Infections in Nursing Homes
Older adults living in skilled nursing facilities are vulnerable to infections because of advanced age, chronic health conditions, and close living quarters. Nursing home infections can cause severe complications, including organ failure and death. While common infections can be prevented with adequate infection-control practices, many nursing homes are cited for deficiencies. Understaffing is often the underlying cause.
If your loved one has experienced complications or death from a nursing home infection, nursing home neglect could be the culprit. We may be able to help you and your loved one hold the nursing home accountable. Call us at (877) 374-1417 today for a free consultation.
Nursing homes have a legal duty to provide a safe, clean environment and quality care. Instead, some facilities are hotbeds of disease where residents are chronically one needle-stick away from a dangerous infection. The Centers for Disease Control and Prevention estimates that one to three million serious infections occur in long-term care facilities yearly.
Where Do Nursing Home Infections Come From?
Nursing home infections come from infected residents, visitors, and staff. When a new resident enters a nursing home or returns from hospitalization, there is a risk of a new infection infiltrating the facility. Daily shift changes also mean staff have multiple opportunities to contract germs and spread them.
There is no practical way to prevent all infections from entering such facilities. However, nursing homes are obligated to stop infections from spreading.
How Are Infections Transmitted?
Patients are most commonly infected during surgical procedures, placement of catheters, and skin punctures. Infections also can enter through sores and broken skin areas. Some pathogens are airborne and may be inhaled.
Some people are infection carriers, which means they harbor infectious bacteria on their skin or in their noses without becoming infected. This condition is known as colonization.
Colonized residents and staff can transmit infections through direct contact or by touching an object that a resident later touches. This danger is why instrument sterilization, glove changes, and handwashing between patients are crucial to an effective infection control program.
Common Nursing Home Infections
The most common nursing home infections include:
- Staph infections, including MRSA
- Urinary tract infections
- Vancomycin-resistant enterococci
- Gram-negative bacterial infections
- Respiratory infections
- Skin infections
- C. Difficile
Bacteria known as staphylococcus can lead to more than 30 different types of infections in multiple body sites. The most common is Staphylococcus aureus. Staph bacteria may cause the following infections:
- Skin infections
- Bone infections
- Food poisoning
- Toxic shock syndrome
- Infections of the heart chambers and valves, known as endocarditis
Staph can be spread through objects, hands, towels, and food. Residents with the highest risk for staph infections possess the following characteristics:
- Vascular disease
- Lung disease
- Other chronic conditions
- Recent surgery
- Implanted devices
- Burn injuries
- Kidney failure requiring dialysis
- Reliance on a catheter, ventilator, or feeding tube
Methicillin-resistant Staphylococcus aureus, or MRSA, is an especially dangerous type of staph infection resistant to most antibiotic treatment. It is one of the most common types of nursing home infections and can lead to other serious infections, including:
- Blood infections
MRSA commonly affects the skin. However, in nursing homes, it can enter the bloodstream during surgery, catheter placement, skin punctures, or other invasive procedures. Residents with surgical wounds, foot ulcers, bedsores, or other broken skin areas are especially susceptible. MRSA is fatal in about 33 percent of cases and may require dialysis for kidney failure.
Approximately one-third of people carry staph bacteria in their noses without experiencing illness, and one to two percent of people carry MRSA without developing serious infections. The bacteria is commonly spread through nursing home personnel’s unwashed hands.
Urinary Tract Infections
Older adults are vulnerable to urinary tract infections due to age-related changes, including immune system variations and urinary system weakening. Urinary tract infections are the most common infections in nursing homes, and adults with indwelling urinary catheters pose the highest risk of developing these complications.
An indwelling catheter is a device that is attached to the bladder to drain urine into a bag. They are only clinically recommended in limited circumstances. According to the Agency for Healthcare Research and Quality, urinary incontinence does not justify their use.
However, nursing homes frequently use indwelling catheters for incontinent residents or those who simply need toileting assistance. Due to understaffing, nursing home personnel are unable or unwilling to take the necessary time to help residents get to the bathroom or keep them clean.
