A multicomponent programme employed in nursing homes results in stronger infection control, higher vaccination coverage, and fewer inappropriate transfers among residents, a Singapore study has shown.
“[T]his study provides evidence that a collaborative strategy encompassing infection prevention and control (IPC) policy reviews, staff education, and vaccination support can strengthen infection control in nursing homes,” the researchers said.
“The use of a structured clinical pathway improved the appropriateness of hospital transfers, aligning decisions with objective clinical criteria while supporting resident well-being,” they added.
Six nursing homes in western Singapore with pre- and postimplementation data were included in this retrospective cohort study, in collaboration with an acute hospital.
The researchers screened a total of 4,801 admissions and included 2,045 fever-related admissions. The collaborative model consisted of IPC training, policy and process reviews, vaccination support, antimicrobial guidance, and implementation of a structured fever and desaturation pathway to standardize hospital transfer decisions.
New methicillin-resistant Staphylococcus aureus (MRSA) acquisition rates decreased from 14.6 percent to 9.7 percent, with a relative reduction of 33.6 percent (95 percent confidence interval [CI], ‒6.8 to ‒3.1; p<0.001). [Ann Acad Med Singap 2026;55:350-357]
Reductions were also recorded in inappropriate fever-related transfers, from 12.0 percent (108/898) to 7.3 percent (61/839), with a relative reduction of 39.2 percent (absolute reduction, 4.8 percent, 95 percent CI, ‒7.5 to ‒2.0; p<0.001).
Notably, influenza vaccination among nursing home residents exceeded 90 percent by 2022. Moreover, adoption of the fever and desaturation pathway was sustained based on staff surveys, with 84 percent reporting regular use, highlighting increased confidence and more standardized triage decisions.
“Although resource-intensive, such work is feasible and sustainable when built on partnership, shared goals, and an appreciation of the unique challenges faced by nursing homes and their staff,” the researchers said.
Challenges
Working with nursing homes always have challenges, including understaffed and underfunded facilities, with leadership often weighing competing priorities. [J Am Med Dir Assoc 2024;25:105261; J Hosp Infect 2013;85:141-148]
“Support from acute hospital teams may be perceived as adding workload or introducing standards that do not align with existing systems, particularly when documentation is manual and clinical outcomes are not routinely captured,” the researchers said.
“Despite these barriers, staff enthusiasm in participating in training and assuming IPC leadership roles demonstrated that improvement was both recognized and welcomed,” they added.
Sustaining this progress will require improving medical support within nursing homes. Many facilities lacked daily medical input, limiting staff capacity to manage acute changes.
“Enhanced access to primary care, deployment of advanced practice nurses, and expansion of hospital-at-home services are potential strategies to fill this gap,” the researchers said. [BMC Health Serv Res 2025;25:872; J Eval Clin Pract 2024;30:484-496]
Another challenge was staff turnover, considering that new employees were not adequately trained in the pathway. Limited documentation of advanced care plans or preferred plans of care also led to uncertainty, with nursing home staff being unsure whether hospitalization was consistent with the residents’ preference.
“Although awareness of advance care planning improved, the absence of clear directives complicated decision-making in some cases,” the researchers said.