Infections in Long-Term Care Facilities
Long-term care residents also are often highly functionally impaired. Many are incontinent, immobile, and confused or demented. The worse the functional status, the greater the likelihood of infection or colonization with resistant microorganisms
For example, incontinence and impaired mental status have consistently been associated with asymptomatic urinary tract infection. MRSA colonization is more likely to be identified in residents with pressure ulcers or fecal incontinence or who are bed bound or require feeding tubes or urinary catheters. In most cases, impaired functional status is a determinant of admission to long-term care and is not modifiable. If the major predictors of infection in long-term care facilities are poor functional status and co-existing chronic illness, and these conditions cannot be altered, to what extent is it realistic to anticipate that endemic infections can be prevented in such residents? In addition, with the number and severity of existing conditions, how much illness or death is attributable to infections per se, rather than to underlying chronic disease? Assessing the impact of infection on patient outcome in evaluating interventions to prevent infection is, thus, often problematic. An example is a decision to provide comfort care but not to treat pneumonia with antibiotics in severely impaired patients.
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