Over 1.5 million people live in nursing homes and long-term care facilities. Every year, they will develop more than 2 million infections, causing complications, expensive treatment, and possible hospitalization. Because these residents are elderly and frail, they already have risk factors that make most infections especially dangerous.
There are three common infections that frequently occur in nursing homes. They are called “endemic” infections because they are ongoing and always present within the facility.
1. Urinary Tract Infections. The most common infection in long-term care facilities is a urinary tract infection (UTI) because of the use of indwelling urinary catheters. At the end of a month, the chances of a resident with a catheter developing a UTI is nearly 100%. One of the main reasons is the lack of good handwashing technique before and after touching the catheter. Catheter use should be as short as possible. Aseptic insertion of the catheter, maintaining a closed system, and always keeping the drainage bag below the level of the patient’s bladder are all critical factors.
WHAT CAN YOU DO: Diligent hand hygiene is the first step, including when wearing gloves. Learn proper daily care of the catheter and keep the drainage bag at the correct level. Observe and report any changes in the appearance of the patient’s urine or vital signs.
2. Respiratory Infections. Pneumonia and lower respiratory-tract infections are the primary reason for hospitalization and death in nursing home residents. Elderly patients are less likely to have a fever, or complain of chills and aches, than younger patients, so early diagnosis may not be possible. They are also more likely to have aspiration pneumonia because of swallowing difficulties. Patients with feeding tubes must always be closely monitored. Studies have also shown that poor oral hygiene is directly related to pneumonia. Dental plaque and gum disease contribute to pneumonia because of the bacteria that remains in the mouth and throat. One study showed that patients who did not receive adequate mouth care were three times more likely to die of pneumonia than those who followed a regular dental care regime.
WHAT YOU CAN DO: Careful attention when feeding is important to avoid aspiration. Mouth care must be ongoing and meticulous throughout the day. Monitor changes in the patient’s vital signs or behavior to detect early signs of a respiratory infection.
3. Skin and Soft Tissue Infections. With the aging process, skin becomes thin, dry, and fragile. The natural barrier that skin provides is easily torn and difficult to heal, allowing bacteria to invade. While there can be acute bacterial infections, such as cellulitis, most are chronic and preventable. The most common condition is pressure sores, caused by immobility, infrequent positioning, incontinence, and poor nutrition. Once a pressure sore develops, daily monitoring and care are required to prevent serious complications such as osteomyelitis and septicemia.
WHAT YOU CAN DO: Repositioning patients who aren’t able to move themselves is critical. Careful observation of the skin, always watching for reddened areas, should be done throughout the shift. Prompt cleaning after episodes of incontinence is important. If a patient already has a pressure sore, observe and note changes in appearance or odor.
Prevention and early diagnosis of common infections can help keep all patients healthy and comfortable. For caregivers, more time can be spent helping patients with other activities, making the environment more pleasant and satisfying for everyone.
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