Garibaldi R A
University of Connecticut Health Center, Department of Medicine, Farmington, CT 06030, USA.
J Hosp Infect. 1999 Dec;43 Suppl:S9-18. doi: 10.1016/s0195-6701(99)90061-0.
Long term care facilities (LTCFs) include a variety of different types of healthcare settings, each with their own unique infectious disease problems. This report focuses on the epidemiological considerations, risk factors and types of infections that occur in elderly patients institutionalized in nursing home settings. In the US, the number of patients in nursing homes continues to grow as the population ages. Today, patients in nursing homes have more complicated medical conditions than they did five years ago as they become even more elderly and the trend continues towards shorter and shorter hospital stays in acute care facilities. The patient population in nursing homes is uniquely susceptible to infections because of the physiological changes that occur with ageing, the underlying chronic diseases of the patients and the institutional environment within which residents socialize and live. In addition, in nursing home settings, problems with infections may be more difficult to diagnose because of their subtle presentations, the presence of co-morbid illnesses which obscure the symptoms of infection and the lack of on site diagnostic facilities. Delays in diagnosing and treating infections allow transmission to occur within the facility. Both endemic and epidemic infections occur relatively commonly in nursing homes. The incidence of endemic infections, such as catheter-associated urinary tract infections, lower respiratory infections and skin infections, is influenced by the debility level of the patients. Calculations of infection rates are influenced by the intensity of surveillance methods at each institution. Many endemic infections are unpreventable. Epidemic infections account for 10-20% of nursing home infections. These include clusters of upper or lower respiratory infections, gastroenteritis, diarrhoea, and catheter-associated UTI's. Epidemic infections are potentially preventable with sound infection control practices. Special attention must be paid to promote universal precautions and give certain patients, such as those with known infection or colonization with Clostridium difficile, MRSA or VRE, special consideration. The potential for epidemic infections with antibiotic-resistant organisms is real. In the nursing home setting, attention must be given to develop and support strong infection control programmes that can monitor the occurrence of institutionally-acquired infections and initiate control strategies to prevent the spread of epidemic infections. Education in infection control issues and attention to employee health is essential to enable staff to care appropriately for today's nursing home population and to prepare them for the even more complicated patients who will be cared for in this type of setting in future.
长期护理机构（LTCFs）包括各种不同类型的医疗保健场所，每个场所都有其独特的传染病问题。本报告重点关注在养老院环境中入住的老年患者所涉及的流行病学因素、风险因素及感染类型。在美国，随着人口老龄化，养老院中的患者数量持续增加。如今，养老院中的患者医疗状况比五年前更为复杂，因为他们年龄更大，而且急性护理机构的住院时间越来越短的趋势仍在持续。养老院中的患者群体由于衰老导致的生理变化、患者潜在的慢性疾病以及居民社交和生活的机构环境，特别容易受到感染。此外，在养老院环境中，感染问题可能更难诊断，原因包括症状不明显、并存疾病掩盖了感染症状以及缺乏现场诊断设施。感染诊断和治疗的延迟会导致感染在机构内传播。地方性感染和流行性感染在养老院中都相对常见。诸如导尿管相关尿路感染、下呼吸道感染和皮肤感染等地方性感染的发生率受患者虚弱程度的影响。感染率的计算受每个机构监测方法强度的影响。许多地方性感染是无法预防的。流行性感染占养老院感染的10 - 20%。这些包括上呼吸道或下呼吸道感染、肠胃炎、腹泻以及导尿管相关尿路感染的聚集性病例。通过合理的感染控制措施，流行性感染是有可能预防的。必须特别注意推广普遍预防措施，并对某些患者给予特殊考虑，例如那些已知感染或定植艰难梭菌、耐甲氧西林金黄色葡萄球菌（MRSA）或耐万古霉素肠球菌（VRE）的患者。对抗生素耐药生物体发生流行性感染的可能性是真实存在的。在养老院环境中，必须重视制定和支持强有力的感染控制计划，该计划能够监测机构获得性感染的发生情况，并启动控制策略以防止流行性感染的传播。开展感染控制问题教育并关注员工健康对于使工作人员能够妥善照料当今养老院中的患者群体，并为未来在此类环境中照料更为复杂的患者做好准备至关重要。
