Infection Management for Geriatrics in Long Term Care Facilities

484 Index Computed tomography, infected pressure Dietary supplements, 43–45 ulcers, 267 immune potentiating effects, 43–46 Contact isolation, ethical issues, 90–91 Diphtheria vaccine, 353–355 Contact precautions, 107–108 Directives, advance, 85–86 gloves, 107–108 healthcare proxy, 86 gown, 108 preferences for treatment, 85–86 patient care equipment, 108 Distribution, antimicrobial therapy, patient transport, 108 resident placement, 107 162–163 Coronavirus, 212–213 Doctor-patient relationship, 83–84 clinical manifestations, 212 Drainage, methicillin-resistant diagnosis, 212–213 epidemiology, 212 Staphylococcus aureus, 396–397 infection control, 213 Dressings, wound, pressure ulcers, therapy, 213 Costs infected, 271 ethical issues regarding, 91 Droplet precautions, 106–107 geriatric population healthcare, 10 long-term care, 7–12 education, 107 Cryptococcosis, 452, 457, 460, 463 mask, 106 resident placement, 106 Debridement resident transport, 106–107 infected pressure ulcers, 270–271 Drugs methicillin-resistant staphylococcus causing anorexia, geriatric population, 66 aureus, 396–397 immune potentiating effects, 43–46 with immunopotentiation, 45–46 Decisional capacity, ethical issues, 84–88 nutrient interactions with, 65 Dementia Economics advanced, 87–88 ethical issues involving, 91 in U.S. population, 3 geriatric population healthcare, 10 Department manager, supervisors, nursing, long-term care, 7–12 alliance with, in infection control Edemic rates, infection control program, program, 125–127 119–121 Departments of health, 128 Dermatophytes, 450–451 Education infection, 453–454, 466–467, 468 droplet precautions, 107 Diarrhea, infectious, 305–312 for employees, residents, visitors, antibiotic therapy, 311 121–122 clinical manifestations, 307 infection control, 105–106 diagnosis, 307–309 in nursing management, 111–113 history, 307–308 infection control professional, 111 laboratory tests, 309 physical examination, 308–309 Efflux pump mechanisms, gram-negative epidemiology, 305–307 bacteria, 432–433 etiology of, 306 infection control, 310–311 Elderly, 27–32 prevention, 311 anorexia, drugs causing, 66 therapy, 310 antimicrobial therapy, 30–31 chronic illness, 35–38 clinical manifestations, 29 epidemiology, 27–29 germ theory, 27–29 pre-antibiotic era, 27

Index 485 [Elderly] [Epidemiologic investigation] growth of population, 4 immunization, 148–149 immune response in, 337–339 infection control, 147–148 infection control program, 116 infection control plan, 136 life expectancy, 5 interventions, implementing, 142–143 nutritional deficiencies, long-term care isolation precautions, 149 facility (LTCF), 53 key aspects, 136 pneumonia, chronic illness, 36–37 line listing, influenza outbreak, 138 respiratory viruses, 200 long-term care facilities, characteristics, susceptibility to infection, 29–30 133–134 vaccination, 337–339 person, place, time, 139–140 visits by children, 4 preliminary hypotheses, 140–141 weight loss, long-term care facility, 54 prevention, 147–149 respiratory tract infections, 143–145 Elements, infection control program, influenza, 143–144 117–127 Legionnaire’s disease, 145 Streptococcus pneumoniae, 144–145 Emergence, resistant pathogens, 364 risk factors, 134–135 Employees selected infectious disease outbreaks, 143–147 health programs, 123–124 skin infections, 146 infection control program education, studies, 141–142 microbiologic/studies, 142 121–122 observational studies, 141–142 End-of-life care, ethical issues, 90 surveillance artifact, 136–137 Energy supplements, 58–62 timing, 137–138 Enterococci, vancomycin-resistant, Epidemiology, respiratory virus, 198–199 411–428 attack rate, 198–199 clinical manifestations, 415–416 viral characteristics, 198 diagnosis, 416–418 epidemiology, 411–414 Equipment, patient