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December 2008
Vol. 18 No. 12
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Guideline on Fever/Infection in Long-Term Care Facilities Updated
Vita Washington

IDSA’s guideline for the evaluation of fever and infection in older adult residents of long-term care facilities (LTCFs) was recently updated.

Key updates include an expanded discussion of the importance of functional decline as a clinical sign of possible infection; targeted evaluations of specific infectious syndromes including scabies, norovirus, and C. difficile; methods for proper diagnosis of serious viral infections; and an outline of how to evaluate suspected outbreaks of infectious diseases. 

The guideline focuses on older adults who are institutionalized and typically have multiple, chronic co-morbidities and functional disabilities—making it difficult to recognize infection in this population.  What’s more, long-term care facilities often have limited on-site resources to evaluate suspected infections (e.g., urinary tract infections and pneumonia) in older adults.    

The guideline provides specific recommendations regarding staffing, including which LTCF staff members are best able to recognize the symptoms of suspected infections in the elderly.  Although there is often limited data to guide clinical evaluation of specific infectious syndromes in LTCF residents, the guideline provides an extensive summary of published data and makes specific recommendations regarding laboratory and diagnostic testing if resources are available. 

The guidelines’ performance measures state that in order to properly diagnose serious infections, it is important to accurately measure, record, and communicate temperature, blood pressure, and respiratory rate of LTCF residents suspected of having infections.  Blood counts (i.e., CBC with differential) should be performed within 12-24 hours, consistent with local standards of practice unless advanced directives prohibit it. 

The fever and infection guideline is being published in the January 15 issue of Clinical Infectious Diseases and is now available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of the IDSA website.
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