Case Types
Infections
Nursing homes experience an average of two million infections per year. Many types of bacterial and viral infections are common in nursing homes. Nursing home residents also are often seen in hospitals, post-acute care centers, dialysis centers, and different units in the nursing homes where they contract infections and can infect other patients.
Can Nursing Homes Be Sued When A Resident Contracts or Dies from an Infection?
Elderly people in nursing homes are at high risk of getting infections. If they do get an infection, they are more likely to experience severe symptoms.
While not infections at nursing homes are the result of negligence or neglect, there are certain scenarios where a nursing home is liable for injuries caused by infections. Lawsuits can be brought against nursing homes for any of the following failures:
- Failure to Have Proper Infection Protocols
- Failure to Train Staff to Identify Infections
- Failure to Contain Outbreaks
- Failure To Prevent Infections
- Failure to Recognize the Signs of Infection
- Failure to Treat Infections
What Are the Most Common Infections at Nursing Homes?
While nearly any infection is possible in a nursing home, the most common infections that nursing home residents contract at nursing homes are:
- Pneumonia
- Aspiration Pneumonia
- Urinary Tract Infections
- MRSA
- MSSA
- Influenza
- Clostridium Difficile (c. diff)
- Gastrointestinal Infections
- Influenza
- Fungal Infections
- Necrotizing Fasciitis (flesh eating bacteria)
- Sepsis
Because these infections are common, nursing home personnel must be well-trained to prevent, recognize, and treat these infections.
How Do Nursing Homes Prevent Infections?
There are several ways that nursing homes can prevent the spread of infections. These include:
- Staff Training: All nursing home staff should be trained on how to prevent infections. They should also be trained on recognizing the signs and symptoms of infection so that residents can be treated and kept away from other residents to prevent the infection from spreading.
- Policies and Procedures: Nursing homes are required to have policies and procedures that are specific to preventing the spread of infections. Unfortunately, however, many nursing homes fail to enforce these policies and procedures.
- Personal Protective Equipment (PPE) and Hand Hygiene: PPE is used to prevent the spread of infection. PPE can include masks or shields, gloves, gowns, and shoe coverings. Different PPE should be worn depending on the type of infection.
- Infection Surveillance: Nursing homes should have a system for tracking and controlling infections within the facility to identify likely sources of infection, control outbreaks, and prevent future infections.
- Isolation and Precautions: If a staff member gets an infection, they should not come to work. If a resident catches an infection, they should be kept away from other residents until they are no longer contagious.
- Sneeze and Cough Etiquette: Many infections are spread through sneezing or coughing. Simple measures like vouchering mouth or nose when you cough or sneeze and providing plenty of tissues can prevent many infections from spreading.
- Resident Care: Nursing homes should have a system in place for urinary catheter cleaning and monitoring, skin care, feeding tube monitoring, and immunization programs.
Are Nursing Homes Required to Identify Signs of Infection?
Nursing homes are required to closely monitor nursing home residents for signs of infection. Nursing home residents are usually elderly and have weak immune systems compared to younger people. Nursing home residents often have numerous other medical conditions (called comorbidities) that make them more likely to get infections and also more likely to suffer severe and even life threatening complications from those infections. Also, when many people are living in a close environment, like a hospital or nursing home, infections are more likely to spread if appropriate precautions are not taken.
Because nursing home residents are at a greater risk of suffering severe complications, nursing homes must identify signs of infection early so that treatment can begin.
Are Nursing Homes Required to Treat Infections?
Most infections are treatable with appropriate antibiotics, viral or fungal treatments, and fluids. Without early treatment, infections can lead to a deadly condition called sepsis and septic shock. This is a condition where organs fail as a result of an infection.
Pneumonia
What is Pneumonia?
Pneumonia is an infection of the lungs. Pneumonia can be caused by bacteria, viruses, and bacteria. Pneumonia and lower respiratory infections are the leading cause of death of nursing home residents. Nursing residents make up 10-18 percent of all hospitalizations for pneumonia. It is estimated that between 10 and 30 percent of nursing home residents who get pneumonia die within 30 days.
Who Is at Risk of Pneumonia?
