Infections in Residents of Nursing Homes

Infections are very common in the setting of long-term care facilities and represent a major cause of morbidity and mortality among institutionalized elderly individuals. Some characteristics specific for the setting of a nursing home favor the spread of infectious diseases. Residents are clustered in a confined living arrangement and daily activities often take place in groups. Some residents are cognitively impaired and unable to follow basic hygiene precautions. Caregivers are often inadequately trained and may have little knowledge of the fundamental principles of infection control. As a conse-quence, adherence to hand washing in particular and other universal precau-tions is poor. Moreover, understaffing is a common problem in nursing homes. Nursing home residents are particularly susceptible to infections be-cause they are physiologically old and often have comorbid underlying dis-eases that predispose them to site-specific infections. It is often difficult to diagnose infections in the elderly. As a result, the diagnosis and treatment may be delayed. These host and setting related factors facilitate direct or in-direct transmission of infectious diseases among the residents in nursing homes. Endemic infections as well as outbreaks are observed in nursing homes. Of particular concern are colonization and infection with antimicrobial Infect Dis Clin N Am 21 (2007) 761–772drug resistant microorganisms. The most common endemic infections are respiratory, urinary, skin and soft tissue, and gastrointestinal infections