Infection In Nursing Homes

Infections are common hazards in nursing homes that can cause serious illness and even death in elderly patients. Respiratory and gastrointestinal infection outbreaks predominate in this setting, with outbreaks of skin and soft-tissue infections also occurring.

It is essential for nursing staff and families of care facility residents to be alert to the signs and symptoms of common infections. With infectious disease, swift action is required should symptoms be present or suspected.

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Prevalence Of Skin Infections In Nursing Facilities Nationwide

When the Coronavirus pandemic raced through the country in 2020, one of the hardest-hit demographics was the older adults living in nursing care facilities.

The pandemic highlighted the high rate of acute and chronic wound infections prevalent in nursing centers, which leads to loss of health, death, regular hospitalization, and substantial healthcare costs.

Why And How Are Infections In Nursing Homes?

The National Nursing Home Survey of 2004 estimated that 1,5 million nursing home residents receive care in 16,100 nursing home facilities in the United States. These residents experience an average of an estimated 2 million infections per year.

Of all the nursing home residents, 88.3% are 65 years and older, with 45% older than 85. Another contributing factor to infections spreading in nursing homes is the transfer of residents between the hospital and the nursing home or between one nursing home setting and another.

Nursing home residents that are particularly susceptible to common infections are patients with:

• Indwelling devices, such as catheters and feeding tubes
• A recent hospital stay

For example, many care facility residents with feeding tubes risk aspiration pneumonia, skin infections, soft tissue infections, and mechanical complications.

Overusing Antibiotics Can Lead To Infections

Infectious diseases and the overuse of antibiotics are the main reasons antibiotic-resistant organisms (ARO) or antibiotic-resistant pathogens are found in the nursing home setting.

Examples of ARO include Methicillin-resistant Staphylococcus aureus (MRSA), resistant Gram-negative bacilli, Carbapenem-resistant Enterobacterales(CRE), and vancomycin-resistant enterococci.

Aro Factors

Nursing Home Residents are at particular risk of ARO or antibiotic-resistant pathogens due to the following factors:

• Age
• Longer-term institutionalization amongst nursing home resident population
• Functional status
• Previous use of antibiotics
• Indwelling devices
• Current illnesses

The prevalence of infections in nursing homes or healthcare facilities is shocking. These facilities should have a disease control protocol and provide quality care to loved ones.

Most Common Infections Of Nursing Home Residents

The following are common infectious diseases most frequently found in nursing homes.

Diarrheal Diseases / Infections

Examples of contagious and non-contagious conditions with typical and atypical symptoms include:

• Infectious gastroenteritis and diarrhea
• Vascular ulcers
• Diabetic patient's wound infections
• MRSA (Methicillin-resistant staphylococcus aureus)
• Pneumonia and bloodstream infections caused by resistant gram-negative bacilli
• Oral health issues

Many infections result from lower levels of gastric acid due to aging. Reduced gastric acid levels increase the risks of developing other outbreaks and infectious gastroenteritis and are reported to occur often among nursing home patients.

Diarrheal Infection Statistics Involving Patients In Nursing Homes

• Nursing home-associated diarrheal infections are 0,41 per 1000 resident care days.
• Most diarrhea attacks among nursing home patients are due to bacterial and viral gastroenteritis.
• An estimated 35% of Norovirus outbreaks reported by the CDC occur in nursing homes.
• There are an estimated 21 million norovirus cases in the US every year
• Nursing home occurrence of Clostridium difficile colonization differs between 4% - 20%, and an estimated 8% - 33% of residents receiving antibiotic treatment will develop a second infection.

Gastroenteritis In Care Facilities

Bacterial and viral gastroenteritis are significant causes of these diseases in nursing homes. It results from a loss of natural gastric acid production in older adults, who are more susceptible to developing infectious gastroenteritis.

Gastroenteritis amongst nursing home residents can lead to morbidity and mortality conditions due to the greater chance of dehydration.

The stomach flu (norovirus) is the most common cause of dehydration and gastroenteritis amongst nursing home residents.

Norovirus Symptoms

Norovirus is a highly contagious virus with symptoms that include:

• Inflammation of the stomach and intestines
• Diarrhea
• Vomiting
• Stomach pain.

Clostridium difficile infections (C.diff) appear to cause infectious diarrhea among nursing home residents. C.diff infections result in an alarming number of mortalities in patients over 65.