The elderly in general are at increased risk of pneumonia. As the body ages, the body has to work harder to fight off an infection. Many nursing home residents are at an even higher risk of developing pneumonia because they have health conditions like diabetes, COPD, heart disease, and asthma. Nursing home residents are at an additional risk of pneumonia because they live in close quarters to other residents who may be infected.
Treatment of Pneumonia
Pneumonia is often diagnosed after a chest x-ray shows particles other than air in the lungs. Nursing home residents should be treated with broad spectrum antibiotics for five to eight days, cough medicine, and breathing treatments. If the symptoms do not go away, the treatment may continue longer.
Causes of Pneumonia at Nursing Homes
Common causes of pneumonia at nursing homes are caused by the nursing home failing to provide immunizations against pneumococcal and flu shot, not practicing good hand hygiene and infection control practices, providing a the resident with a poor diet, failing to provide appropriate movement and therapy resulting in the resident being immobile, and exposure to residents with pneumonia.
Signs and Symptoms of Pneumonia
The elderly sometimes have different symptoms of pneumonia than younger people do. The signs and symptoms of pneumonia in the elderly can vary but often include some of the following:
- Difficulty breathing or chest pain
- Changes in mental awareness or confusion in the elderly
- Cough
- Shortness of breath
- Fever
- Lower body temperature in the elderly
- Chills or excessive sweating
- Diarrhea, nausea, or vomiting
- Balance issues
- Urinary incontinence
- Loss of appetite
- Inability to perform day-to-day tasks
Aspiration Pneumonia
What is Aspiration Pneumonia?
Aspiration pneumonia is an infection of the lungs that occurs when food, fluids, vomit, or other materials enter the lungs. Aspiration pneumonia is common in the nursing home setting. Aspiration pneumonia is usually preventable with appropriate care.
Who Is at Risk of Aspiration Pneumonia?
People who are on a feeding tube are at risk for developing aspiration pneumonia. When on a feeding tube, stomach contents can back up into the lungs causing swelling and infection. Other people at risk for developing pneumonia are people who have difficulty swallowing. This is a common condition referred to as dysphagia. Certain medications, like opioids and antipsychotics, increase the risk of developing aspiration pneumonia.
Treatment of Aspiration Pneumonia
Aspiration is usually treated with antibiotics. In severe cases, the person may need hospitalization and extensive treatment.
Causes of Aspiration Pneumonia at Nursing Homes
The most common cause of aspiration pneumonia is poor oral care. Proper oral hygiene can prevent most instances of aspiration pneumonia. When the mouth is dirty and full of bacteria, that bacteria seeps into the lungs causing an infection. This does not happen when the mouth is kept clean. Other instances of aspiration pneumonia occur when gastric contents are regurgitated into the lungs. This is common for residents who have feeding tubes and also residents who eat lying down.
Signs and Symptoms of Aspiration Pneumonia
Signs And symptoms of aspiration include:
- Coughing greenish, dark, or foul smelling phlegm, or phlegm that contains blood or pus
- Problems swallowing
- Bad breath
- Fever
- Wheezing
- Excessive sweating
- Confusion
- Food or tube feeding material (if tube fed) in phlegm
Urinary Tract Infections
What is a Urinary Tract Infection?
Urinary tract infections (UTI) are the most commonly diagnosed infection in nursing homes. Urinary tract infections are usually treatable. Urinary tract infections account for 15 percent of all hospitalizations in the elderly. Without treatment, urinary tract infections can be deadly.
Who Is at Risk of Urinary Tract Infection?
The elderly are at risk of developing urinary tract infections because of age related changes in the body. These risk factors include changes in the immune system, malnutrition, poor bladder control, urinary retention, incontinence, prostate hypertrophy, constipation, poorly controlled diabetes, and having a prior UTI. The single greatest risk factors for developing urinary tract infections are a history or urinary tract infections and the presence of a catheter. Approximately 50 percent of residents with a catheter will develop a catheter-related urinary tract infection.
Nursing home caregivers must be aware of the risk factors for developing a urinary tract infection.
