Nursing Home Infections

Infections are a common hazard in nursing homes that can cause serious illness and even death in elderly patients. Outbreaks of respiratory and gastrointestinal infection predominate in this setting, but outbreaks of skin and soft-tissue infections also occur.

It is important for families of nursing home residents to be alert to the signs and symptoms of common infections, and to take swift action if an infection is suspected.

Are you concerned that your loved one infection in a nursing care center was the result of the staff's negligence? At Nursing Home Law Center, LLC our nursing home abuse lawyers are legal advocates for victims who cannot protect themselves from others who cause them harm.

Contact our legal team today at (800) 926-7565 (toll-free phone call) or use the contact form to schedule a free consultation.

The 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.

This, once again, highlighted the high rate of acute and chronic wound infections prevalent in a nursing center, 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, with these residents experiencing an average of an estimated 2 million infections per year.

Of all the nursing home residents, 88.3% of them are aged 65 years and older, with 45% older than 85 years.

Another contributing factor to infections in nursing homes spreading 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

As an example, nursing home residents who have feeding tubes carry the risk of aspiration pneumonia, skin infections, soft tissue infections, and mechanical complications.

Overusing Antibiotics Can Lead to Infections

Infections and the overuse of antibiotics are the main reasons that antibiotic-resistant organisms (ARO) 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.

Risk factors that put nursing home residents at risk of antibiotic-resistant organisms are:

  • Age
  • Longer-term institutionalization
  • Functional status
  • Previous use of antibiotics
  • Indwelling devices
  • Current illnesses

The prevalence of infections in nursing homes is shocking. These facilities should be a place of quality care where our loved ones' daily needs and assistance can be met.

Most Common Infections Found In A Nursing Home

The following are the most common infections are prevalent in a nursing home.

Diarrheal Diseases / Infections

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

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

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

Diarrheal Infection Statistics Involving Patients in Nursing Homes

  • The occurrence of 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 secondary infection.

The major causes of diarrheal diseases in nursing homes are bacterial and viral gastroenteritis. This is the result of a loss of natural gastric acid production in older adults, who are more susceptible to developing infectious gastroenteritis.

Gastroenteritis amongst nursing homes 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 is a highly contagious virus with symptoms that include:

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

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

Respiratory Infections And Influenza

Statistics on 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

The 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 in comparison to the younger patients.

A Lack of Oral Care and Serious Infections

Effective diagnosis is usually done by blood tests and chest x-rays. 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.

Ensuring an improved quality of oral health among nursing home residents is of paramount importance in combating pneumonia, other respiratory infections, and further secondary infections.

Aspiration Pneumonia

Aspiration pneumonia is a regular occurrence in nursing homes and is often associated with swallowing problems in the mouth or throat (oropharyngeal dysphagia) and regurgitation of gastric contents. These swallowing problems most commonly result from impaired muscle function, sensory changes, growths, and obstructions in the mouth or throat.

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

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

Lower respiratory tract infections are of the most deadly, and yet most avoidable SSTIs healthcare-associated infections in nursing homes and a leading cause of hospital admissions amongst nursing home residents.

Skin and Soft Tissue Infections (SSTIs)

Common infection examples include cellulitis, necrotizing fasciitis, and erysipelas statistics:

  • SSTIs are the third most common infection 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

Skin and soft tissue infections have a high incidence among nursing home residents as the skin’s integrity degenerates with age, including the deterioration of the dermis and the epidermis, creating a longer period of healing for wounds.

When skin becomes dry and itchy often due to old age, the frequent scratching can also serve as a mechanism for SSTIs.

Risk factors contributing to SSTIs:

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

Different types of SSTIs:

  • Erysipelas on the dermis of the legs, with a classic orange-peel look of the infected skin.
  • Necrotizing fasciitis is caused by a destructive infection, killing off the skin cells rapidly. This can be due to prior injury, surgery, irradiation, cancer, diabetes mellitus, alcoholism, and malnutrition.
  • Impetigo looks like honey-colored crusted erosions and is contagious.
  • Folliculitis occurs on body surfaces with short, coarse hair such as the scalp, neck, beard area, axillae, buttocks, and limbs. A furuncle or boil is a deeper infection of the hair follicle.
  • Herpes zoster (shingles) - Caused by reactivation of latent varicella-zoster virus (VZV) or chickenpox. Risk factors for the outbreak of herpes zoster are stress and immune suppression.
  • Onychomycosis - Caused by a fungal nail infection found more frequently in the elderly and more often in males than females.

Other types of skin and soft tissue infections among nursing home patients include intertrigo, tinea Versicolor, scabies, and herpes simplex. Chronic wound infections include infected pressure ulcers, vascular ulcers, and diabetic wound infections.

Pressure Ulcers are SSTIs that are not only frequent infections but also gravely serious infections in nursing care facilities. The risk factors that contribute are immobility, impaired mental capacity, and incontinence.

According to the 2004 National Nursing Home Survey:

  • About 159,000 or 11% of residents in nursing facilities had pressure ulcer skin infections. Stage 2 pressure ulcers were the most common
  • Residents 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 skin infections (decubitus ulcers) than those with longer 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 is a chronic wound infection and presents as a bacterial infection of the skin and tissues beneath the skin. It can present suddenly or arise with wounds and is commonly found on the head, neck, arms, shins, and feet. It is not contagious.

Symptoms of cellulitis include:

  • Tenderness
  • Swelling
  • Redness
  • Skin that feels warm to the touch

The following symptoms could develop when cellulitis becomes a serious infection:

  • Fever
  • Chills
  • Sweats
  • Delirium or confusion
  • Pain
  • Swollen lymph nodes

The leading cause of SSTI mortality amongst nursing home residents is a secondary infection in the bone, skin, and blood. The prevention, early detection, and successful treatment of infection in the SSTIs are therefore paramount.

Urinary Tract Infections (UTI)

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

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

A urinary tract infection is the most regular infection found 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, but it can also be caused by other problems
  • Burning during urination or an increase in the frequency of urination after the catheter is removed. Sometimes people with catheter-associated urinary tract infections do 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 as soon as possible at (800) 926-7565, and allow them to protect your rights and get the compensation you deserve.

Our legal team promises you will not pay any upfront fees until we can obtain fair compensation on your behalf to resolve your nursing home negligence claim. All confidential or sensitive information you share with our law firm remains private through an attorney-client relationship.


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