care, contact infection control, 419–423 precautions, 108 prevention, 423–424 therapy, 418–419 Ethical issues, 80–82 treatment, 418 acquired immunodeficiency syndrome, Environment hygiene, infection control 88 advance directives, 85–86 program, 126–127 healthcare proxy, 86 Epidemic curve, 140 preferences for treatment, 85–86 Epidemic rates, infection control program, autonomy, 80 beneficence, 80–81 121 cost, 91 Epidemiologic investigation, 133–153 decision to hospitalize, 86–87 decisional capacity, 84–88 antimicrobial-resistant organisms, dementia, advanced, 87–88 146–147, 363–472 doctor-patient relationship, 83–84 end-of-life care, 90 antimicrobial use, 149 everyday ethics, 81–82 case ascertainment, 139 fidelity, 81 case definition, line listing, 138–139 cohort, case-control studies, 141 epidemic curve, 140 gastrointestinal infections, 145–146 geographic assessment, 140 host factors, 139–140

486 Index [Ethical issues] Gender, nursing home population, 7 goals of care, 82–83 Geographic assessment, in epidemiologic prioritization of, 83 health promotion, 88 investigation, 140 human immunodeficiency virus, 88 Geriatric healthcare infection control, by staff, 91–92 infectious disease interventions, 79–98 economics, 10, 11 interdisciplinary team, 88–89 long-term care, 7–12 interventions, 89 isolation, contact, 90–91 changes in, 12–13 justice, 81 Medicaid, 9–12 medical director, 92 Medicare, 8–9, 11 nonmaleficience, 80–81 private funding, 12 promises to those with advanced illness, source of funds, 8 93 Geriatric population, 27–32 quality of life, 85 anorexia, drugs causing, 66 research issues, 92–93 antimicrobial therapy, 30–31 right to refuse care, 87 chronic illness, 35–38 clinical manifestations, 29 Evaluation of infection control program, epidemiology, 27–29 128–129 germ theory, 27–29 Feeding tubes, pneumonia, 234–235 pre-antibiotic era, 27 Fever, 73–76, 477 growth of, 4 immune response in, 337–339 definition of, 75 infection control program, 116 diminished response, 73–75 life expectancy, 5 evaluation of, 477–480 nutritional deficiencies, long-term care robust response, 76 of unknown origin, 76 facility, 53 Fidelity, as ethical issue, 81 pneumonia, chronic illness, 36–37 Fluoroquinolones, 166–167 respiratory viruses, 200 Friction, pressure ulcers, infected, 261–262 susceptibility to infection, 29–30 Fungal infection, 449–472 vaccination, 337–339 antifungal agents, 463–466 visits by children, 4 epidemiology, 449–453 weight loss, long-term care facility, 54 filamentous, 460–461 Germ theory, 27–29 Gloves, use of, 107–108 invasive, 452–453, 467 Glycopeptide-resistant Enterococci, invasive filamentous, 452–453, 411–428 457–458, 463, 469 clinical manifestations, 415–416 clinical manifestations, 453–458 diagnosis, 416–418 epidemiology, 411–414 Gastric content aspiration, pneumonia, infection control, 419–423 234–235 prevention, 423–424 therapy, 418–419 Gastroesophageal reflux, pneumonia, 234 treatment, 418 Gastrointestinal infection Glycopeptides, resistance, 376–377 Glycylcyclines, antibiotic resistance, defined, 475 epidemiologic investigation, 145–146 374 Gown, contact precaution, 108

Index 487 Gram-negative bacteria, 429–448 Hepatitis B virus, 316–318, 330–332 antibiotic resistance chronic, 327 prevalence of, 433–435 frequency, 331 risk factors, 435–436 incidence, United States, 317 Bush–Jacoby–Medeiros classification, postexposure protection, 331–332 beta-lactamases, 430 screening, 331 clinical infections, 436–437 vaccination, 331, 332 diagnosis, 437–438 efflux pump mechanisms, 432–433 Hepatitis C virus, 318–320, 333 epidemiology, 429–436 chronic, 327 extended-spectrum beta-lactamases, incidence, United States, 319 431 postexposure protection, 333 inducible chromosomal beta-lactamases screening, 333 AmpC, 431–432 vaccination, 333 infection control, 440–441 metallo-beta-lactamases, 