Infections in Nursing Homes and Long-Term Care Facilities. Verghese A, Berk S (eds,v New York, S Karger, 1 990, 248 pages, hardcover.
The editors of this book have as their aim to "present the problems of infectious diseases in the nursing home," because these diseases "account for the majority of the transfers of the nursing home patient to the hospital and are a frequent cause of demise."
This slim volume has many pertinent facts and practice plans to reduce both the morbidity and mortality of infections in elderly nursing home patients. This is not a basic book; it is a highly sophisticated symposium of the epidemiology, clinical features, management, and prevention of infections usually seen in nursing home residents, eg, bacteremias, pneumonia, tuberculosis, urinary tract infections, infected pressure ulcers, common cutaneous infections (candidiasis, scabies, herpes zoster), and gastrointestinal infections. There is a thoughtprovoking, sensitive chapter about AIDS in the nursing home.
Scattered throughout the book are timely, helpful facts and tips on infections in the elderly, eg, "a change in the person's usual state of health should prompt regular measurement of vital signs and a search for infection," and "hyperglycemia may be one of the first clues to presence of infection in a diabetic patient." Of special interest to nurses and physicians are discussions of antibiotic therapy considerations, including cost containment and cost effectiveness of such therapy.
Another interesting facet is the book's global perspective of infections in nursing homes. A well-written chapter on urinary tract infections is a report of a research study done at the Athens (Greece) Home for the Aged. The book's brief last chapter is a commentary on nursing homes outside North America. This chapter would have been much stronger if the editors had included global issues on infections and infection control that ultimately affect nursing home residents.
The editors make a plea for the use of nursing homes as teaching/research centers. Of particular importance to nurses are the many ideas for nursing research. For example, the statement is made that it is "not clear whether antipyretic medications adversely affect the course of infection in man." All too often nurses have a tendency to give antipyretic medication under standing orders and without a proper etiologic determination; therefore, this subject is well-worth researching. Methods for providing more and better infection control training for nursing personnel is another area proposed for study.
An appeal is made for more education of physicians, nurses, residents, and families regarding the need for and efficacy of immunizations, especially against tetanus, pneumonia, and influenza.
This text should be "must" reading by health professionals caring for nursing home residents. The content should form the basis for inservice programs and improved practice in infection control.