Treatment of Urinary Tract Infections
The standard treatment for urinary tract infections is antibiotics. The antibiotics are used to kill the bacteria causing the infection. If a fungus is causing the urinary tract infection, an antifungal medication will be prescribed to kill the fungus that is causing the infection. If the urinary tract infection is severe, it may require intravenous antibiotics and hospitalization.
Causes of Urinary Tract Infections at Nursing Homes
Urinary tract infections occur when bacteria or fungi enter the urinary tract. Many urinary tract infections are caused by E. Coli bacteria. E. Coli is a bacteria that is present in feces. It can enter the urinary system through the urethra. This is often caused by nursing home residents being left in their feces. Other common causes of urinary tract infections at nursing homes are from a dirty, infected urinary catheter. A urinary catheter is a tube that allows urine to flow from the bladder to a bag. When urinary catheters are not kept clean or changed frequently, it can cause bacteria to enter the bladder causing a urinary tract infection.
Signs and Symptoms of Urinary Tract Infections
Like many illnesses, signs and symptoms of urinary tract infections are different in the elderly. The most common signs of urinary tract infections in the elderly include:
- Confusion
- Delirium
- Agitation
- Low blood pressure
- Poor appetite
- Falls
- Drowsiness
Nursing home caregivers must be aware of the signs and symptoms so they can diagnose the disease early and provide effective treatment.
MSSA (Methicillin-Susceptible Staphylococcus Aureus) and MRSA (Methicillin-Resistant Staphylococcus Aureus)
What are MRSA and MSSA?
MSSA (methicillin-susceptible staphylococcus aureus) and MRSA (methicillin-resistant staphylococcus aureus) are infections caused by a type of bacteria commonly found on the skin. These are commonly referred to as staph infections. The primary difference is that MSSA can be treated by many antibiotics, while MRSA is resistant to treatment by antibiotics.
Who Is at Risk of MRSA and MSSA?
Staph bacteria is all around us and on our skin. People who are most at risk of developing staph infections are those with weakened immune symptoms, respiratory illness like COPD, nursing home residents, and especially people with open wounds. When a person has an open wound, such as a bedsore, it provides an opportunity for staph to enter the open area and enter the bloodstream.
Treatment of MRSA and MSSA
The standard treatment for urinary tract infections is antibiotics. The antibiotics are used to kill the bacteria causing the infection. If a fungus is causing the urinary tract infection, an antifungal medication will be prescribed to kill the fungus that is causing the infection. If the urinary tract infection is severe, it may require intravenous antibiotics and hospitalization.
Causes of MRSA and MSSA at Nursing Homes
Staph bacteremia occurs when MSSA or MRSA enters the bloodstream. Poor infection control policies at the nursing home is a major cause of staph infections. These include staff washing their hands before coming in contact with patients, following appropriate food safety precautions, and frequently cleaning surfaces that residents are likely to come into contact with. If a person has wounds, which could include scrapes, surgical wounds, or bedsores, nursing staff must use sterile bandages and keep the area clean.
Signs and Symptoms of MRSA and MSSA
The most common signs of MRSA and MSSA are:
- Cellulitis: a red swollen tissue under the skin that is often painful
- Impetigo: fluid-filled blisters that form and burst. They leave behind a yell or brown crust.
- Abscesses: These are red, painful sores under the skin. They are also called boils.
Once staph bacteria has entered the bloodstream, it is referred to as bacteremia. The symptoms are often more severe. The symptoms of staph bacteremia include:
- Temperature changes: This includes temperatures that are both higher and lower than usual.
- Mental decline: This includes being confused, sleepy, or even difficult to wake up.
- Extreme illness: This may include increased heart rate, low blood pressure, shortness of breath or discomfort.
Influenza
What is Influenza?
Influenza is also called the flu. Influenza is a serious respiratory illness that infects the throat, nose, and sometimes lungs. Influenza can spread quickly from resident to resident at a nursing home if proper precautions are not taken. If a nursing home does not take appropriate measures to prevent influenza, it may rise to the level of abuse, neglect, or negligence.
How Is Influenza Prevented at Nursing Homes?
Nursing homes are responsible for preventing nursing home residents from getting influenza and also from spreading pneumonia.
