INFECTIOUS-DISEASES AND DEATH AMONG NURSING-HOME RESIDENTS - RESULTS OF SURVEILLANCE IN 13 NURSING-HOMES

An increasing proportion of the U.S. population resides in nursing hom es (NHs). No surveillance system exists for infections in these facili ties. To determine the incidence and types of infections in NH residen ts, and to identify predictors of death among residents with infection s, we initiated a surveillance system at 13 NHs in California during a 6-month period from October 1989 through March 1990. The study includ ed 1754 residents, among whom 835 infections were identified during th e study period. The most common infections were urinary tract infectio ns (UTIs; 286, 34.2%), respiratory tract infections (RTIs; 259, 31%), and skin infections (150, 17.9%). Of the 259 residents with respirator y tract infections, 69 (27%) had pneumonia. Antimicrobials were prescr ibed for 646 (77%) of the infectious episodes. Residents with pneumoni a were more likely to die than residents with other infections (4 of 6 9 versus 12 of 766; P = 0.04). Symptoms of altered body temperature (f ever, hypothermia, chills) and change in mental status also were assoc iated with an increased risk of a fatal outcome (10 of 260 versus 6 of 575; P = 0.01) and (7 of 127 versus 9 of 708; P = 0.004). This study suggests that the most common infections among NH residents are UTIs, RTIs, and skin infections. Pneumonia, symptoms of fever, and mental st atus changes all were associated with increased mortality. The frequen cy of infections among NH residents and their impact on resident outco me highlights the need for infectious disease surveillance in this pop ulation (Infect Control Hosp Epidemiol 1994;15:494-496).