This special issue includes six articles about various aspects of the general topic of infection in the elderly.
Assessing infection in the elderly requires knowledge of physiological changes in aging that predispose the population to infection, skills to evaluate clinical signs and symptoms that often present in an atypical way, and nursing care measures to prevent or reduce severity of common infections. This article provides information that will be useful to nurses working with the elderly - whatever their work setting - and specific suggestions for assessment and intervention.
Dorothy Fraser, RN, MS, FNP, shares her wealth of information about care of the elderly that is derived from her years as a nurse practitioner. She is currently completing doctoral work in gerontology and teaching nursing students at the University of Southern California, Los Angeles.
Even before the Bloodborne Pathogens Standard was finalized by the Occupational Safety and Health Administration (OSHA) in late 1991, personnel working with the elderly were concerned about their risks for infection with the hepatitis B virus (HBV) and the human immunodeficiency virus (HIV). Phyllis L. Spechko, BS. RN, CANP, poses the question, "Can you become infected with a bloodborne pathogen from your older patient?" She answers the question with statistics and practical information, and describes simple precautions health care workers can take to reduce their risks of infection. Ms. Spechko spent several years as a nurse practitioner for an HIV-related research project before she initiated and managed the postexposure management program at the Occupational Health Center of the University of California San Diego Medical Center four years ago.
Tuberculosis has made a dramatic comeback in the last few years, and Evelyn Lancaster, RN, BSN, discusses the impact of this disease on long-term care facilities. She describes the epidemiology, transmission, and pathogenesis of Mycobactenum tuberculosis, differentiates between infection and disease, and provides three useful tables. Ms. Lancaster has specialized in tuberculosis control for almost a decade, and provides consultation and education about this topic throughout the San Diego County medical community.
Methicillin-resistant Staphylococcus aureus, or MRSA, is an organism about which there is considerable confusion, and its management in long-term care facilities presents several nursing challenges. Carol O'Boyle Williams, MS, RN, CIC, and Karen Feldt, MS, RN, C, review the epidemiology, transmission, and clinical manifestations of the organism. Next, they acknowledge the constraints presented by the nursing home environment, and suggest several factors that facilitate safe care in this setting for residents known to be colonized or infected with MRSA. Ms. Williams and Ms. Feldt have strong backgrounds in infection prevention and control and gerontology, and are both doctoral students at the University of Minnesota School of Nursing.
All long-term care facilities (LTCFs) are required to have a program for infection surveillance, prevention and control. Many aspects of these programs are the same in acute care and long-term care facilities; but others seem unique to LTCFs. Vicki Pritchard, RN, MSN, CIC, discusses the unique concerns for LTCFs. She describes resources that are available from the Association for Practitioners in Infection Control (APIC), including "The APIC Guideline for Infection Prevention and Control in Long-Term Care Facilities," published in 1992. Ms. Pritchard is a member of the APIC Committee for Long-Term Care and is a co-editor of the APIC Newsletter for LTCFs.
The last article in this special issue is a report of a study of "The Role of the Nurses' Aide in Identifying 'Clues' to Infection in Nursing Home Residents." It includes data from interviews with 50 nurses' aides in a large nursing home in Southern California. Prior to being research assistant for this study, my co-author, Kimberly Schäfer, worked as a nurses' aide while in college. Her personal insight about the nurses' aide's world was particularly useful in designing and implementing the study.
As we move into the next century with more elderly people, fewer resources per capita, and increasing regulatory demands to reduce complications in residents while improving safety for care providers, the role of the nurses' aide is likely to become even more critical. Our study suggests several ways to maximize the potential of this large work force by recognizing them as the most likely persons to initially recognize "clues" to resident problems such as infection.
We hope you will find the information in this special issue useful, and we welcome your comments.