長期照護機構住民的感染症

Infections in Residents Living in Long-Term Care Facilities

林永捷(Yung-Jie Lin) ； 彭莉甯(Li-Ning Peng) ； 陳亮恭(Liang-Kung Chen)

《台灣老年醫學暨老年學雜誌》 6卷2期 (2011/05) Pp. 73-85

https://doi.org/10.29461/TGG.201105.0001

摘要

感染症是導致長期照護機構老年人住院及死亡的主要原因之一。老年人由於免疫功能較差、患有慢性疾病、多重器官退化、生活功能障礙、侵入性的醫療處置、多重用藥等特性，使得老年人感染機會增加。但是又因為老人對治療反應不如預期、易產生併發症及後遺症，故感染後之死亡率也較高。長照機構老人罹患感染症時，其外表症狀常與實際病變嚴重度不成比例，且常表現出不典型的症狀或徵象，再加上溝通不良、病史不易收集，以及長照機構對於感染症定義方式與醫療院所不同等因素，早期發現與治療更加困難。良好訓練的照顧者，可以藉由辨別長照機構常見感染症的症狀或徵象，發現有異狀的老人，適當地轉介給醫師，直接在長照機構內接受一般的治療，或須將病人轉送急性照顧醫療機構，作後續的治療照顧。本文獻回顧可以提供長期照顧機構老人的醫療服務人員參考，關於感染症發生率、診斷方式、常見的致病原及治療原則。老年人感染症的處置，往往預防勝於治療。了解常見的感染症，有助於降低老年人感染症的發生率、後遺症及死亡率。

關鍵字

長期照護機構 ； 感染 ； 定義 ； 群聚感染 ； 治療

並列摘要

Infection is a frequent, potentially life-threatening, but often treatable problem in long-term care facility (LTCF) residents. Immunity decline, high frequency of chronic diseases, aging organ systems, functional impairment, experience of invasive treatment, and polypharmacy all contribute to the high infection rates of LTCF residents. As their responses to general treatment tend to be more unpredictable, LTCF resident are more vulnerable to complications and sequelae after infection. However, the external symptoms often fail to reflect the seriousness of the infection in infected LTCF residents, or they may show atypical signs and symptoms of infection. Moreover, it is clear that the standard definitions of nosocomial infections developed for use in acute care hospitals are not applicable to most LTCFs. These are some of the major reasons causing difficulty in early detection of infections in LTCF residents. Caregiver should be trained to equip with the abilities of recognizing problems in elderly LTCF residents, performing initial assessment of the infection, and promptly notifying the primary care clinician to decide whether the infected elderly patients can be adequately treated in-house at the LTCF or need to be transferred to an acute-care facility.The study reviews the characteristics of LTCF residents suffering infections as well as the definitions, prevalence and incidence, pathogens, outbreak, diagnosis and treatment of infections at LTCFs so as to help caregivers develop a comprehensive understanding of infections in elderly LTCF residents and apply the understanding to help prevent infection and subsequent complications and reduce its incidence and mortality.

並列關鍵字

Long-Term Care Facilities ； Infection ； Definitions ； Management ； Outbreak