The Journal of Gerontology reported in 2001 that every year more than 25% of residents living in nursing homes are transferred to the hospital or emergency room for evaluation and treatment of infections. Infection is the most frequent reason for the transfer of nursing home residents to the hospital. Urinary tract and respiratory tract infections are the most common type of infections resulting in hospitalization. The authors of the 2001 study discovered that a majority of medications prescribed for the patients while they were still in the nursing home were written without a direct physician examination, “raising key questions about practice patterns and the effect on patient care and costs.”
Methicillin-resistant Staphylococcus aureus (MRSA) is a dangerous, sometimes fatal disease and is a major source of illness acquired in nursing homes. MRSA spreads easily—most commonly by health care workers’ hands. Antibiotics like penicillin are ineffective against the organism. Nursing home residents are particularly vulnerable because this infection tends to increase with advancing age. Hospitals have isolation facilities and greater access to infection control expertise which make it easier to introduce effective interventions in hospital setting. In the nursing home setting, however, infection control training is not as prevalent as in hospitals.
Yet, nursing homes can take advantage of lessons learned from hospital research. To address the issue of infection and MRSA in particular, nursing homes should screen recently admitted residents, ensure proper hand washing and high standards of cleaning and decontamination.
It is critical that nursing home staff to make infection control a priority and to communicate this priority to all staff.
Sepsis (or septicemia) is a bacterial blood infection. Older adults and persons with impaired immune systems are at increased risk. Symptoms of sepsis may include elevated heart rate, rapid breathing, abnormal temperature, and decreased appetite. Symptoms of severe sepsis or septic shock include: a change in mental status (such as confusion or decreased alertness); diarrhea; low blood pressure, dizziness; warm, flushed skin; skin rash or bleeding; and decreased urine output. Complications of sepsis can cause serious illness and may be fatal. “Severe” sepsis involves the malfunction or failure of one or more of the patient’s organs. The Mayo Clinic reports that approximately 750,000 people in the U.S. get severe sepsis every year, resulting in the deaths of over 200,000 people.
A person’s skin normally provides a barrier against viral and bacterial infections. An open wound, however, compromises this barrier and allows a bacterial infection that leads to the development of sepsis. Immobilized patients require preventive care and vigilant examination to prevent the development or progression of pressure sores. Decubitus ulcers are serious and well-recognized medical conditions encountered frequently in elderly and immobilized patients. Complications of decubitus ulcers substantially increase the risk of premature death from infections such as septicemia. Septicemia from decubitus ulcers has been associated with a mortality rate of approximately 50%. For this reason careful and diligent observation and, when necessary, timely and aggressive intervention is required to protect the nursing home resident.
Once a resident develops a pressure sore, increased vigilance and careful monitoring are required to ensure healing rather than progression to infection of the underlying bone. At a minimum, the standard of care requires reasonable efforts to avoid fecal contact and prompt removal of feces from the skin. When nursing home residents are neglected and have prolonged contact with bacterially contaminated fecal material, the naturally protective skin surface breaks down. The prolonged contact with fecal material in the decubitus ulcer results from the nursing home’s failure to provide timely attention and care, exposing the resident’s underlying tissues to toxic bacteria.
Life-threatening complications of decubitus ulceration including complications of chronic inflammation, protein loss and septicemia must be part of a responsible nursing home’s ongoing and frequent assessment of an at risk patient. Fever in a patient at risk for septicemia is a critical vital sign that requires a timely response from nursing home staff. Even as a resident’s wound progresses, special avenues of treatment and wound care may be available but are often not provided in time or at all due to neglect.
If you believe a loved one has been a victim of physical abuse, sexual abuse, or mental abuse in a nursing home or other elder care facility, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a FREE CONSULTATION.