The most reliable ways to prevent the spread of influenza are:
- Vaccinating residents and staff
- Strictly following infection control protocols
- Having workers, residents, and staff wash their hands thoroughly
- Requiring staff to stay home if they have any signs or symptoms of influenza
- Training staff not to use each other’s phones, desk, computer, or other work tools without disinfecting them
- Using appropriate personal protection equipment (PPE) including gloves, masks, and gowns and changing them between seeing residents.
- Isolating residents who have any signs or symptoms of pneumonia or who have tested positive
Studies have shown that the best way to prevent the spread of influenza at nursing homes is for residents and staff to get vaccinated against the flu. Vaccinations can significantly reduce the number of infections, the severity of the infections, and the potential for an outbreak.
Nursing home residents who have symptoms of pneumonia or have had pneumonia confirmed by laboratory testing need to be isolated immediately.
How is Influenza Treated?
There are prescription drugs called antivirals that can be used to treat nursing home residents who have influenza. These are similar to antibiotics except they treat viruses instead of bacteria. These antiviral medicines must be given within 48 hours of flu symptoms beginning. Nursing homes must pay close attention to their residents so that they can treat them early.
How is Flu Transmitted in Nursing Homes?
Flu is transmitted from resident to resident in one of three ways:
- Droplets
- Aerosol
- Contact
Droplets that are too large to be inhaled into the lungs fall to the surfaces and the ground. Small particles called aerosols can remain suspended in the air. Those small particles can be inhaled into the lungs. Influenza can also be transferred when infectious particles come in contact with mucous membranes, like the nose.
Who Is at Risk of Getting Influenza?
Everyone is at risk of developing influenza. However, nursing home residents are at the highest risk of developing influenza. They are also at a higher risk of experiencing severe symptoms if they do get influenza. People with long-term chronic health conditions that weaken their immune system are also at a higher risk of getting influenza. These include people with chronic lung conditions like bronchitis and COPD.
As many as 5 percent of nursing home residents who contract influenza die. 85 percent of all influenza deaths occur in people over the age of 65.
Signs and Symptoms of Influenza
Unlike the common cold, influenza symptoms commonly come on abruptly.
Common symptoms of influenza are:
- Fatigue and weakness
- Aches and pain, commonly severe
- Chest discomfort, can be severe
- Fever
- Headache
- Stuffy nose
- Sneezing
- Sore throat
- Chills
Severe symptoms of influenza include:
- Difficulty breathing or shortness of breath
Pain in the chest or abdomen - Dizziness, confusion, or extreme drowsiness
Severe muscle pain - Loss of balance and unsteadiness
- Worsening of chronic medical conditions
- Seizures
Clostridioides Difficile (C. diff)
What is C. Diff?
C. diff is the short and common name for clostridium or clostridioides difficile. C. diff bacteria are common in the environment. Most people are exposed to c. diff bacteria, but do not get the infection. Typically, people only get the infection after they have been taking antibiotics. This is because antibiotics kill bad bacteria but also the good bacteria that keep us healthy. When the good bacteria are killed, it allows the bad bacteria to take over. This can allow the c. diff bacteria to take over. Also, if a person comes in contact with c. diff during this time period, they can get sick.
Once a person gets c. diff, it is extremely contagious. C. diff spreads when people touch surfaces, food, or objects that are contaminated with feces from a person who has c. diff.
Mild to moderate c. diff is easily treated with antibiotics. Severe c. diff, on the other hand, can cause the colon to become inflamed and swell. This is a condition called toxic megacolon. If allowed to progress, c. diff can result in sepsis and death.
Half a million people get c. diff each year. 15,000 people die from c. diff annually.
Who is at Risk for C. Diff?
Many people in nursing homes are at risk of developing c. diff. People most at risk of developing c. diff are those people who:
- Have recently stayed in a nursing home or hospital
- Are elderly (65 and older)
- Are taking antibiotics
- Have a weakened immune system
- Have had c. diff before
- Have been exposed to c. diff
Because nursing home residents are at risk of developing c. diff, nursing homes must vigilantly monitor their residents for any signs and symptoms of c. diff.
How is C. Diff Diagnosed?