Approximately 50 percent of catheterized residents develop catheter-associated urinary tract infections, known as CAUTI. Infection risk is further increased by the following:
- Overuse of antibiotics to treat asymptomatic bacteria in the urine
- Poor hand hygiene by staff
Urinary tract infections are dangerous in adults older than 65. They experience symptoms that would be atypical in other age groups, including delirium, confusion, frequent falls, loss of appetite, rapid heartbeat, and hypotension. Without treatment, the infections can spread to the kidneys or cause sepsis.
Vancomycin-resistant enterococci is a type of bacteria normally present in the female urinary tract and human intestines. It can also be found in the environment and lead to serious infections resistant to the antibiotic Vancomycin.
These infections can cause endocarditis, urinary tract infections, abdominal and pelvic infections, and central nervous system infections.
Gram-Negative Bacterial Infections
Gram-negative bacteria are a large category of antibiotic-resistant bacteria with protective cell membranes preventing white blood cells from repelling them. These membranes also are what make gram-negative bacteria resistant to antibiotic treatment.
Gram-negative bacteria pose a significant health threat to nursing home residents because they spread among vulnerable populations with reduced immunity.
They can lead to dangerous secondary infections, including:
- Inflammation of the abdominal cavity linings
- Urinary tract infections
- Bloodstream infections
- Surgical site infections
Carbapenem-resistant Enterobacterales are the most common gram-negative bacteria in nursing homes. They caused 13,100 infections in hospitalized patients in 2017, resulting in an estimated 1,100 deaths. Carbapenem antibiotics are considered the last line of defense for bacterial infections.
Nursing home patients with the highest risks of contracting these bacteria include:
- Patients requiring ventilators, urinary catheters, and intravenous medications
- Patients on long-term antibiotic treatment
- Patients with weakened immune systems
The most well-known type of Carbapenem-resistant Enterobacterales is Escherichia coli, also known as E. coli, and Klebsiella pneumoniae. These bacteria are spread through the following mechanisms:
- Contact with infected or colonized people
- Contact with feces, such as through unwashed hands
- Improperly sterilized medical equipment
Symptoms of Klebsiella pneumoniae can cause fever, chills, pain, and loss of consciousness often as a result of this bacteria causing infections of specific organs, including:
- Urinary tract infection
- Skin infections
- Liver or spleen infections
- Any other locations
E. coli can cause diarrhea, stomach cramps, nausea, and vomiting. These symptoms can cause dehydration, malnutrition, and intense suffering. Dehydration and malnutrition may cause permanent organ damage or death in elderly nursing home residents.
Norovirus is the virus that causes stomach flu. Symptoms include severe nausea and vomiting, diarrhea, stomach cramps, fever, chills, headache, muscle aches, and fatigue. It is highly contagious through direct contact with an infected person, consuming contaminated foods or liquids, touching contaminated surfaces, and unwashed hands.
In young, healthy adults, norovirus typically self-resolves without complications, but elderly adults in nursing homes are at risk of prolonged illness, leading to dehydration, malnourishment, and dangerous weight loss.
Also known simply as the flu, influenza is a common nursing home infection that can lead to pneumonia, bronchitis, and other severe lower respiratory infections that require hospitalization. It is highly contagious, and outbreaks in nursing homes can be explosive.
Influenza can lead to hospitalization and death at any age. However, older adults, especially those over 75, have a higher risk of both outcomes. In addition to respiratory complications, influenza can lead to cardiovascular, neurological, and musculoskeletal complications.
Understaffing contributes to the rapid spread of influenza in long-term care facilities. Staff may be forced to work while sick, and uninfected patients often have to share caregivers with infected patients. When combined with poor hand hygiene and other infection control deficiencies, residents have little chance of avoiding contracting influenza.
