Bacterial infections in a hospital-based skilled nursing facility

Area of Science:

• Geriatric Medicine
• Infectious Diseases
• Hospital Epidemiology

Background:

• Nursing home residents face a high risk of bacterial infections.
• Veterans Administration hospital-based nursing home care units (VA NHCU) present unique challenges in infection control.

Purpose of the Study:

• To retrospectively analyze the incidence and types of bacterial infections in a VA NHCU over one year.
• To identify common pathogens and risk factors for infection, especially in residents with indwelling urinary catheters.

Main Methods:

• Retrospective chart review of 132 residents in a VA NHCU over a 1-year period.
• Documentation and categorization of bacterial infections (pulmonary, urinary, integumentary).
• Analysis of causative organisms and prevalence in catheterized versus non-catheterized residents.

Main Results:

• 35 non-Foley-catheter-related bacterial infections were documented in 21 residents.
• Urinary tract infections (UTIs) were most common (18 cases), with 47.8% of catheterized residents developing symptomatic UTIs.
• Pseudomonas aeruginosa, E. coli, and Proteus mirabilis were significant UTI pathogens; Streptococcus pneumoniae and Hemophilus influenza predominated in pulmonary infections.

Conclusions:

• The institutional setting significantly influences infection patterns in elderly nursing home residents.
• Frequent multi-organism colonization in catheterized residents questions the utility of monthly urine cultures.
• Hospital-based nursing home units require consideration of acute care access and education on hospital-acquired bacterial flora.