432 Hepatitis D virus, 320–321 porin channels, 432 Hepatitis E virus, 321 resistance, 429–433 Hepatitis G virus, 321 prevention of, 441–442 Herpes zoster, 283–289 therapy, 438–440 treatment options, 438 changes in immunity, 37 clinical manifestations, 284–285 Hand washing, 107–108 diagnosis, 285 Healthcare workers, vaccination of, 356 epidemiology, 283–284 Hepatitis, 313–336 infection control, 287–289 prevention, 289 clinical manifestations, 322–327 therapy, 285–287 acute hepatitis, 322–323 chronic hepatitis, 323–324 analgesics, 286–287 hepatocellular carcinoma, 324–325 anti-inflammatory, 286 antiviral therapy, 286 diagnosis, 323 postherapeutic neuralgia, 287 epidemiology, 313–321 HIV (see Human immunodeficiency infection control, prevention, 327–333 interferon-based therapy, exclusion virus) Home healthcare, economics, 8 criteria, 326 Hospital patient selection, 326–327 therapy, 325–327 acute care, vs. long-term care facility, 15–26 acute hepatitis, 325 chronic hepatitis, 325–327 initial evaluation, 18–20 treatment, 322–327 recognition of infection, 17–18 Hepatitis A virus, 313–316, 328 staffing, 15–17 clinical course, 316 subacute care infection control, frequency, 328 postexposure protection, 330 20–21 screening, 328–329 transfer, to acute care setting, vaccination, 329 vaccine, 329 21–22 decision to hospitalize, 86–87 Human immunodeficiency virus, ethical issues in, 88 Hypotheses, preliminary, in epidemiologic investigation, 140–141

488 Index Identification of infection, 101–102 [Infection] clinical manifestations, 101 tuberculosis, 245–256 diagnostic specimens, 101 urinary tract infection, 173–195 vaccinations, 337–362 Imaging studies, infected pressure ulcers, vancomycin-resistant Enterococci, 266–268 411–428 computed tomography, 267 Infection control, professional, 111, magnetic resonance imaging, 267 117–119 plain radiography, 266–267 radionuclide scintigraphy, 267–268 education, 111 Immune dysfunction, 33–50 Infection control program, 115–132, 136 aging and, 33–50 Immune response, 38–42 administration of facility, alliance with, Immunization, epidemiologic 125 investigation, 148–149 admissions, social worker, partnerships Immunosenescence, 34 between, 127 Infection antibiotic resistance, 124 aging antibiotic utilization, 124–125 demographics, 1–14 Association for Professionals in effect of, 33–50 epidemiology, 27–32 Infection Control and Epidemiology, 128 antibiotic resistance, 363–382 barriers to, 127 antimicrobial therapy, 155–171 department manager, supervisors, bronchitis, 223–244 nursing, alliance with, 125–127 Candida, 449–472 departments of health, 128 cellulitis, 283–304 education, for employees, 121–122 clinical manifestations of, 71–78 elements of, 117–127 diarrhea, infectious, 305–312 employee health programs, 123–124 epidemiologic investigation, 133–153 environment hygiene, 126–127 geriatric healthcare, demographics, 1–14 evaluation, 128–129 gram-negative bacteria, 429–448 geriatric population, 116 herpes zoster, 283–304 infection control professional, 117–119 immune dysfunction, illness-related, information, infection, sources for, 120 long-term care facility (LTCF) 33–50 outbreak investigation, steps to, 122 infection control program, 115–132 policies, 123 influenza, 197–222 need for, 116–117 interventions, ethical issues, 79–98 outbreak investigation, 121 long-term care, vs. acute care hospitals, oversight committee, 117 partnerships within, 125–127 15–26 policy, procedure development, 122–123 nursing management of, 99–114 quality improvement, 126 nutrition, 51–70 regulatory requirements, 116–117 pneumonia, 223–244 federal, state, local, 116–117 pressure ulcers, 257–282 resident health program, 124 respiratory viruses, 197–222 resources, regional, local, national, 128 scabies, 283–304 Society for Healthcare Epidemiology of Staphylococcus aureus, methicillin- America, 128 resistant, 383–410