Approximately one to two of every 1,000 nursing home residents develop pneumonia, with mortality rates ranging from 13 to 41 percent. The following residents have the highest risk of developing pneumonia:
- Residents who receive IV therapies
- Residents on hemodialysis
- Residents who have been hospitalized more than two of the past 90 days
Pneumonia itself is not contagious, but it is often a secondary infection from other common nursing home infections that are very contagious, such as gram-negative bacteria, influenza, and COVID-19.
Older adults are susceptible to skin infections because the skin becomes thinner, loses elasticity, and produces fewer oils during old age. These factors make the skin more prone to injury and slower to heal. The skin is a protective barrier preventing pathogens from entering the body. Skin infections can remove this defense and serve as an entry point for serious internal infections.
Also known as pressure ulcers, bedsores are among nursing homes’ most common skin infections and are an important red flag for neglect. Pressure ulcers occur from prolonged pressure on certain areas of the skin, especially when a resident is not kept dry or repositioned often enough.
These sores are painful, difficult to treat, and increasingly prone to infections as they worsen. The most common sites where bedsores form include the following:
- The sacrum, which is the area just above the tailbone
- The heels
- The top of the femur
- The “sit bones” beneath the pelvis
- The back of the head
- Inner knees
- Protruding areas of the ankle
Infected bedsores can penetrate skin layers and cause secondary infections, including bone infections, sepsis, and flesh-eating disorder. Poorly managed bedsores can be fatal.
People with diabetes are susceptible to poor wound healing and often develop sores, known as ulcers, which fail to heal. They are commonly found on the feet. They can become infected and cause skin infections while serving as a doorway to internal infections. Approximately 14 to 24 percent of diabetic patients with foot ulcers undergo amputations.
Although diabetic patients may be predisposed to ulcers, this does not mean the condition is inevitable. Diabetic ulcers 14 to 24 percent when the following measures are implemented:
- Appropriate foot care
- Adequate blood sugar control
- Well-fitting footwear
- Skincare to maintain an appropriate level of moisture
Understaffed nursing homes often neglect foot care until it is too late and an irreversible ulcer has formed. Poor infection control procedures increase the risk of infections entering the body through the wound, which may be poorly managed in many nursing homes.
Body lice, also known as scabies, are mites that burrow into the skin and cause rashes, discomfort, and severe itching. They are highly contagious and can spread between residents and staff.
Intense scratching from untreated mite infestations can cause bacterial skin infections, making elderly adults vulnerable to sepsis and other serious infections. The presence of scabies among nursing home residents is a telltale sign of nursing home neglect.
Sepsis is an extreme response to an infection that leads to severe tissue damage and organ failure. It occurs when an infection triggers a chain reaction in the body. The initial infection is often bacterial, but viruses and fungi can also lead to sepsis. Most sepsis cases start in the lung, urinary tract, skin, or gastrointestinal tract.
The CDC has identified the following risk factors for sepsis infections in nursing home residents:
- Age of 65 or older
- Chronic medical conditions, such as diabetes
- Weakened immune system
- Recent hospitalization
The risk is further increased when poor infection control practices in nursing homes facilitate the spread of infections. Sepsis is such a serious infection that it accounts for approximately 33 percent of hospital deaths. Once sepsis sets in, it can progress rapidly. The following symptoms are warning signs of sepsis:
- Weak pulse
- Extreme pain
- Shortness of breath
- Clammy skin
Clostridioides difficile is a common infection in nursing homes and hospitals that causes colon inflammation. Two-thirds of all C. difficile cases affect adults 65 and older, accounting for more than 80 percent of C. difficile deaths. Approximately 100,000 new cases occur in nursing homes annually.
C. difficile is contagious and may cause the following symptoms:
- Stomach tenderness
- Nausea and vomiting
- Low appetite
Many nursing home residents are already in a high-risk group nutritionally. Any condition that prevents food consumption can cause weight loss, malnourishment, and dehydration. These complications are especially severe when diarrhea is also present. Irreversible damage and death often result from these symptoms, making C. difficile a serious and life-threatening nursing home infection.
