Long-term acute care hospitals were created to care for patients too sick for a nursing home and too expensive if care for in an acute care hospital. Patients in these hospitals may have many reasons for nosocomial infections.
Patients at a long-term acute care hospital tend to have:
(1) chronic respiratory failure, often requiring prolonged ventilatory support
(2) chronic neurological deficits (coma. paralysis, head injury, etc)
(3) chronic complex musculoskeletal disorders
Problems for infection control:
(1) ventilator-associated or aspiration pneumonia
(2) decubitus ulcers
(3) intravascular catheter-related infections
(4) urinary tract infections, often catheter-associated
(5) colonization by organisms resistant to multiple antibiotics
Infection control practices may need to include:
(1) Careful use (stewardship) of antibiotics.
(2) Preventive measures for ventilator-associated pneumonia, decubital ulcers and urinary catheters.
(3) Screening for resistant organisms.
(4) Contact precautions.
(5) Chlorhexidine baths.
(6) Staff education.
(7) Environmental cleaning, including medical device fomites..
(8) Cohorting.
(9) Programs to improve handwashing.