Index 489 [Infection control program] Long-term care surveillance, 119–121 changes in, 12–13 edemic rates, 119–121 demographics, 1–14 epidemic rates, 121 economics, 7–12 source of funds, nursing home, home Influenza, 198–207 healthcare, 8 chronic illness, 35–36 epidemiologic investigation, 143–144 Long-term care facility, vs. acute care impact of age, chronic illness, 35–36 hospital, 15–26 line listing, 138 vaccine, 339–343 initial evaluation, 18–20 administration, 341–343 recognition of infection, 17–18 antiviral medications, dosage, 342 resources, 15–17 effectiveness, 340–341 staffing, 15–17 indications, 341 subacute care infection control, 20–21 revaccination, 341–343 transfer, to acute care setting, 21–22 safety, 343 Long-term indwelling catheter infection control, 189 Innate immunity, 38–39 urinary tract infection, 181, 184, 190–191 acquired immunity, interaction between, 40–42 Macrolides, 165 resistance, 369–372 Interdisciplinary team, 88–89 mechanism, 370–371 Invasive filamentous fungal infections, Magnetic resonance imaging, infected 452–453, 457–458, 463, 467, 469 pressure ulcers, 267 clinical manifestations, 453–458 Investigation, of outbreak, infection Malnutrition consequences of, 56–58 control program, 122 geriatric population, 51–56 Isolation reversible causes of, 55 contact, 90–91 Mask, for infection control, 106 precautions, in epidemiologic Medicaid, 9–12 investigation, 149 expenditures, 11 Medical director, 92 Justice, as ethical issue, 81 administration, alliance between, 125 Ketolides, antibiotic resistance, 371–372 Medicare, 8–9 Laboratory tests, infection, 478–480 geriatric population, 8–9, 11 Legionnaire’s disease, epidemiologic Medications investigation, 145 causing anorexia, geriatric population, 66 Life expectancy, geriatric population, 5 immune potentiating effects, 43–46 Line listing with immunopotentiation, 45–46 nutrient interactions with, 65 case definition, in epidemiologic Metabolism, antimicrobial therapy, 163 investigation, 138–139 Metallo-beta-lactamases, 432 Methicillin-resistant Staphylococcus influenza outbreak, 138 Linezolid, methicillin-resistant aureus, 383–410 antibiotic resistance, 369 Staphylococcus aureus, 395–396 clinical manifestations, 392–393 Local resources, infection control program, clinical features, 393 128 syndromes, 392–393

490 Index [Methicillin-resistant] National resources, infection control debridement, 396–397 program, 128 diagnosis, 393–394 drainage, 396–397 Nonmaleficience, 80–81 epidemiology, 384–392 Novel drugs, future development of, 377 infection caused by, 388–392 NPUAP (see National Pressure Ulcer infection control, 397–403 antibiotic use, 400 Advisory Panel) decolonization, 402–403 Nursing, supervisors, department manager, education, 399–400 isolation, 402 alliance with, in infection control outbreak management issues, 401–403 program, 125–127 precautions, 400–401 Nursing home care (see also Long- surveillance, 399 term care) prevention, 403–404 community services available risk factors, 392 outside of, 6 surgical procedures, 396–397 demand for, 1–7 therapy, 395–397 economics, 7–12 antimicrobial agents, 396 factors affecting need for, 2 linezolid, 395–396 fever, 75 topical agents, 396 infection presentations, 73 vancomycin, 395 Nursing management, 99–114 transmission of, 388 airborne precautions, 104–106 education, 105–106 Microbiological studies, 101 resident placement, 105 in epidemiologic investigation, 142 resident transport, 105 infected pressure ulcers, 264–266 respiratory protection, 105 urinary tract infection, 176–178, antibiotic-resistant microorganisms, 181–182 108–111 colonized, 109 Microcirculation, tissue, pressure ulcer, 260 infected, 109 Micronutrient supplements, 60 resident’s culture status, 109 Mineral supplements, 62–63 uncontained, 109 