Practice guideline for evaluation of Fever and infection in long-term care facilities.
Practice guideline for evaluation of Fever and infection in long-term care facilities.
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DOI：
10.1016/s1525-8610(04)70213-3
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发表时间：
2001-09-01
影响因子：
7.6
通讯作者：
Yoshikawa, T T
中科院分区：
文献类型：
--
作者：
Bentley, D W;Bradley, S;Yoshikawa, T T
美国的老年人口（即65岁的人）正在迅速扩大，在未来30年内将增加近一倍。据估计，140%的65岁以上的人在其一生中的某个时候需要在长期护理机构（LTCF），如熟练护理机构（SNF）接受护理。在大多数情况下，LTCF的居民都很老，有与年龄相关的免疫变化，慢性认知和/或身体障碍，以及改变宿主抵抗力的疾病;因此，他们非常容易感染及其并发症。LTCF居民的感染诊断通常很困难，因为LTCF在护理目标、人员配置比例、初级保健提供者类型、实验室检测的可用性和感染标准方面与急性护理设施不同。因此，用于诊断急性护理设施中患者感染的指南和实践标准可能不适用于LTCF中的居民。此外，疾病和感染的临床表现往往是微妙的，非典型的，或不存在的非常老。感染LTCF的居民发热可能较低或不发热。对疑似感染的LTCF居民的初步评估可能不由医生完成。虽然护士通常对LTCF居民的感染进行初步评估，但需要进一步研究来确定这种做法的适当性和有效性。如果没有限制诊断的指令（由住院医生或护理人员预先或当前），
The elderly population (ie, persons aged 65 years) in the United States is rapidly expanding and will nearly double in number over the next 30 years. It is estimated that 140% of persons aged 65 years will require care in a long-term care facility (LTCF), such as a skilled nursing facility (SNF), at some point during their lifetime. For the most part, residents of LTCFs are very old and have age-related immunologic changes, chronic cognitive and/or physical impairments, and diseases that alter host resistance; therefore, they are highly susceptible to infections and their complications. The diagnosis of infections in residents of LTCFs is often difficult because LTCFs differ from acute-care facilities in their goals of care, staffing ratios, types of primary care providers, availability of laboratory tests, and criteria for infections. Consequently, guidelines and standards of practice used for diagnosis of infections in patients in acute-care facilities may not be applicable nor appropriate for residents in LTCFs. Moreover, the clinical manifestations of diseases and infections are often subtle, atypical, or nonexistent in the very old. Fever may be low or absent in LTCF residents with infection. The initial evaluation of an LTCF resident suspected of an infection may not be done by a physician. Although nurses commonly perform initial assessments for infection in residents of LTCFs, further studies are needed to determine the appropriateness and validity of this practice. Provided there are no directives (advance or current by resident or caregiver) limiting diagnostic