Nebraska population

11. 2010 - revised reportable disease regulations implemented in Nebraska
Conditions added for laboratories reporting via Automated Electronic Laboratory Reporting (ELR)
Acinetobacter spp.
Streptococcus pneumoniae
Enterococcus spp.
Influenza
Klebsiella spp.
Clostridium difficile
Staphylococcus aureus
Meningococcal disease, invasive (Neisseria meningitidis)

12. Objectives
Calculate estimated incidence rates among nursing home residents for selected agents for 2010 ̶ 2011
Compare estimated incidence rates for nursing home residents and non-nursing home cases who are 65 years and older

13. METHODS

14. HL-7 SAS Codes ELR (All Reportable Conditions)
Nebraska’s Electronic Diseases Surveillance System (NEDSS)
Different line lists with selected variables are created and exported as excel files
HL-7
SAS Codes

15. Nursing home data “Nursing home associated case”-
any lab report where patient address = Nursing home address
Obtained addresses of all 231 licensed Nursing home facilities
Nursing home line list and 2011
Selected agents
Clostridium Difficile
Enterococcus Sp.
Influenza
Methicillin Resistant Staphylococcus Aureus (MRSA)
Non MRSA Staph
Streptococcus Pneumonia
** For influenza only positive cases were included

16. ** For influenza only positive cases were included
Non-nursing home data
Lab report data (ELR) for 2010 ̶ 2011
Selected agents
Clostridium Difficile
Enterococcus Sp.
Influenza
Methicillin Resistant Staphylococcus Aureus (MRSA)
Non MRSA Staph
Streptococcus Pneumonia
** For influenza only positive cases were included

17. Estimated incidence rates for nursing home residents 2010 ̶ 2011
Total number of licensed beds in Nebraska were used as proxy for convenience as population at risk to calculate the estimated incidence rates in nursing home facilities
Incidence Rate = Number of cases Number of licensed beds*
* Proxy for population at risk

18. Compare estimated incidence rates for nursing home residents and non-nursing home cases
Assumption : Majority of the population in nursing home was 65 years and above
All the licensed beds in Nebraska were used by this population
Incidence Rate = Number of cases in nursing home who are 65 yrs and older
Total number of licensed beds
Non-nursing home cases
Number of cases for 65 years and above was included
Age specific population for Nebraska was used to calculate the incidence (Denominator)
Incidence Rate = Number of cases who are 65 yrs and older
Population at risk who are 65 yrs and older

19. RESULTS

20. Number and proportion of lab reports for which patient address was available
Year
Total
Count
(n)
% of available address
2010
2660
2394
90%
2011
7136
6315
88.49%

21. Total # of Nursing homes in Nebraska
Number and proportion for Nursing homes in Nebraska identified in the Lab reports for 2010 and 2011
Total Number of Beds – 16,975
Median: 62
Range:
Total # of Nursing homes in Nebraska
# identified in 2010, 2011
Percentage %
231 48
20.77

22. Nursing home associated cases by age and gender -2010 and 2011
Total
2010
2011
Statewide incidence
Male Total %
Female
% Missing gender inform.
Age Median
Age Range
Clostridium Difficile 71 32 39
4.18
59.2
36.6
4.22 79
30-97
Enterococcus Sp. 13 11 2
0.77
38.5
30.8
30.76 67
66-91
Influenza 24
1.41
58.3
41.7
30-99
MRSA 7 4 3
0.41
71.4
28.6 74
66-81
Non MRSA -Staphylococcus Aureus
0.24
25.0 50
78.5
72-81
Streptococcus Pneumonia 10 6
0.59
60.0
40.0
58.5
26-104

23. Estimated incidence rates for nursing home residents using total number of licensed beds (16,975) in Nebraska

24. Estimated incidence rates: nursing home residents vs
Estimated incidence rates: nursing home residents vs. non nursing cases (65 years and above)

25. Evaluation
Chart Review
Validate number of nursing home cases

26. Next Steps Add question to the investigation:
“ If you are a nursing home resident?”
Nursing home survey
To get number of residents in each nursing home
Age and gender information

27. Limitation Total population in nursing homes
Age specific information for nursing home cases
Address information
No consideration for missing address

28. Acknowledgement Bryan Buss*, DVM, MPH, DACVPM Eryn Murphyᴪ MS
Tom Safranek**, MD
* CDC Career Epidemiology Field Officer (CEFO), Nebraska Department of Health and Human Services
**State Epidemiologist, Nebraska Department of Health and Human Services
ᴪEpidemiology Syndromic surveillance Coordinator

29. THANK YOU !!!
Questions?!