The incidence of bacterial infections occurring in 132 residents in a Veterans Administration hospital-based nursing home care unit (VA NHCU) was studied retrospectively over a 1 yr period. There were a total of 35 non-Foley-catheter-related bacterial infections documented during this time, occurring in 21 residents. Of these infections, 14 were pulmonary, 18 urinary and 3 of the integument. Of the 23 residents having indwelling urinary catheters, 47.8% became clinically symptomatic due to a urinary tract infection at least one time during the year. Thirty-six per cent of these infections were due to Pseudomonas aeruginosa and 48% were due to E. coli and Proteus mirabilis. Eighteen of 23 residents (78.3%) with Foley catheters had more than one predominant organism cultured from their urine during the year, making the practice of monthly cultures not very useful in considering treatment. If one grouped all urinary tract infections on the NHCU, the major pathogens were Pseudomonas (19.5%), Klebsiella (17.1%), Proteus (17.1%) and E. coli (14.6%). Documented pulmonary infections were predominantly due to Streptococcus pneumonia (50.0%) and Hemophilus influenza (35.7%). Our data suggest that the location of the institutional setting must be considered in caring for the elderly resident in a skilled nursing facility. Future plans to establish hospital based nursing home units must consider the benefits resulting from easy access to acute health care and educational programs against problems of hospital bacterial flora.
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