Many cases of c. diff are highly suspected based on the clinical signs and symptoms. A stool sample is collected and tested to confirm the diagnosis of c. diff. Nursing homes have access to these tests. Because it takes 24 to 48 hours to get the results of the stool sample, nursing homes should begin antibiotic therapy before the results of the stool sample are available.
How is C. Diff Treated?
C. diff is treated with antibiotics. Antibiotic treatment is usually started before the results of the stool sample are back. This is because there are almost no side effects of the medication, but c. diff can progress quickly from mild to moderate to severe without treatment. A different antibiotic is used to treat c. diff than a traditional antibiotic.
Most cases of c. diff heal quickly with antibiotic treatment. About 15 percent of all cases of c. diff have symptoms that return after the initial round of oral antibiotics. This is called recurrent c. diff. The vast majority of those cases resolve with another round of antibiotics.
In severe cases, treatment is more complicated. It can result in hospitalization, a fecal microbiota transplant, and even surgery to remove the colon. If the c. diff has been allowed to progress to sepsis or septic shock, then additional treatment is needed in the intensive care unit.
What Causes C. Diff at Nursing Homes?
C. diff can be caused in one of two ways:
- Antibiotic use
- Exposure to the infection
Many patients begin to experience signs and symptoms of c diff within about 5 days of beginning antibiotics. Nursing staff should pay special attention to residents who are on antibiotics or who have recently taken antibiotics for any signs of c. diff.
C. diff infections are highly contagious and can spread rapidly through a nursing home. Nursing homes must isolate any residents who have symptoms of c. diff or who have tested positive for c. diff. If a resident comes into contact with another resident who has c. diff or if they are exposed to something that resident touched or came into contact with, they can easily contract c. diff. In addition to isolating residents, staff and any person who comes into contact with a resident must wear personal protective equipment (PPE), including masks, gloves, gowns, and shoe covering. They must also wash their hands thoroughly.
What are the Signs and Symptoms of C. Diff
Nursing staff must be aware of the signs and symptoms of c. diff because it is common and can progress rapidly without treatment. As the infection becomes more severe, so do the symptoms.
With mild to moderate c. diff, the most common symptoms are:
- Watery diarrhea 3 or more times a day for more than 1 day
- Mild belly cramping
Many people describe the smell of c. diff as being different from other feces. They describe it as unusually strong and sometimes sweet. This is because of increased acids in the feces caused by the infection.
As the infection progresses, so do the symptoms. Severe symptoms of the infection include:
- Increased watery diarrhea, as many as 10-15 times per day
- Belly pain and cramping, which can be severe
- Loss of appetite
- Weight loss
- Nausea
- Fast heart rate
- Increased temperature (fever)
- Kidney failure
- Increased white blood cell count
- Swollen belly
- Blood or pus in the stool
If c. diff is not treated, it can result in severe dehydration, toxic megacolon, sepsis, and death.
Signs and Symptoms of Influenza
Unlike the common cold, influenza symptoms commonly come on abruptly.
Common symptoms of influenza are:
- Fatigue and weakness
- Aches and pain, commonly severe
- Chest discomfort, can be severe
- Fever
- Headache
- Stuffy nose
- Sneezing
- Sore throat
- Chills
Severe symptoms of influenza include:
- Difficulty breathing or shortness of breath
Pain in the chest or abdomen - Dizziness, confusion, or extreme drowsiness
Severe muscle pain - Loss of balance and unsteadiness
- Worsening of chronic medical conditions
- Seizures
Gastroenteritis
What is Gastroenteritis?
Gastroenteritis is caused when the stomach and intestines become inflamed because of a bacterial or viral infection. Gastroenteritis can be a minor condition or it can result in potentially life-threatening complications without appropriate care. Gastroenteritis can be particularly dangerous for the elderly. It is dangerous because of the infection itself, but also because it can result in severe dehydration for a resident. Nursing homes must take all steps to prevent stomach infections in the elderly because it can be so dangerous.
Bacterial gastroenteritis is often caused by food contaminated with the bacteria E. coli, salmonella, and campylobacter.
One of the most common forms of viral gastroenteritis at nursing homes is an infection called Norovirus. Norovirus is actually the name for a group of viruses that cause inflammation of the stomach and large intestine. Noroviruses are highly contagious viruses that can spread quickly.