Respiratory Infections And Influenza

Statistics on the most common infectious diseases of the lung, such as pneumonia, aspiration pneumonia, and lower respiratory tract infections:

• The 2004 Nursing Home Survey reported a 2.3% prevalence rate for pneumonia amongst residents.
• The United States nursing home residents contribute to 10–18% of all people hospitalized for pneumonia, resulting in a general hospital bill of an estimated US $10,000 per admission.
• The occurrence of nursing home-associated pneumonia differs from 0.3 to 2.3 episodes per 1000 resident care days.
• In 2017, CRE caused 13,100 hospitalizations and 1,100 deaths in the USA
• Elderly nursing home residents can show atypical symptoms where the medical care provider fails to make an accurate pneumonia diagnosis.
• About 25% might not show fever, chills, pleuritic chest pain, and muscle pain compared to younger patients.

Poor Oral Hygiene

Blood tests and chest x-rays usually make an effective diagnosis. Poor oral hygiene is a risk factor contributing to pneumonia. Data reveals that dental plaque is a common source of bacteria that can lead to pneumonia.

Serious Infections With ARO

Many different types of Enterobacterales can develop ARO resistance, including Klebsiella pneumonia, CRE (Carbapenem-resistant Enterobacterales), and Escherichia coli (E. coli).

These bacteria can cause severe infections, including pneumonia, bloodstream infections, urinary tract infections, wound infections, and meningitis.

Infections in the lower respiratory tract are among the deadliest yet most avoidable SSTIs healthcare-associated infections in nursing homes and a primary cause of hospital admissions amongst nursing home residents.

Skin and Soft Tissue Infections (SSTIs)

Common examples include cellulitis, staph infections (necrotizing fasciitis), and erysipelas. SSTI statistics are as follows:

• SSTIs are the third most infectious disease in long-term care facilities
• SSTIs have a reported prevalence rate of 1% - 9% and an incidence rate of 0,9 to 2,1 cases per 1000 resident days
• Between 2% to 28% of nursing home residents have pressure ulcers.
• The prevalence of fungal nail infections is an estimated 18% in the 60-79 age group.

SSTIs, including staph infections, have a high incidence among nursing home residents as the skin's integrity degenerates with age.

SSTI Risk Factors

Factors contributing to the risk of this type of skin infection:

• Slow immune system
• Decreased sweat gland function
• Thinning of skin
• Low skin moisture content
• Diabetes and hypertension
• Decreased blood flow

Other skin and soft tissue infections among care facility patients include intertrigo, tinea Versicolor, scabies, diabetic wound infections, and herpes simplex. Chronic wound infections include pressure ulcers, vascular wounds, and diabetic wound infections.

2004 National Nursing Home Survey Statistics

According to the survey regarding care facilities, the following statistics were reported:

• About 159,000 or 11% of residents in nursing facilities had pressure ulcer skin infections, with Stage 2 pressure ulcers the most common
• Elderly patients aged 64 years and under were more likely than older residents to have pressure ulcers
• Residents of a year or less were more likely to have an infection of the skin (decubitus ulcers) than those with more extended stays
• One in five nursing home residents with a recent weight loss had infected pressure ulcers
• Thirty-five percent of residents in nursing facilities with stage 2 or higher decubitus ulcers received special wound care services in 2004

Cellulitis

Cellulitis is a chronic bacterial wound infection of the skin and tissues beneath the skin. It can show suddenly or arise with wounds and is commonly found on the head, neck, arms, shins, and feet. It is not contagious.

The leading cause of SSTI mortality amongst nursing home residents is a secondary infection in the bone, skin, and blood.

Urinary Tract Infections (UTI)

Statistics on urinary tract infections, including the kidneys, bladder, ureters, and urethra, include:

• The 2004 Nursing Home Survey reported a 5.7% prevalence rate for urinary tract infections amongst residents.
• An estimated 3% - 7% of residents with an indwelling catheter will get urinary tract infections every day that urinary catheters remain.
• By the 30th day, 100% of residents will present bacteria in their urine, partly due to urinary tract infections related to using catheters or similar devices.
• About 50% of all nursing home residents will experience symptomatic UTIs

UTI Symptoms

A urinary tract infection is the most frequent infection in the nursing home population. It also remains the most over-diagnosed infection with symptoms that include:

• Burning or pain in the lower abdomen or below the stomach
• Fever
• Bloody urine may be a sign of infection
• Burning sensation during urination or an increase in the frequency of urination after the catheter is removed. Sometimes a person with a catheter-associated urinary tract infection will not have these symptoms of infection.

Contact a Nursing Home Negligence Attorney To Resolve Your Compensation Claim

Were you harmed or did you suffer the loss of a loved one in nursing home negligence? Contact nursing home negligence lawyers at (800) 926-7565, and allow them to protect your rights and get the compensation you deserve.

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Resources:

• Skin Diseases in Nursing Homes
• Elderly Infections - Dermatology Online Journal