Moisture, pressure ulcers, infected, 262 communication, 101–102 Mucocutaneous infections, localized, contact precautions, 107–108 gloves, 107–108 458–459, 461–462 gown, 108 mucous membrane infections, 459 hand washing, 107–108 nail infections, 458–459 patient care equipment, 108 skin infections, 458 patient transport, 108 Mucomycosis, 458 resident placement, 107 Multivitamin supplements, 62–63 droplet precautions, 106–107 education, 107 Nails mask, 106 Candida infections of, 455 resident placement, 106 infections, mucocutaneous, 458–459, resident transport, 106–107 461–462 education, 111–113 infection control professional, 111 National Pressure Ulcer Advisory Panel staff education, 111–112 Classification, 258

Index 491 [Nursing management] [Nutrition] identification of infection, 101–102 status assessment, 56–58 clinical manifestations, 101 supplements, 43–45 diagnostic specimens, 101 micronutrient, 60 microbiology, 101 urinary tract infections, 64 nursing process, 100 weight loss, geriatric population, 54 prevention, 102–111 risk for acquiring infection, with Observational studies, in epidemiologic resistant microorganism, 109–110 investigation, 141–142 room placement, resident with antibiotic-resistant Occupational Health and Safety microorganisms, 110 Administration, website, 129 standard precautions, 102–104 hand washing, 102–103 Onychomycosis, 454 occupational health, bloodborne management of, 461 pathogens, 104 personal protective equipment, Oral hygiene, pneumonia, 234 103–104 Oropharyngeal candidiasis, 454–455, 462 surveillance, 99–101 Oseltamivir, 203–204 Nursing process, 100 dosing, 203 Nutrition, 51–70 efficacy, 203 resistance, 204 anorexia, in geriatric population, drugs side effects, 204 causing, 66 OSHA (see Occupational Health and appetite stimulants, 64–65 Safety Administration) barriers to consumption, geriatric Out-of-pocket expenditures, geriatric population, 52 population, 11 body mass index, nutritional assessment Outbreak investigation and, 57 infection control program, 121 commercial formula supplements, 58–62 steps to, 122 Oversight committee, infection control trials of, 59 drug-nutrient interactions, 65 program, 117 interventions, in LTCF, 58–63 malnutrition Parainfluenza, 210–212 clinical manifestations, 211 consequences of, 56–58 diagnosis, 211 geriatric population, long-term care epidemiology, 210–211 infection control, 211–212 facility, 53 therapy, 211 modification of immunity with, 43 reversible causes of, 55 Partnerships, in infection control program, micronutrient supplementation trials, 60 125–127 mineral supplements, 62–63 multivitamin supplements, 62–63 Penicillin-resistant pneumococci, 369 nutritional deficiencies, geriatric Pharmaceuticals population, 53 causing anorexia, geriatric population, 66 pneumonia, 63 immune potentiating effects, 43–46 pressure ulcers, 63–64 with immunopotentiation, 45–46 protein-energy supplements, 58–62 nutrient interactions with, 65 Pharmacodynamics, antimicrobial therapy, 163–164

492 Index Pharmacokinetics, antimicrobial therapy, [Pneumonia] 162–163 vaccine, 233–234 volume depletion, 232 absorption, 162 clearance, 163 Porin channels, gram-negative bacteria, distribution, 162–163 432 metabolism, 163 Placement, resident Pre-antibiotic era, 27 airborne precautions, 105 Precautions, standard, 102–104 contact precautions, 107 infection control, 106 hand washing, 102–103 Plain radiography, infected pressure ulcers, occupational health, bloodborne 266–267 pathogens, 104 Pneumococcal vaccine, 343–351 personal protective equipment, 103–104 Pressure ulcers, infected, 257–282 antibody response, 349–350 adjunctive measures, 271 cost effectiveness, 350 antibiotic regimens, 273 drug interactions, 351 antimicrobial therapy, 272 efficacy, 345–349 clinical assessment, 264 microbiology, 343–344 clinical manifestations, 263–264 safety, 350–351 cost of, 263 Pneumococci, penicillin-resistant, 369 debridement, 270–271 Pneumonia diagnosis, 264–268 antibiotic regimens, 231 epidemiology, 257–263 chronic illness, 36–37 friction, 261–262 clinical manifestations, 226 imaging studies, 266–268 diagnosis, 226–227 epidemiology, 223–226 computed tomography, 267 magnetic resonance imaging, 267 etiology, 225 plain radiography, 266–267 incidence, 223–224 radionuclide scintigraphy, 267–268 mortality, 225–226 incidence, 257–259 pathogenesis, 224–225 infection control, 272–276 risk factors, 224 locations of, 261 feeding tubes, 234–235 microbiological evaluation, 264–266 gastric content aspiration, 234–235 moisture, 262 impact of age, chronic illness, 36–37 National Pressure Ulcer Advisory Panel nutrition and, 63 prevention, 233–235 Classification, 258 gastroesophageal reflux, 234 nutrition and, 63–64 oral hygiene, 234 pressure, 259–261 pharmacologic interventions, 234 vaccination, 233–234 reduction of, 270 therapy, 227–232 prevention, 276–278 antimicrobial agent, 229–232 risk factors, 259–262 duration of treatment, 229 initial route of treatment, 228 reducing, 269 oral therapy, switch to, 229 shearing stress, 262 treatment location, 228 surgery, 271–272 therapy, 268–272 tissue microcirculation, 260 wound care, 269–272 dressings, 271

Index 493 Prioritization, goals of care, 83 [Respiratory syncytial virus] Private funding, geriatric healthcare, 12 epidemiology, 207–208 Procedure development, infection control infection control, 210 therapy, 209–210 program, 122–123 Promises, to those with advanced illness, Respiratory tract infection defined, 473–474 ethics in, 93 epidemiologic investigation, 143–145 Protein-energy supplements, 58–62 influenza, 143–144 Proxy, healthcare, 86 Legionnaire’s disease, 145 Pulmonary aspergillosis, chronic Streptococcus pneumoniae, 144–145 necrotizing, 457–458 Respiratory viruses, 197–222 amantadine, 201–202 Quality improvement, in infection control dosing, 201–202 program, 126 efficacy, 201 resistance, 202 Quality of life, 85 side effects, 202 Quinolones, resistance, 374–375 antiviral drugs, 202 chemoprophylaxis, 201–204 mechanism of action, 374–375 clinical manifestations, 199 mechanism of resistance, 375 control, 204–207 infection control, 204–205 Race, nursing home population vaccination, 205–207 representation, 7 coronavirus, 212–213 clinical manifestations, 212 Radionuclide scintigraphy, infected diagnosis, 212–213 pressure ulcers, 267–268 epidemiology, 212 infection control, 213 Refusal of care, right to, 87 therapy, 213 Regional resources, infection control diagnosis, 199–200 epidemiology, 198–199 program, 128 attack rate, 198–199 Regulatory requirements, 116–117 viral characteristics, 198 geriatric population, clinical infection control program, 116–117 manifestations, 200 Research, ethical issues in, 92–93 influenza, 198–207 Resident health program, 124 oseltamivir, 203–204 Residents, infection control program dosing, 203 efficacy, 203 education, 121–122 resistance, 204 Resistance side effects, 204 parainfluenza, 210–212 amantadine, 202 clinical manifestations, 211 antibiotic, 124, 363–382 diagnosis, 211 epidemiology, 210–211 gram-negative bacteria, 430, 434 infection control, 211–212 antimicrobial, 435 therapy, 211 in gram-negative bacteria, 436 infection control program and, 124 mechanisms of, 371 oseltamivir, 204 rimantadine, 202 zanamivir, 204 Respiratory protection, 105 Respiratory syncytial virus, 207–210 clinical manifestations, 208 diagnosis, 209

