Clinicians should use objective findings focused on the respiratory tract and specific bedside criteria to properly diagnose pneumonia in eldercare facilities, an infectious disease expert asserts in a new article in JAMDA.
While most residents with pneumonia can be treated successfully in nursing homes, there is an urgent need for facility-acquired pneumonia diagnosis and treatment guidelines, wrote Joseph M. Mylotte, M.D., an infectious disease expert from the State University of New York at Buffalo.
Two or more primary factors should be present to ensure best practices, Mylotte proposes. These include cough, shortness of breath, elevated respiratory rate (>25/per minute), reduced oxygen saturation (<94% on room air or decrease of >3% from baseline saturation), and an abnormal chest exam. Secondary criteria are fever, change in mental status, or change in functional status.
The care team should also look for aspiration risk factors. These include history of stroke, dysphagia, Parkinson’s disease, presence of a feeding tube, and/or excess sedation. If the key bedside criteria are met, the next step is to obtain a chest X-ray, which can help distinguish between pneumonia and pneumonitis, or noninfectious lung inflammation.
When pneumonia is found, keeping proper documentation is a crucial measure, as the disease is one of three most common infections in nursing home residents, and associated with high mortality rates in this setting, he concluded.
The article, Nursing Home-Associated Pneumonia: Part I, Diagnosis, is joined by Part II, which focuses on causes and treatment.
