Overview for Caregivers in the Long-Term Care Setting - Infection

Pneumonia

The microbiology (pathogens seen) is similar in LTC to that of community acquired pneumonia. Treatment is usually based on common organisms seen. 34% nasogastric tube fed residents commonly have Pseudomonas aeruginosa.  Almost 50% of cases, a viral infection precedes the development of pneumonia and plays a role in the pathogenesis of pneumonia.  There is a need for early detection as opposed to relying on transfer to acute care. For frail individuals in LTC homes there are potential adverse outcomes related to transfer to acute care.

Why is it important?

• The overall incidence 1-1.2 per 1,000 patient days which is 10x that of community elderly.
• 33 out of 1000 LTC residents are hospitalized versus 1.14 out of 1000 in the community
•  Delay in administration of antibiotics may lead to increased patient morbidity and mortality.
•  Initiation of antibiotics after eight hours is associated with increased mortality.
•  Inappropriate use of antibiotics may adversely affect patient outcomes and increase antimicrobial resistance.

Key Considerations

•  A number of risk factors contribute to this: older age; male; swallowing problems; inability to take oral medications;
   immobility.
•  Increased transmission risk associated with: malnutrition; Chronic disease; Sedative use;  Invasive devices
   (tube feeding);  Prolonged antimicrobial use
•  Environmental risks can contribute to LTC acquired pneumonia; Institution; shared staff; contacts at group activities;
    low immunization rates; excessive antimicrobial use; colonization with antimicrobial resistant organisms and co-
    existing complex care issues including: Co-morbidities such as diabetes, heart failure, chronic obstructive
    pulmonary disease, stroke and dementia

Urinary Tract Infections (UTI)

On its own, the presence of bacteria in the urine (bacteriuria) does not signify infection.  Urinary Tract Infection (UTI) is
the presence of clinical symptoms attributed to the genitourinary tract in association with significant bacteriuria.
Asymptomatic bacteriuria (ASB) is defined as isolation of a specified quantitative count of bacteria in an appropriately
collected urine specimen from an individual without symptoms or signs of urinary tract infection.

Why is it important?

•  Urine of the institutionalized patient may be colonized with bacteria.
•  50% of females and 30% of males in a LTC setting have asymptomatic bacteriuria.
•  There is no evidence to support treatment of Asymptomatic Bacteriuria
•  There must be presence of bacteriuria and symptoms associated with UTIs. These symptoms are generally
    accepted to be new or increased urinary:
     i)    frequency   
     ii)   urgency
     iii)  incontinence
     iv)  flank pain or tenderness
     v)   suprapubic pain or tenderness 
     vi)  gross hematuria

Key Considerations

•  In men, decreased use of condom catheters for incontinence may be beneficial
•  If there are no white blood cells on an initial dipstick: 90% assurance that there is no UTI

References

1.  Abbott-McNeil, D., Barber, D., Murphy, S. and Puxty, J. (2009). Long-Term Care (LTC) Acquired Infections –
     Pneumonia.  Retrieved April 2014 from:   
     http://www.sagelink.ca/sites/default/files/uploads/csah/BTC_LTC/July-2010-toolkits/july2010-pneumonia-in-ltc-
     manual.pdf


2.  Abbott-McNeil, D., Barber, D., Murphy, S. and Puxty, J. (2009). Acquired Infections in Long Term Care (LTC):
     Urinary Tract Infections (UTI).  Retrieved April 2014 from:       
     http://www.sagelink.ca/sites/default/files/uploads/csah/BTC_LTC/July-2010-toolkits/july2010-uti-in-ltc-resource-
     toolkit.pdf

Issue/Condition - Problème / état: 
Sector of Care - Secteur des soins: 
Resource Type - Type de Ressources: 
Author/Publisher - Auteur/Éditeur: 
Centre for Studies in Aging and Health
Date Published: 
2014-01