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Infections in long-term care facilities
In a long-term care facility one resident's infection quickly becomes an outbreak: residents are frail, live together and are cared for by the same staff; so diagnose early (even without fever), isolate by type of organism, keep hand hygiene, give preventive treatment when needed — and avoid unnecessary antibiotics.
Why it matters in the exam
The exam presents an influenza outbreak on a nursing ward — two or more residents with influenza-like illness within 72 hours, at least one laboratory-confirmed — and asks what to do: oseltamivir treatment for those who are ill, and oseltamivir prophylaxis (75 mg once a day) for all residents who are not ill, even if vaccinated, for at least two weeks and until about a week after the last case. Candidates are also asked about outbreak diarrhoea: norovirus or C. difficile.
Recurring points: against norovirus and C. difficile hand washing with soap and water is preferred to an alcohol rub, with cleaning by a chlorine-based agent; a staff member ill with norovirus returns to work 48 hours after symptoms resolve; C. difficile is treated with fidaxomicin or oral vancomycin; "crusted" (Norwegian) scabies in a debilitated patient is highly contagious and requires treatment of all contacts at once; and resistant organisms (MRSA, ESBL, CRE) require contact precautions, with a national CRE control programme operating in Israel.
Candidates are also asked about prevention: annual influenza vaccination for residents and staff (in adults from age 65 — high-dose or adjuvanted vaccine when available), pneumococcal vaccines, oral hygiene to prevent pneumonia, removal of unnecessary catheters, and an antibiotic stewardship programme. Pneumonia in a care-home resident is treated like community-acquired pneumonia, unless there are risk factors for resistant organisms.
Key points
- Influenza outbreak: 2 or more ill within 72 hours; prophylactic oseltamivir for all residents.
- Norovirus and C. difficile — soap and water and chlorine.
- C. difficile — fidaxomicin or oral vancomycin.
- Crusted scabies — treat all contacts together.
- Vaccines, hand hygiene and antibiotic stewardship.
Summary table
| Infection | Features | Action |
|---|---|---|
| Influenza | Outbreak: 2 or more ill within 72 hours, one confirmed | Treat the ill; prophylactic oseltamivir for all residents, at least two weeks |
| Norovirus | Sudden vomiting and diarrhoea, rapid spread | Soap and water, chlorine, isolation; staff return 48 hours after recovery |
| C. difficile | Diarrhoea after antibiotics | Fidaxomicin or oral vancomycin; soap and water; sporicidal cleaning |
| Crusted scabies | Thick scaling, little itch, highly contagious | Permethrin and oral ivermectin; treat all contacts together |
| Resistant organisms (MRSA, ESBL, CRE) | Carriage is common | Contact precautions; do not treat carriage without infection |
| Pneumonia | Sometimes without fever, confusion | As community-acquired pneumonia, unless at risk of resistant organisms |
A free exam question
מה ההגדרה המדויקת ביותר של התפרצות מחלה מנינגוקוקית בקהילה ? (the question as examined, in Hebrew)
- א. הופעת 2 חולים לפחות במחלה ,ללא קשר לזן
- ב. כש קיים קשר אפידמיולוגי בין החולים
- ג. שיעור התקף ( ATTACK RATE )באוכלוסייה בסיכון הוא לפחות 10:100000
- ד. הופעת 10 או יותר חולים במחלה מנינגוקוקית תוך 3 שבועות לכל הפחות
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Sources
- IDSA clinical practice guidelines — Seasonal influenza in adults and children (including institutional outbreak management), 2018 — Outbreak control and antiviral chemoprophylaxis
- IDSA/SHEA clinical practice guideline — Clostridioides difficile infection in adults, 2017 (focused update 2021) — Treatment and infection prevention
- CDC — Guideline for prevention of norovirus gastroenteritis outbreaks in healthcare settings, 2011 — Hand hygiene, cleaning and staff exclusion
- Geriatrics Review Syllabus (American Geriatrics Society), 11th edition (2022) — Infections in long-term care
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.