Jonathan Rosenfeld's Nursing Homes Abuse Blog : Jonathan Rosenfeld's Nursing Homes Abuse Blog | Lawyer & Attorney : Strellis & Field Law Firm | Bed Sores, Senior Neglect, Elder Abuse, Sexual Abuse: Chicago, Illinois

An English study evaluating the prevalence of MRSA (MRSA stands for methicillin-resistant Staphylococcus aureus) in nursing homes has revealed residents and staff are at risk for contracting the bacteria. The sampling 1,111 residents and 553 staff in 45 nursing homes revealed 24% of residents and 7% of the staff were MRSA carriers.

According to Dr. Paddy Kearney, Consultant Medical Microbiologist with the Northern Health and Social Care Trust, "We decided to carry out the study after noticing an apparent increase in recent years in the number of patients who had MRSA when they were admitted to hospital from nursing homes."

Kearney blames nursing homes' indifference to MRSA as a contributing factor in its prevelence.  "In hospitals routine checks are carried out to identify those most at risk of MRSA colonization  (carrying it on their skin and/or nose) and infection control policies are put in place but this is not always feasible in private nursing homes."

Why MRSA is problematic for nursing home residents

MRSA is a strain of staph that's resistant to most antibiotics commonly used to treat it.  In the older population, the ineffectiveness of certain drugs is dangerous because a weakened immune system has difficulty fighting off serious infection.  The prevalence of MRSA is believed to be related in some respects to the overuse of antibiotics.  MRSA can be fatal.

Medical professionals now use the term, health-care associated MRSA (HA-MRSA) to describe MRSA in a nursing home or hospital setting.   

Most strains of MRSA can still be treated with the antibiotic 'vancomycin'.  However, new strains of drug-resistant MRSA are now becoming more prevalent and the use of vancomycin to treat MRSA is becoming less effective.  If MRSA is isolated to a wound, doctors may chose to drain the would and not presrcibe any vancomycin.

How To Prevent MRSA In Long-Term Care Settings

• Wash your hands.  Scrub hands briskly for at least 15 seconds, then dry them with a disposable towel and use another towel to turn off the faucet.
• Use hand sanitizer containing at least 60 percent alcohol for times when you don't have access to soap and water.
• Don't share personal grooming items, such as towels, razors, toothbrushes, bed sheets or clothing
• Keep wounds covered with dry bandages.
• Shower frequently with soap and water.
• Keep MRSA patients separated from the general population
• Take antibiotics as prescribed and don't share with others

Resources On MRSA

MRSA: Understand your risk and how to prevent infection, MayoClinic.com

Prevalence of Methicillin-Resistant Staphylococcus aureus Colonization in Residents and Staff in Nursing Homes in Northern Ireland. Journal of the American Geriatrics Society. 57(4):620-626, April 2009

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A case case of horrific nursing home neglect (perhaps more accurately nursing home abuse) has been reported in New Mexico.  The owner of an Albuquerque Nursing Home, has been found guilty of in the death of resident who was left sitting on top of a bedpan for more than 24-hours. 

The incident occurred on Christmas day, 2005, when the owner of the facility placed the bedpan under 76-year-old Richard Gerhardt and disappeared.  Gerhardt was bed-bound at the time because he was recovering from a broken hip.  By the time the incident had been discovered, the bedpan had become embedded in Gerhardt's skin.  An open wound soon developed and became infected that ultimately led to his death five days later.

The nursing home faces a possible $5,000 fine and/or loss of federal funding (Medicare).  “Nursing home[s] and care facilities are paid to provide round the clock care to those who cannot care for themselves… Protecting this population is of paramount importance to the New Mexico attorney general and similar violations will be prosecuted vigorously,” said Elizabeth Staley, director of the New Mexico attorney general Elder Abuse and Medicaid Fraud Division.  Read more about this incident involving the death of nursing home resident here.

Sentencing for the case is set for March 13.

Related Article

Nursing Home Owner Convicted in Bedpan Death
2009-02-22 05:40:37 (GMT) (WiredPRNews.com - Law, News)

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 The second most frequently encountered 'never event' is an infection from a central venous catheter.  Infections due to improperly maintained and inplanted central venous catheters accounted for 29,536 cases in hospitals in 2007.  A central venous catheter is a tube usually inserted in an arm or chest and threaded through a vein until it reaches a large vein close to the heart.  Central venous catheters are used to administer medication, supply nutrition or blood products.  

There are three main types of central venous catheters:

• PICC Line: A 'peripherally inserted central catheter.'  PICC's are the most common type of central venous catheter accounting for more than 50% of the vascular catherizations because it may be inserted relatively easily.  PICC's are inserted into a vein in the arm as opposed to the neck or chest.
• Tunneled Catheter: A surgically inserted catheter in the neck or chest and is passed under the skin.  Only the end of the catheter is visible through the skin.  Passing the catheter under the skin allow people greater mobility and helps the catheter stay in place.
• Inplanted Port Catheter: Similar to the tunneled catheter, but the entire catheter is left under the skin.  Medication must be injected through the skin and into the catheter.