Once you eat food contaminated by bacteria or a virus, it infects your body by causing inflammation of the stomach and intestine. The inflammation of the stomach and intestine triggers the body’s immune response to begin vomiting or have diarrhea. Norovirus is commonly referred to as “food poisoning” or the “stomach flu.”
Who Is at Risk for Gastroenteritis?
Anyone living in confined areas is at risk of getting gastroenteritis or Norovirus. This is because they are likely to share the same contaminated food and be exposed to the same unsanitary environment where the virus is likely to spread. Norovirus is common in nursing homes and cruise ships.
Nursing home residents are at a high risk of getting gastroenteritis if infection and food safety protocols are not followed. Nursing home residents share common food prepared in a central kitchen. This contaminated food is served to all residents causing a sudden outbreak. Nursing home residents also frequently come into contact with other residents who may be infected. They are also likely to touch contaminated surfaces throughout the day.
Nursing home staff are also likely to pass the infection. They come into contact with residents and surfaces throughout the day. They are at risk of contracting the infection and then infecting other residents.
Treatment of Gastroenteritis
If norovirus is suspected, a doctor may order a rapid stool test to determine the presence of the infection. There are no quick stool tests for bacterial infections.
There are few treatments to kill the virus causing viral gastroenteritis. It is essential that nursing homes hydrate and rehydrate residents. This can be done through special drinks purchased at the pharmacy, water, sports drinks, broths, or with an IV in more severe cases of dehydration. Nursing homes can also give medications to control vomiting and diarrhea to prevent severe dehydration.
Antibiotics can be given for bacterial gastroenteritis. Symptoms begin to go away within a few days. Just as in viral gastroenteritis, nursing homes must ensure that the resident gets proper hydration to avoid becoming dehydrated. Extreme dehydration can cause organ failure and death.
Causes of Gastroenteritis at Nursing Homes
Most causes of gastroenteritis in nursing homes are caused by poor food preparation, poor cooking hygiene, and failing to keep surfaces people come in contact with clean.
Staff either undercook food or touch a contaminated surface and then touch food before serving it. Because food is prepared in a central kitchen at a nursing home, the contaminated food is often served and many people are contaminated before anyone has symptoms. Bacteria and viruses causing gastroenteritis can also be spread by touching a contaminated surface and then touching their eyes, noses, or mouth before serving food.
Nursing staff are also at a high risk of contracting gastroenteritis because of their close and constant contact with nursing home residents. Once they contract the virus, they can easily spread the infection to nursing home residents.
Is Gastroenteritis Preventable in Nursing Homes?
Prevention of gastroenteritis begins with excellent infection control practices, proactive hand hygiene, and keeping surfaces clean and disinfected.
Food must be thoroughly cooked and never come into contact with contaminated surfaces.
Nursing home residents who have gastroenteritis must be isolated from all other residents until their symptoms have passed.
Staff who come into contact with infected residents, must wear appropriate personal protective equipment (PPE) including gloves and masks to avoid spreading the virus.
Infected staff must not be permitted to come to work until all symptoms have gone away.
If these steps are taken, most cases of gastroenteritis can be avoided.
Signs and Symptoms of Gastroenteritis
Symptoms of gastroenteritis often begin 24-72 hours after exposure to the bacteria or virus. The most common signs of gastroenteritis are:
- Nausea
- Diarrhea
- Vomiting
- Abdominal cramping and pain
In more severe cases, people may experience:
- Dehydration
- Electric imbalance
- Bloody diarrhea
- Fever (sometimes very high)
Vomiting and diarrhea can spread the infection to others.
Necrotizing Fasciitis (flesh eating bacteria)
What is Necrotizing Fasciitis?
Necrotizing fasciitis is a bacterial infection that spreads quickly and can quickly cause death. Necrotizing fasciitis is a “flesh eating bacteria” or “flesh eating disease.” Necrotizing fasciitis literally means death of fascia (the tissue under the skin).
It requires immediate surgical treatment to prevent it from spreading and causing death. There are numerous different bacteria that can cause necrotizing fasciitis.
Who Is at Risk of Necrotizing Fasciitis?