494 Index [Respiratory viruses] SHEA (see Society for Healthcare respiratory syncytial virus, 207–210 Epidemiology of America) clinical manifestations, 208 diagnosis, 209 Shearing stress, pressure ulcers, infected, epidemiology, 207–208 262 infection control, 210 therapy, 209–210 Sino-orbital aspergillosis, 457 rhinovirus, 213–214 Skin infection clinical manifestations, 214 diagnosis, 214 Candida, 455 epidemiology, 213 defined, 475 infection control, 214 epidemiologic investigation, 146 therapy, 214 mucocutaneous, 458, 461 rimantadine, 201–202 Skin test criteria, positive tuberculin dosing, 201–202 efficacy, 201 reaction, 251 resistance, 202 Social worker, admissions, partnerships side effects, 202 therapy, 200–204 between, 127 zanamivir, 203–204 Society for Healthcare Epidemiology of dosing, 203 efficacy, 203 America, 128 resistance, 204 Source of funds, long-term care, 8 side effects, 204 Staff Rhinovirus, 213–214 education of, 111–112 clinical manifestations, 214 infection control, 91–92, 111–112 diagnosis, 214 Staphylococcus aureus, methicillin- epidemiology, 213 infection control, 214 resistant, antibiotic resistance, 369 therapy, 214 Streptococcus pneumoniae, epidemiologic Right to refuse care, 87 investigation, 144–145 Rimantadine, 201–202 Subacute units, admission criteria, 9 Supervisors, department manager, nursing, dosing, 201–202 efficacy, 201 alliance with, in infection control resistance, 202 program, 125–127 side effects, 202 Supplements, 43–45 Ringworm, 453 energy, 58–62 Room placement, resident with antibiotic- immune potentiating effects, 43–46 micronutrient, 60 resistant microorganisms, 110 mineral, 62–63 multivitamin, 62–63 Scabies, 295–300 nutritional, commercial formula, 58–62 clinical manifestations, 296 Surgical procedure diagnosis, 297 methicillin-resistant Staphylococcus epidemiology, 295–296 aureus, 396–397 infection control, 298–299 pressure ulcers, infected, 271–272 prevention, 299–300 Surveillance, infection control program, therapy, 297–298 119–121 edemic rates, 119–121 epidemic rates, 121 Surveillance artifact, in epidemiologic investigation, 136–137 Symptomatic bacteriuria, 184–185

Index 495 Syncytial virus, respiratory, 207–210 Ulcers, pressure, 257–282 clinical manifestations, 208 adjunctive measures, 271 diagnosis, 209 antibiotic regimens, 273 epidemiology, 207–208 antimicrobial therapy, 272 infection control, 210 clinical assessment, 264 therapy, 209–210 clinical manifestations, 263–264 cost of, 263 Team, interdisciplinary, 88–89 debridement, 270–271 Temperature, baseline, 75 diagnosis, 264–268 Terbinafine, 465–466 epidemiology, 257–263 Tetanus vaccine, 351–352 friction, 261–262 Tetracyclines, resistance, 373–374 imaging studies, 266–268 computed tomography, 267 mechanism of action, 373 magnetic resonance imaging, 267 Tinea capitis, 453 plain radiography, 266–267 Tinea corporis, 453 radionuclide scintigraphy, Tinea cruris, 453 267–268 Tinea pedis, 453–454 incidence, 257–259 Tinea versicolor, 451, 454 infection control, 272–276 Tissue microcirculation, pressure ulcer, 260 locations of, 261 Tissue penetration, antimicrobial therapy, microbiological evaluation, 264–266 moisture, 262 163 National Pressure Ulcer Advisory Panel Topical agents, methicillin-resistant Classification, 258 nutrition and, 63–64 Staphylococcus aureus, 396 pressure, 259–261 Transfer, to acute care facility, indications reduction of, 270 prevention, 276–278 for, 480 risk factors, 259–262 Transport of resident, 105, 106–107, 108 reducing, 269 Trimethoprim-sulfamethoxazole, 167 shearing stress, 262 surgery, 271–272 resistance, 372–373 therapy, 268–272 mechanism of action, 372 tissue microcirculation, 260 mechanism of resistance, 373 wound care, 269–272 dressings, 271 Tuberculosis, 245–256 assessment, 253 Urinalysis, 182–183 clinical manifestations, 247 Urinary tract infection, 64, 173–195 drug regimens, 252 education, 253–254 bacteriuria, distribution of infecting epidemiology, 245–247 organisms, 177 impact of age, chronic illness, 36–37 infection control, 247–254 Candida, 459–460 containment, 249–253 catheter diagnosis, 248–249 surveillance, 248–249 chronic indwelling, 179 treatment, 250–251 long-term indwelling, 181 pathogenesis, 246–247 clinical impact, 178–179 prevention, 251–253 clinical manifestations, 180–181 skin test criteria, positive tuberculin reaction, 251 treatment regimens, 250

