Management of Respiratory Infections in Skilled Nursing Facility Residents with COPD

Immediate Recognition and Assessment

• Fever is defined as a single oral temperature ≥37.8°C (100°F), or repeated measurements ≥37.2°C (99°F) orally or ≥37.5°C (99.5°F) rectally, according to the Infectious Diseases Society of America 1, 2, 3
• The American Geriatrics Society recommends recognizing that 15% of serious infections in elderly patients may be afebrile 4
• Nursing assistants must be trained to immediately report functional decline, not just respiratory symptoms, as infection is present in 77% of episodes showing new or worsening confusion, falls or decreased mobility, incontinence, failure to cooperate with usual care, or decreased oral intake, as suggested by the Journal of the American Geriatrics Society 1, 3, 5, 6

Risk Stratification for COPD Patients

• The Infectious Diseases Society of America notes that difficulty swallowing is a risk factor for aspiration, which increases the risk of pneumonia 7, 6
• The American Diabetes Association recommends assessing for diabetes mellitus, which predisposes to secondary infections 6
• Indwelling catheters increase the risk of bacteremia 39-fold, according to the Infectious Diseases Society of America 6

Early Intervention Protocol

• The American Thoracic Society recommends ensuring adequate hydration status and supplemental oxygen if oxygen saturation declines 6
• The Society of Healthcare Epidemiology of America suggests monitoring for progression to Type 1 exacerbation, including worsening dyspnea, new or worsening hypoxemia, fever, or functional decline 6

Infection Prevention Measures

• The Centers for Disease Control and Prevention recommend annual influenza vaccination, which has 68% efficacy in preventing death in frail elderly 7
• The Infectious Diseases Society of America suggests pneumococcal polysaccharide vaccination 7
• Skilled nursing facilities must establish rapid notification protocols, adequate staffing ratios, and clear temperature monitoring schedules, as recommended by the Clinical Infectious Diseases journal 2, 6, 9

Antibiotic Considerations for Progression

• The Infectious Diseases Society of America recommends suspecting drug-resistant Streptococcus pneumoniae, gram-negative enteric organisms, and Staphylococcus aureus if cold progresses to suspected bacterial superinfection or pneumonia in COPD patients from skilled nursing facilities 4
• Empiric coverage should be β-lactam plus macrolide or doxycycline for hospitalized patients with cardiopulmonary disease from long-term care, as suggested by the Praxis Medical Insights 4