McGeer's Criteria: Standardized Infection Surveillance Definitions for Long-Term Care Facilities
McGeer's criteria are standardized surveillance definitions used to identify and monitor infections in long-term care facilities, particularly nursing homes, with specific clinical and laboratory parameters for various types of infections including urinary tract infections, respiratory infections, and skin/soft tissue infections.
Background and Purpose
- McGeer's criteria were developed to provide consistent surveillance definitions for infections in long-term care settings, allowing for standardized reporting and monitoring of infection rates 1
- These criteria are widely used in nursing homes as part of infection control programs and antimicrobial stewardship efforts 2
- They serve as surveillance tools rather than diagnostic criteria, though they are sometimes inappropriately used for clinical decision-making 3
Key Components of McGeer's Criteria
McGeer's criteria provide specific definitions for various infection types:
Urinary Tract Infections (UTIs)
- For non-catheterized residents: requires specific clinical symptoms (such as acute dysuria, fever, new/increased urgency) plus laboratory evidence of infection 3, 1
- For catheterized residents: different criteria apply, focusing on systemic symptoms and laboratory findings 1
- Studies show 77% of antibiotic prescriptions for UTIs in nursing homes may be inappropriate when evaluated against McGeer's criteria 1
Skin and Soft Tissue Infections (SSTIs)
- Requires either presence of pus at the suspected site OR at least four of the following: new/worsening warmth, redness, swelling, tenderness, serous drainage, or constitutional symptoms 2
- Only 25% of antibiotic prescriptions for SSTIs in nursing homes meet McGeer's criteria, indicating potential overtreatment 2
Respiratory Tract Infections
- Includes specific criteria for pneumonia, lower respiratory tract infections, and common cold syndromes 1
- For pneumonia: requires radiographic evidence plus specific clinical signs/symptoms 4
- Studies show 61% of antibiotic prescriptions for respiratory infections may not align with these criteria 1
Clinical Application and Limitations
- McGeer's criteria are primarily designed for infection surveillance rather than clinical diagnosis or treatment decisions 3
- There is a notable distinction between surveillance criteria and criteria practitioners use in clinical practice 3
- Awareness and utilization of McGeer's criteria vary significantly between healthcare professionals:
Impact on Antimicrobial Stewardship
- McGeer's criteria can be leveraged to assess appropriateness of antibiotic prescribing in long-term care facilities 1
- Implementation of these criteria as part of antimicrobial stewardship programs can help reduce inappropriate antibiotic use 2
- During the COVID-19 pandemic, adherence to McGeer's criteria decreased, with increased inappropriate prescribing for UTIs 1
Clinical Implications
- Healthcare providers should understand that McGeer's criteria are primarily surveillance tools and may not always align with optimal diagnostic and treatment approaches 3
- When evaluating suspected infections in long-term care residents, clinicians should consider both McGeer's criteria for surveillance purposes and appropriate diagnostic criteria for clinical decision-making 2, 3
- Antimicrobial stewardship programs should incorporate education about these criteria to improve appropriate antibiotic prescribing 1
Common Pitfalls
- Using McGeer's criteria as the sole basis for clinical treatment decisions rather than as surveillance tools 3
- Initiating antibiotics without meeting recommended diagnostic standards, particularly for UTIs and SSTIs 2, 1
- Failing to distinguish between surveillance definitions and clinical diagnostic criteria 3
- Overreliance on non-specific symptoms (like change in mental status) that may have multiple causes beyond infection 3