The bacteria that causes necrotizing fasciitis enters through a break or opening in the skin. People at highest risk of developing flesh eating disease are people with damage to their skin, including:
- Bedsores (pressure injuries)
- Surgical wounds
- Cuts and scrapes
- Burns
- Puncture wounds.
Many nursing home residents are at risk of developing flesh eating disease because they have had a recent surgery, have developed bedsores, or experienced other damage to their skin, including cuts and scrapes.
Most people who get necrotizing fasciitis also have other illnesses that lower their body’s ability to fight off infections. These illness include:
- Cancer
- Cirrosis (scarring of the liver)
- Diabetes
- Kidney disease
- Obesity
- Problems with immune system
This makes nursing home residents especially vulnerable to necrotizing fasciitis because they often have conditions that lower their immune system.
How is Necrotizing Fasciitis Treated?
Necrotizing fasciitis is an emergency condition. It requires immediate treatment in a hospital. The first line of treatment is to prescribe strong IV antibiotics and surgically remove the infected tissue and surrounding areas. Without immediate treatment, the infection will continue to spread and kill tissue resulting in death.
What Causes Necrotizing Fasciitis at Nursing Homes?
Necrotizing fasciitis occurs at nursing homes when staff fail to maintain appropriate infection prevention practices by washing their hands and keeping surfaces clean, or by failing to properly clean and care for wounds.
What are the Complications of Necrotizing Fasciitis?
Necrotizing fasciitis can cause organ failure, shock, sepsis and death without immediate treatment. Up to 1 in 3 people with necrotizing fasciitis experience toxic shock syndrome. 1 in 5 people with necrotizing fasciitis die. Even with treatment, it can result in life-long complications including severe scarring and limb loss.
What are the Signs and Symptoms of Necrotizing Fasciitis?
Early signs and symptoms of necrotizing fasciitis include:
- Fever
- Swollen, red, or warm area of the skin that spreads quickly
- Severe pain, including pain around the area of the skin that is red
The later signs and symptoms of necrotizing fasciitis are:
- Changes in the color of the skin
- Blisters, ulcers, or black spots on the skin
- Pus or oozing from the infected area
- Tiredness (fatigue)
- Nausea or diarrhea
- Dizziness
Sepsis
What is Sepsis?
Sepsis is a life-threatening emergency. Like a heart attack or stroke, time matters. The risk of death increases by the hour with sepsis.
Sepsis is not itself an infection. It is the body’s extreme response to an infection. In response to the infection, the body’s immune system attacks itself. Infections that most commonly cause sepsis are lung infection, urinary tract infections, and skin infections, and gastrointestinal infections. These are infections that commonly occur at nursing homes.
Sepsis can lead to organ failure, called septic shock, and death. Also, severe sepsis, even with treatment, can cause severe complications and a condition called post-sepsis syndrome.
At least 1.7 million people in America develop sepsis. 350,000 people with sepsis die while they are hospitalized or put on hospice service because they are dying because of sepsis. 30 percent of people with sepsis die while being treated in the hospital.
Who Is at Risk of Sepsis?
The greatest risk factor for sepsis is infection. Any infection can cause sepsis without appropriate treatment. The greatest risk for sepsis is the risk of an infection and the ability to fight off that infection. That includes:
- Elderly (those 65 years and older)
- People with weakened immune system
- People with chronic illnesses
- Diabetes
- Kidney disease
- Lung disease (COPD)
- People with recent hospitalizations or severe illness
- People who previously had and survived sepsis
How is Sepsis Treated?
The main treatment for sepsis is antibiotics that are given through a vein (intravenously). This kind of treatment is usually not available in the nursing home setting. It is critical that nursing homes immediately transfer any resident with signs of sepsis to the hospital for treatment. When treating sepsis, time is of the evidence. The risk of survival and a positive outcome changes by the hour. Every moment that passes makes the sepsis more difficult to treat and increases the likelihood of long-term complications.
What Causes Sepsis at Nursing Homes?
The initial cause of sepsis is an infection. The elderly are particularly vulnerable to sepsis because of their weakened immune system and often having multiple other conditions.
