The elderly are at higher risk for infections due to several factors including decline in the function of their immune system, poor nutrition, lack of activity, as well as medications and other illnesses that inhibit their ability to fight off infections. The best defense is a good offense and that starts with realizing what you are up against.
Drug resistant bacteria, swine flu, avian flu, e-coli, flesh-eating bacteria, West Nile Virus, it seems like we have a new bug to fear every month. And so-called “super bugs” that were once the purview of hospitals are now being acquired in the community setting. These are bad enough in a healthy adult but they are often deadly for our elderly parents.
As hospital stays are shortened, more procedures and surgeries being done on an outpatient basis, the need for good infection control guidelines in the home and community is becoming increasingly more important. To complicate matters even more, home care has gone high-tech with tracheotomies, ventilators, dialysis, intravenous medications and other invasive procedures. Our population is living longer and with chronic illnesses that require the skilled care of nurses, therapists and aides in the home to educate and assist with care.
With the lack of 24 hour professional monitoring, it is up to the family and/or caregivers to be the first line of defense in the prevention of infection as well as the recognition of the early signs and symptoms. Something as simple as a cold can be deadly to someone with chronic breathing problems such as COPD. A small scratch in the elderly can rapidly become septic requiring emergency treatment. (Sepsis is a bacterial infection spread throughout the body and is more commonly called blood poisoning). Good infection control cannot be over-emphasized.
The Chain of Infection
Infection requires a chain of six steps to occur and a break in the chain lessens the likelihood of infection occurring. Those six steps are an infectious agent, a reservoir, a portal of exit, a mode of transmission, a portal of entry, and a susceptible host.
1. Infectious agent: a microorganism, usually bacteria, virus or fungus, or the more common term, germ. The virulence or strength of the germ is determined by its ability to invade and multiply in normal, healthy individuals. While an organism may not be virulent for a healthy individual, in a compromised person such as the elderly it becomes pathogenic (causes illness).
2. Reservoir: There must be a favorable environment for growth and replication. This is the source of the infection such as a sick person, a contaminated object or a carrier species (insect, rodent, animal).
3. Portal of Exit: This is the route the infectious agent takes out of the reservoir such as through the nose, mouth, sexual organs, feces and through blood.
4. Mode of Transmission: This is how it moves from reservoir to host. Contact or touching an infected person such as kissing, sexual intercourse, and shaking hands, or an infected object such as shopping cart handles, phones, computer mouse and door handles. Droplet transmission through sneezing, coughing, and being spit on. Things routinely taken into the body such as air, food and liquids. Insects, rodents and animals don’t actually cause disease, they merely transfer it to us via biting, blood and feces.
5. Portal of Entry: This is how the infection enters the body such as through the mucous membranes of the nose or mouth and through a cut or injury to the skin.
6. Susceptible Host: Someone who is at risk. This includes those who are lowered immunity, fatigued, stressed, anemic, not immunized, poor nutritional status and those with underlying disease.
Tomorrow, we’ll look at breaking the chain, the first step in prevention.