496 Index [Urinary tract infection] [Vaccination] defined, 474–475 microbiology, 343–344 diagnosis, 181–184 safety, 350–351 catheter, long-term indwelling, 184 clinical diagnosis, 183–184 pneumonia, 233–234 microbiological diagnosis, 181–182 respiratory viruses, 205–207 urinalysis, 182–183 tetanus, 351–352 epidemiology, clinical relevance, varicella vaccine, 355 174–179 Vancomycin-resistant Enterococci, host response, 178 infection control, 188–189 411–428 catheter, long-term indwelling, 189 clinical manifestations, 415–416 general, 188–189 diagnosis, 416–418 microbiology, 176–178 epidemiology, 411–414 prevalence, incidence, 174–175 infection control, 419–423 prevention, 189–191 prevention, 423–424 catheter, long-term indwelling, therapy, 418–419 190–191 treatment, 418 risk factors, 176 Vancomycin-resistant Staphylococcus therapy, 184–188 antimicrobial treatment, 185–187 aureus, 395 catheter, chronic indwelling, 188 Varicella vaccine, 355 duration of treatment, 187–188 Visitors, infection control program symptomatic bacteriuria, 184–185 education for, 121–122 Vaccination, 337–362 Volume depletion, pneumonia, 232 diphtheria, 353–355 Vulvovaginitis, 457, 462 geriatric population, immune response, 337–339 Weight loss, geriatric population, long- of healthcare workers, 356 term care facility, 54 influenza, 339–343 administration, 341–343 World-Wide Web Virtual Library: antiviral medications, dosage, 342 Epidemiology, 129 effectiveness of, 340–341 indications, 341 Wound care revaccination, 341–343 dressings, 271 safety, 343 pressure ulcer, 269–272 pneumococcal vaccine, 343–351 antibody response, 349–350 Yeast infections, 451–452, 454–457, 467, cost effectiveness, 350 468 drug interactions, 351 efficacy, 345–349 epidemiology of, 449–453 Zanamivir, 203–204 dosing, 203 efficacy, 203 resistance, 204 side effects, 204 Zygomycosis, 458

About the Editors THOMAS T. YOSHIKAWA is Chairman and Professor of the Department of Internal Medicine, Charles R. Drew University of Medicine and Science and Martin Luther King, Jr.–Charles R. Drew Medical Center, Los Angeles, California. The author of numerous journal articles, book chapters, and books, including Antimi- crobial Therapy in the Elderly Patient and Acute Emergencies and Critical Care of the Geriatric Patient (both titles, Marcel Dekker, Inc.), he is a Fellow of the American College of Physicians–American Society of Internal Medicine, the In- fectious Diseases Society of America, and the Gerontological Society of America, as well as a member of the American Geriatrics Society and the American Soci- ety for Microbiology, among others. He is Editor-in Chief of the Journal of the American Geriatrics Society. He received the B.A. degree (1962) from the Uni- versity of California, Los Angeles, and the M.D. degree (1966) from the Univer- sity of Michigan, Ann Arbor. JOSEPH G. OUSLANDER is Director of the Division of Geriatric Medicine and Gerontology and the Emory Center for Health in Aging; Chief Medical Officer of the Wesley Woods Center; and Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia. The author or coauthor of numerous journal arti- cles, book chapters, and books, he is past president of the American Geriatrics Society and serves as Deputy Editor for the Journal of the American Geriatrics Society. He is a Fellow of the American Geriatrics Society and the Gerontological Society of America. Among other awards, he was named David H. Solomon Lec- turer (2001). Dr. Ouslander received the B.A. degree (1973) from The Johns Hop- kins University, Baltimore, Maryland, and the M.D. degree (1977) from Case Western Reserve University, Cleveland, Ohio. 497