COVID-19 struck nursing homes particularly hard. According to the Illinois Department of Health, 46 percent of all Illinois COVID-19 deaths occurred in nursing homes.
Early in the pandemic, it was well-established that the elderly population had the highest risk of hospitalization and death from COVID-19. Immune system challenges, frailty, and chronic illnesses contribute to these risks, and most patients who require skilled nursing care suffer from one or more of these conditions. Nursing homes knew these factors and should have been well-prepared to protect patients.
A study by the United States Office of the Inspector General of the Department of Health and Human Services found that nursing homes were unprepared for COVID-19. More than 1,300 nursing homes studied had infection rates of 75 percent or higher during peak outbreak periods and a 20 percent mortality rate.
Some nursing home workers allege they were not provided adequate personal protective equipment and were forced to work while sick, even with COVID-19, due to staff shortages.
COVID-19 remains a threat in nursing homes, and there is no indication that the facilities are more prepared today than in 2020.
Why Do So Many Nursing Home Residents Develop Infections?
Nursing home residents are vulnerable compared to younger adults because of their advanced age, health conditions, and close living quarters with other adults prone to infections. When one nursing home resident develops a contagious infection, all residents are at risk.
Although nursing homes cannot always control what infections come into the facility, there is no excuse for allowing them to spread. The Centers for Medicaid and Medicare Services has established infection control procedures, but Illinois is one of the worst states in the nation for infection control violations.
Common infection control violations in nursing homes include:
- Failure to wash hands between patients
- Washing hands too quickly or without soap
- Failure to sterilize instruments between patients
- Failure to change gloves or other disposable protective clothing between patients
- Unsanitary food handling practices
- Using the same gloves to handle clean and dirty dishes
- Requiring staff to come to work while sick
- Poor hygiene, such as leaving residents in soiled or wet clothing or linens
- Catheterizing patients when it is not clinically indicated
According to the CDC, health care providers should wash their hands for at least 20 seconds between patients with soap and water or enough alcohol-based hand sanitizer for their hands to remain wet for the same amount of time. They also should take care to wash every area of each hand. Staff should never touch anything after touching a patient until after washing their hands.
Personal protective equipment should be used when treating contagious patients and properly removed before tending to other patients. Even if gloves were worn while treating a prior patient, nursing home staff should still wash their hands after removing their gloves.
The bottom line is that an effective infection control program takes time, and most deficiencies can be traced to understaffing in nursing homes. Many nurses and assistants are caring, dedicated workers. But their impossible workloads force them to rush between patients without taking the time to follow infection control procedures.
The Consequences of Infections in Nursing Homes
When one nursing home resident develops an infection because of nursing home neglect, there is no reason to believe the facility will take the necessary precautions to prevent other residents from developing the same infection.
Every resident who develops a serious infection faces a high risk of one or more of the following consequences:
- Organ failure
- Permanent tissue damage
- Deadly secondary infections, including pneumonia and sepsis
- Severe chronic pain
- Loss of a limb
- Severe emotional distress
- Loss of consciousness
Legal Help for Nursing Home Neglect
If a nursing home has failed your older family member, they deserve justice. We can file a nursing home neglect lawsuit on their behalf, and your family member could receive significant financial compensation.
Our award-winning nursing home abuse lawyers were among the first attorneys in the nation to stand up to nursing homes on behalf of elderly adults who otherwise lacked the means to advocate for themselves. Our founders, Steven Levin and John Perconti, are well-known throughout the country as pioneers in nursing home litigation. Contact us today to schedule a free consultation.
against a facility located in the northern suburbs for a former nursing home resident who sustained injuries as a result of a pressure sore.
record nursing home pressure sore settlement against a suburban Hillside nursing home and physician for a 59-year-old resident who developed multiple painful and infected bedsores which took four years to heal
for the family of an 88-year-old assisted living facility resident who developed severe and infected bed sores which ultimately brought about her death. Her doctor was criminally indicted for his conduct and charged with involuntary homicide