1. Recognizing Signs and Symptoms suggestive of infection WHY IMPORTANT Recognizing active infections is an important strategy to reduce the impact of infections on the LTC population – increased discomfort for resident, alteration of care, cost of additional resources, including antibiotics. Symptoms suggestive of an infection described and communicated will prompt an assessment to determine if and what intervention is indicated. Symptoms communicated to the Infection Preventionist become a major “clue” used in the infection Surveillance process.

2. INFECTIONS in the nursing home Atypical presentation of acute diseases, including infections, is common in the LTC population Typical signs of infection are frequently absent Changes caused by infection in the elderly are often subtle and nonspecific

3. ATYPICAL PRESENTATION More often seen in persons with cancer, renal (kidney) or liver failure, congestive heart failure, cardiovascular disease, diabetes Decline in functional status, including New or Increased - Confusion - Incontinence - Falling - Deteriorating mobility - Reduced food intake/Anorexia - Failure to cooperate with staff

4. FEVER Up to one-third of nursing home residents may present without a robust fever response Baseline temperatures are lower in frail nursing home residents than in healthy younger persons Elevated fever also associated with multisystem diseases such as temporal arteritis, rheumatoid arthritis, also some medication, and others (1)Single oral temperature greater than 100 (2)Repeated oral temp above 99 (rectal 99.5) (3)Increase in temp of more than 2 degrees over baseline

5. URINARY TRACT Frequency Urgency – Sensation of having to urinate urgently Dysuria – Pain or burning during void Hesitancy – sensation of not being able to urinate easily or completely Change in urine – bloody, cloudy, foul- smelling Incontinence - New or increased Lower abdominal pain Less often – fever, chills, malaise

6. SKIN and SOFT TISSUE Erythema - Redness Tenderness Warmth Drainage: * Pus * Serous – blood tinged Pain Swelling around device site or wound Rash

7. LOWER RESPIRATORY Chest pain Cough: - New or increased - Dry or sputum production Increased pulse Increased respirations Gastrointestinal disorders- loss of appetite, nausea, vomiting, abdominal pain Malaise – fatigue, tiredness Shortness of breath Skin color – Dusky or purplish

8. Reporting and Recording Each organization will have a system to facilitate On-going awareness/assessment for change in resident status Adequate communication of observation - where to document, who to tell Designated responsibility to facilitate action related to reported signs and symptoms