Risk factors for nosocomial pneumonia in the elderly
Article Abstract:
Pneumonia is the second most frequent of nosocomial (hospital-acquired) infections, and the most deadly, with death reported in up to half the cases. The elderly are three times more likely to develop nosocomial infections than other hospitalized patients. The two major types of risk factors for nosocomial infections are: factors which allow microorganisms access to vulnerable body parts, such as aspiration and chest or abdominal surgery; and reduction in the resistance to microbes, including severe illness and suppression of immune function. The association between risk factors and nosocomial pneumonia was studied in 33 patients in acute-care hospitals and in 27 patients in long-term-care facilities. The results confirm that a combination of risk factors predisposes elderly patients to nosocomial pneumonia. The best predictors for the infection in hospital patients were difficulty with mouth and pharyngeal (upper respiratory tract) secretions, and presence of a nasogastric tube. Other risk factors identified in these patients included current neurologic or kidney disease, deteriorating health, decreased awareness or disorientation, and dependence on others for basic care activities, such as bathing, bowel function, and feeding. Depressed consciousness was probably important because such patients tend to aspirate pharyngeal secretions during sleep. Patients in long-term-care settings were most at risk for nosocomial pneumonia when they had difficulty with mouth and pharyngeal secretions, deteriorating health, and confusion, agitation, falls, or wandering. Other risk factors in this group of patients included suctioning, malnourishment or recent weight change, upper respiratory infection, and inhalation therapy. The study identifies risk factors for which elderly patients in each type of institution should be assessed. Further research is needed to identify and test protocols for preventing nosocomial pneumonia in the elderly. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Prospective, controlled study of vinyl glove use to interrupt clostridium difficile nosocomial transmission
Article Abstract:
Diarrhea and colitis, or inflammation of the intestine, caused by infection with the bacterium Clostridium difficile, are nosocomial or hospital-acquired infections. The mode of this bacterial transmission is not clear. Based on evidence indicating that C. difficile often contaminates the hands of health care workers, the effect of using disposable vinyl gloves during patient care was evaluated by studying the prevalence of C. difficile infection. The incidence of C. difficile diarrhea was monitored six months before and after an intensive education program about glove use on two wards. The education program consisted of lectures, posters, and the placement of boxes of vinyl gloves at patients' bedsides. The rate of C. difficile infection on these two wards was compared with two wards that did not receive a glove education program. The incidence of C. difficile diarrhea decreased from 7.7 cases per thousand patients discharged before the education program to 1.5 per thousand during the glove program. There was no change in the incidence of C. difficile diarrhea on the wards without the glove education program. The prevalence of C. difficile infection without gastrointestinal symptoms also decreased on the glove-use wards, but not on the wards without the educational program. The wards that received the training used 61,500 gloves at a cost of $2,768, compared with the use of 42,100 gloves, costing $1,895, on the other two wards. The results demonstrate that vinyl glove use was associated with a decreased incidence of C. difficile diarrhea; they are consistent with previous evidence suggesting that nosocomial C. difficile infection is transmitted by hands. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Gram-negative bacillary pneumonia in the nosocomial setting: role of aztreonam therapy
Article Abstract:
The risk of gram-negative bacterial infection is increased among hospitalized patients, patients with weakened systems after transplantation or as a result of cancer chemotherapy, and patients with underlying disease. Gram-negative bacterial pneumonia is the major cause of death due to nosocomial, or hospital-acquired, infection in the United States. Risk factors for nosocomial pneumonia include changes in the composition of the bacteria normally inhabiting the upper respiratory tract and changes in the protective barriers of the lower respiratory tract, which ordinarily prevent the invasion of bacteria from the pharynx. Aztreonam, a new monolactam antibiotic, was shown to be both safe and effective in treating infections caused by aerobic gram-negative bacteria. The role of aztreonam in treating nosocomial pneumonia was assessed. Studies show that aztreonam serves as an effective alternative treatment for infections caused by gram-negative bacteria, which have developed resistance to cephalosporin and aminoglycoside antibiotics. In addition, aztreonam combined with aminoglycosides may produce a greater therapeutic effect against gram-negative bacteria than if the antibiotics were used separately. Clinical trials have confirmed the effectiveness of aztreonam in treating gram-negative nosocomial pneumonia. Aztreonam may be combined with antibiotics that are active against gram-positive, anaerobic bacteria to produce optimal antibiotic therapy of infections caused by several types of bacteria. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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