More than 40% of bloodstream infections are accounted for in people with central venous catheters. An estimated 1% to 5% of people with central venous catheters who get an infections die from them. In order to reduce the likelihood of infection, the following should be done:

• Use sterile technique when working with a person who has a central venous catheter.
• Clean the exposed area of the catheter on a regular basis.
• Dressings should be changed at a minimum of every week.
• The catheter should be flushed regularly.
• The exposed end of the catheter should be routinely check for inflammation and discoloration--the early signs of a potential infection.

Basic maintenance and observation should be part of all hospital and nursing home patients routine.  If you have acquired a blood infection during your hospital or nursing home stay, do not assume that your condition was inevitable.  For more information on infections of central vascular catheters this is a useful article.

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Fifteen residents of the Gallagher Center of Saint Mary's Home in Erie, PA have developed what physicians believe was scabies, a contagious skin infection caused by skin mites. An unknown number of staff and patients' family members also developed the condition.  The first case was reported in the spring, though most cases were reported in June and July according to the facility.  The original patient was treated by a dermatologist, but other cases followed.

Once the the nursing home realized that it was dealing with a scabies outbreak, every patient in the 39-bed Alzheimer's unit examined. The nursing home also ordered the entire unit disinfected, including patients' beds three straight days.  Scabies is usually not a dangerous condition, but it can lead to painful skin infections. It is spread by skin-to-skin contact and by sharing towels or bed sheets.  Scabies is commonly treated with the prescription drugs permethrin (Elimite, Acticin) and crotamiton (Eurax).

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A lawsuit was recently filed against Calvin Johnson Care Center in Belleville, Illinois.  The lawsuit claims that while Fred Moss was admitted to the facility for long-term nursing and rehabilitation, the facility failed to supervise him and was neglectful in their treatment.  As a result of the nursing home neglect, Mr. Moss contracted cellulitis and gangrene in his scrotum and penis which ultimately required the removal of his testicle.   A copy of the lawsuit is here.

My guess is that the man in this lawsuit was catheter dependent. Many nursing home residents are incontinent and have catheters for discharge of urine.  Catheters require ongoing maintenance.  For example, nurses must clean and empty the catheter several times per day.  Further, if a nursing home resident has a Foley Catheter it must be removed and changed at regular intervals.  Failure to properly clean and maintain a catheter may result in a urinary tract infection and ultimately surgical removal of a testicle.

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'Sepsis' is a bacterial infection in the bloodstream or body tissues.  In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below below 4000 cells/mm.

Frequently, people use the term sepsis to describe 'severe sepsis' and 'septic shock.'  Severe sepsis is used to describe people who have organ dysfunction following a diagnosis of sepsis.  People diagnosed with septic shock have sepsis with hypo-tension (abnormally low blood pressure).

Sepsis is a common medical condition; it accounts for:

• 1-2% of all hospitalizations
• 25% of all intensive care visits
• 10th most common cause of death

Causes

Exposure to different microbes (germs) can cause sepsis.  Sepsis is most commonly caused by bacteria, but it can also be caused by exposure to virus and fungi.  Many people develop sepsis after experiencing infections such as: pneumonia, meningitis, cellulitis, urinary tract infection.  Amongst nursing home residents, people who have pressure sores and amputations are particularly vulnerable.

Treatment

In order for treatment to be most effective, it must be implemented as soon as the diagnosis is made.  Generally treatment consists of antibiotics and surgical drainage.  Nutritional supplements are also suggested as treatment for sepsis.

Related:

Is sepsis related to bed sores?

Lawsuit Alleges: One Week In The Nursing Home Results In Significant Deterioration Of Pressure Sores & Sepsis

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Development of a pressure sore can be devastating for both the individual and his or her family. Frequently, there are questions as to how to properly treat the wound. Before an adequate treatment plan can be developed, it is important to conduct a thorough assessment of the wounds. Below is an assessment compiled by Donna Sardina, RN, MHA, WCC President, Wound Care Education Institute that appeared recently on the McKnight's website:

What should be included in wound documentation to support appropriate caregiving measures?

Assessment and documentation should be carried out at least weekly. The exception is when there is evidence of deterioration, in which case both the wound and the patient's overall management must be reassessed immediately.

When wound complications or changes in wound characteristics are noted, documentation should be completed daily until the wound is stable. Documentation should include at a minimum:

Assessment findings–Type of wound, staging, correct anatomical location, measurements; presence of tunneling/undermining; drainage (amount, color, consistency, odor); wound base tissue (slough, eschar, granulation, epithelialization); wound edges (curled, callused, macerated, detached);  periwound (intact, scaly, induration, edema, redness, warmth, color).

Symptoms of infection–Fever, increased white count, hypotension, general malaise, redness, swelling, induration, streaking, purulent drainage, temperature of surrounding tissue.

Pain–Intensity, location, quality/patterns of radiation and character, duration, variations, patterns, alleviating and aggravating factors, current and past pain management plan, effects of pain, pain goal, physical exam of pain.

If a review of your family member's medical chart does not properly address the above documentation, it is unlikely they are receiving the care necessary to heal from the pressure sore or wound.

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• Wash hands frequently
• Stop the use of catheters when not in use
• Use antibiotics only when necessary
• Keep immunizations up-to-date

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