Nursing homes prevent sepsis in two ways: (1) by preventing the infection and (2) by treating the infection early. This also means that nursing homes cause infections in two ways: (1) by failing to prevent infections and (2) by failing to treat infections promptly.
Signs and Symptoms of Sepsis
The signs and symptoms of sepsis vary depending on the stage of the condition. Common signs and symptoms of sepsis include:
- Rapid heart rate or breathing
- High or lower than normal body temperature
- Confusion or mental status changes
- Weakness and fatigue
- Chills and shivering
- Clammy or sweaty skin
- Difficulty breathing
- Physical pain or discomfort
- Abdominal pain, vomiting, or nausea
- Low blood pressure
- Elevate white blood cell count
- Elevated lactate levels
Is Septic Shock Different Than Sepsis?
Sepsis may progress to a condition called septic shock if it isn’t treated. Septic shock is the final and most severe form of sepsis. Sepsis was previously referred to as “blood poisoning.”
Septic shock is a severe drop in blood pressure and causes organ failure. Symptoms of septic shock include:
- Inability to stand up
- Severe change in mental status, such as delirium
- Extreme sleepiness or difficulty staying awake
As your heart pumps, it produces enough blood pressure to push the blood to organs. When a person’s blood pressure drops dramatically because of septic shock, the organs cannot function causing multiple organ failure and death.
Representative Cases
Stephen
Stephen was a 69-year-old man with a history of schizophrenia and a traumatic brain injury. He was known to “scarf” or “wolf” his food. He would attempt to take large bites of food and quickly swallow it without chewing. He was seen by a speech therapist who recommended that staff closely monitor him when eating to make sure that he took small bites, chewed his food thoroughly, and then swallowed his food. Nursing staff did not follow the speech therapist’s recommendations. Stephen was given a tray of food to eat alone in his room. This was a common practice. When staff arrived in his room to retrieve his meal tray, he was unresponsive and covered in vomit after aspirating his food. Staff then waited 41 minutes to call 911. Once in the hospital, Stephen was diagnosed with aspiration pneumonia and sepsis. Stephen never recovered and died. The jury awarded $26,000,000 in Trumbull County, Ohio.
Scott
Scott was a 44-year-old man who was in a nursing home for rehabilitation following a spinal cord injury. A urinary catheter was placed because he could no longer control his bladder. Scott began exhibiting signs and symptoms of a urinary tract infection. Nursing home staff did not send him to the hospital until he could no longer respond and was urinating blood, however. By the time Scott was sent to the hospital, multiple organs had failed and he was in septic shock. Scott died from the septic shock caused by the untreated urinary tract infection.
Henrietta
Henrietta was a 70-year-old resident of a nursing home. Over a period of days, Henrietta showed signs of an infection. The nursing home’s staff did not take any action until the staff found her unresponsive and gasping for air. She was critically ill when she arrived at the hospital. The hospital was unable to save her life. She died from septic shock caused by a urinary tract infection.
Jack
Jack was an 84-year-old resident of a nursing home in Knox County, Ohio. He had previously lived at home before falling and injuring his leg. He was admitted to a nursing home for rehabilitation to allow his leg to heal. While at the nursing home, his family became concerned about his care. He was losing weight, becoming weak, and suffering from stomach cramping. He then began experiencing diarrhea. After doing online research, his family became concerned that he was suffering from an infection called clostridium difficile (c diff.). The nursing home assured his family that he did not have c diff. The nursing home said he was suffering from a mildly irritated stomach. Two days later, he was taken to the hospital where he was diagnosed with c. diff. The infection had progressed to cause a systemic illness called sepsis. He died from organ failure caused by untreated c. diff. The jury returned a verdict for $5,000,000. This was double the highest recorded verdict in the county’s history.
Darlene
Darlene was a 65-year-old woman who moved into a nursing home for rehabilitation before returning home. She had multiple wounds that were not properly cleaned, treated, or covered. She contracted the flesh eating disease necrotizing fasciitis. By the time she was hospitalized, the infection had caused irreparable damage. She died from severe sepsis caused by necrotizing fasciitis.
How Much is My Nursing Home Infection Case Worth?
Every case is unique and has to be evaluated on its specific facts. The only way to determine the value of your nursing home infection case is to begin an investigation.
