Pressure ulcer prevalence, incidence, risk factors, and impact.

Long-term care facilities (LTCFs) may be defined as institutionsthatprovidehealthcaretopeoplewhoareunabletomanage independently in the community. 1 This care may be chronic care management or short-term rehabilitative services. The term nursing home is defined as a facility licensed with an organized professional staff and inpatient beds that provides continuous nursing and other services to patients who are not in the acute phase of an illness. There is considerable overlap between the 2 terms. Morethan1.5millionresidentsresideinUnitedStates(US) nursing homes. In recent years, the acuity of illness of nursing home residents has increased. LTCF residents have a risk of developing health care-associated infection (HAI) that approaches that seen in acute care hospital patients. A great deal ofinformationhasbeenpublishedconcerninginfectionsinthe LTCF, and infection control programs are nearly universal in that setting. This position paper reviews the literature on infections and infection control programs in the LTCF. Recommendations are developed for long-term care (LTC) infection control programs based on interpretation of currently available evidence. The recommendations cover the structure and function of the infection control program, including surveillance, isolation precautions, outbreak control, residentcare,andemployeehealth.Infectioncontrolresources are also presented. Hospital infection control programs are well established in the US. Virtually every hospital has an infection control professional (ICP), and many larger hospitals have a consulting hospital epidemiologist. The Study on the Efficacy of Nosocomial Infection Control (SENIC) documented the effectiveness of a hospital infection control program that applies standard surveillance and control measures. 2 The major elements leading to a HAI are the infectious agent, a susceptible host, and a means of transmission. These elements are present in LTCFs as well as in hospitals. It is not

/pdf/shea-apic-guideline-infection-prevention-and-controlin-the-15lxnaw486.pdf

SHEA/APIC Guideline:Infection prevention and controlin the long-term care facility

PRESSURE ulcers are a serious and all too common complication of immobility among the elderly. The prevalence of pressure ulcers is 3 to 11 percent in acute care hospitals and nursing homes.1 2 3 One study has suggested that the incidence over a three-week period among bedridden and chairbound patients is 7.7 percent.1 As many as 50 percent of patients with pressure ulcers are over the age of 70.4 Among geriatric patients and nursing home residents, pressure ulcers are associated with a fourfold increase in the risk of death.5 6 7 The in-hospital mortality rate among patients with pressure ulcers is between 23 and . . .

Pressure ulcers among the elderly.

Objective To investigate the burden of pressure ulcer-associated mortality in the United States and to examine racial/ethnic differences and associated comorbidities. Design A descriptive study with matched odds ratio comparisons. Setting The United States, 1990-2001. Participants Pressure ulcer-associated deaths were identified from national multiple cause-coded death records from 1990 to 2001. Main outcome measures Age-adjusted mortality rates and matched odds ratio comparisons of pressure ulcer-associated deaths with deaths from other conditions. Main results Between 1990 and 2001, pressure ulcers were reported as a cause of death among 114,380 persons (age-adjusted mortality rate, 3.79 per 100,000 population; 95% confidence interval [CI], 3.77-3.81). For 21,365 (18.7%) of these deaths, pressure ulcers were reported as the underlying cause. Nearly 80% of pressure ulcer-associated deaths occurred in persons at least 75 years old. Septicemia was reported in 39.7% of pressure ulcer-associated deaths (matched odds ratio, 11.3; 95% CI, 11.0-11.7). Multiple sclerosis, paralysis, Alzheimer disease, osteoporosis, and Parkinson disease were reported more often in pressure ulcer-associated deaths than in matched controls. Pressure ulcer-associated mortality was higher among blacks than among whites (age-adjusted rate ratio, 4.22; 95% CI, 4.16-4.27). Conclusion Pressure ulcers are associated with fatal septic infections and are reported as a cause of thousands of deaths each year in the United States. Incapacitating chronic and neurodegenerative conditions are common comorbidities, and mortality rates in blacks are higher than in other racial/ethnic groups.

Pressure ulcers: more lethal than we thought?

There is intense antimicrobial use in long-term-care facilities (LTCFs), and studies repeatedly document that much of this use is inappropriate. The current crisis in antimicrobial resistance, which encompasses the LTCF, heightens concerns of antimicrobial use. Attempts to improve antimicrobial use in the LTCF are complicated by characteristics of the patient population, limited availability of diagnostic tests, and the virtual absence of relevant clinical trials. This position paper recommends approaches to management of common infections in LTCF patients and proposes minimal standards for an antimicrobial review program. In developing these recommendations, the position paper acknowledges the unique aspects of provision of care in the LTCF.

Antimicrobial use in long-term-care facilities. SHEA Long-Term-Care Committee.

• We studied 104 episodes of bacteremia in 102 patients with decubitus ulcers observed over five years in the hospitals of one metropolitan area. The ulcers were considered to be the "probable" source of bacteremia in 49% of episodes. Another site of infection was documented in 86% of patients. Proteus mirabilis, Staphylococcus aureus , and Escherichia coli were the most frequent blood isolates in these patients, but only Bacteroides species correlated with "probable" origin of bacteremia from the ulcers. The overall mortality was 55%, with 51% of deaths being attributed to infection. These findings emphasize the importance of decubitus ulcers as potential sources of bacteremia in hospitalized patients. ( Arch Intern Med 1983;143:2093-2095)

Bacteremia Associated With Decubitus Ulcers

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Bacteremia Associated With Decubitus Ulcers