A retrospective study of nosocomial pneumonia at a long-term care facility.
BACKGROUND
Results of a passive surveillance system (pneumonia confirmed by x-ray examination) suggested that in 1989 a total of 187 cases of nosocomial pneumonia had occurred at the Canandaigua Veterans Administration Medical Center among 250 long-term care patients.


METHODS
A retrospective study was undertaken to validate cases and to enumerate risk factors. A chart review showed that 136 of 187 cases (72%) met predetermined criteria for nosocomial pneumonia.


RESULTS
Three nursing units characterized as at high risk had a pneumonia rate of 1.90 per 1000 patient days, as compared with a rate of 0.70 cases per 1000 patient days on the two other units. There were no differences in age, mean white blood cell count, or clinical symptoms between high- and average-risk patients. Two thirds of all patients had a history of chronic aspiration. High-risk patients were more likely to be confined to bed, to have a debilitating neurologic disease, and to require tube feedings. Twenty percent of patients on high-risk units died of nosocomial pneumonia or with nosocomial pneumonia as a contributory factor.


CONCLUSIONS
Facility-associated pneumonia is an important cause of morbidity and mortality in long-term care facilities.
McDonald
A M
AM
Department of Nursing, Veterans Administration Medical Center, Canandaigua, NY 14424.
Dietsche
L
L
Litsche
M
M
Spurgas
R
R
Ledgerwood
R
R
Subitha
C J
CJ
LaForce
F M
FM
D003428:Cross Infection / Q000453:epidemiology*; D006746:Hospital Bed Capacity, 500 and over; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D009518:New York / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology*; D011159:Population Surveillance; D012112:Residential Facilities / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors