Nursing Homes Abuse Blog - By Jonathan Rosenfeld

As many as 80 patients and staff at a California Nursing Home have become ill due to an outbreak of norovirus at their facility.  The first symptoms of illnesses related to norovirus were first reported on November 6th at Country Villa Healthcare Center in Novato, CA.

Several of the patients became so ill that they required treatment at a hospital.

However, it wasn't until November 10th that officials at Country Villa elected to notify public health officials. The delay in reporting the norovirus outbreak significantly impair efforts by state officials to secure the origin of this outbreak.  

But was the delay intentional?

Cynical me, I tend to think nursing home operators are a fairly intelligent bunch and delays reporting an incident or situation to officials outside of the facility are an intentional decision calculated to protect the facility.  

In cases involving norovirus, the source of the outbreak may be related to poor sanitation or improper handling of food served at the facility.  In delaying an investigation several days, facilities have an opportunity to rectify unfit conditions before inspectors can issue a citation.

Norovirus (also referred to as Norwalk Virus) is a gastrointestinal illness that can be easily spread though in-person-contact.  Most people infected with norovirus usually recover on their own after letting the illness take it course.  However, norovirus can be particularly troublesome for elderly patients with weakened immune systems which put the person at risk for further complications.

Related:

Norovirus outbreak prompts quarantine of Marin nursing home, MercuryNews.com November 22, 2011

Nursing Homes Poorly Controlling Infections Amongst Patients

Norovirus Infiltrates Illinois Nursing Homes

Elderly Nursing Home Patients Are Particularly Susceptible To Illness Related To Contaminated Food

A study by McGill University researchers that was published in the Journal of the American Medical Association (JAMA) suggests that a private room in a hospital’s intensive care unit (ICU) can decrease the chances of contracting an infection.  

The study compared rates of infection in an ICU before and after the hospital changed from shared rooms with curtains to private, single rooms.  The results of the study showed that the combined rate of infection for C. difficile, MRSA (methiciliin-resistant Staphylococcus aureus), and vancomycin-resistant Enteroccucus decreased by 54% after the change to private rooms.  

Private rooms can cut down on the number of people a person suffering from infection is exposed to, which reduces the transmission of bacteria and germs.  Private rooms may use better infection control practices, which helps reduce the incidence of infection.  

Clostridium difficile (C.difficile) is a naturally occurring bacteria that can cause serious diarrhea and intestinal problems in the elderly and other patients with compromised immune systems who are taking antibiotics.  (See Nursing Homes Abuse Blog “Left Untreated, Stomach Aches Can Be Deadly for Elderly Nursing Home Patients”)  

Many cases of C. difficile occur in healthcare settings because of increased use of antibiotics and a high density of people vulnerable to infection.  Elderly patients (≥ 65 years old) are ten times more likely to suffer from a C. difficile infection than younger people.  

MRSA (methicillin-resistant Staphylococcus aureus) is another infection that is a serious problem in health care settings, especially for patients who have undergone surgery or other invasive procedures.  Healhcare-associated MRSA (HA-MRSA) is caused by staph bacteria that are resistant to the antibiotics that are typically used to treat staph infections.  (See Nursing Homes Abuse Blog “Nursing Homes Remain Ideal Breeding Grounds for Strains of MRSA Infections”)

Because elderly patients are more susceptible to contracting dangerous infections, hospitals should make efforts to provide private rooms to elderly patients.  The added cost of private rooms can be countered by the money saved from not having to treat patients for hospital-acquired infections.  Patients in the ICU who contract an infection usually have a longer average hospital stay by about 8-9 days, which costs $3.5 billion per year in the United States.  

Therefore, for these health and financial incentives, hospitals should look into creating more private ICU rooms in order to cut the rate of dangerous infections.  

Special thanks to Heather Keil, J.D. for her assistance with this Nursing Homes Abuse Blog entry.

Sources:

The McGill Tribune: For ICU Patients, Private Rooms Help Cut Infection Rates
Archives of Internal Medicine: Infection Acquisition Following Intensive Care Unit Room Privatization
Advin: Infection Acquisition Following Intensive Care Unit Room Privatization
Eureka Alert: Research Shows Single-Patient Rooms Reduce Hospital Interactions in ICU
The Gazette: Private Rooms Reduce Spread of Disease
Science Daily: Private Room Intensive Care Units Associated with Lower Infection Rates
JAMA: Single-Patient Rooms for Safe Patient-Centered Hospitals

Staff at Brewer Rehab and Living Center, a Maine nursing home, have been afflicted with an outbreak of scabies.  The outbreak was reported to the Maine Center for Disease Prevention where officials rendered advice on treat patients and staff with the mite.

Scabies is a very small mite that causes allergic reaction-type problems when it burrows beneath the skin.  Common reactions to the scabies mite include: severe scratching, rashes, skin discoloration, and other skin irritations.

Scabies is spread through person-to-person contact as well as through contact with clothing and linens that were not sanitized.  In order to prevent the spread of the mites, experts suggest using specialized soaps and shampoos as well as cleaning clothes and lines with hot, soapy water.

Related:

Brewer nursing home hit by scabies, Bangor Daily News

Scabies Outbreak In Pennsylvania Nursing Home

Nursing Home Injury Laws: Maine

The Chicago Tribune recently reported that 129 nursing home patients have been diagnosed with norovirus at three un-named nursing homes in McHenry County.

As authorities from the Illinois Department of Health investigate this norovirus outbreak, six patients have already been hospitalized for this illness.

Norovirus is an illnesses that include nausea, vomiting, diarrhea, and some stomach cramping. Some cases are also associated with low-grade fever, chills, headache, muscle aches, and a general sense of tiredness.

The spread of norovirus can usually be stopped with good sanitation practices such as hand washing and disinfecting surfaces.

The elderly and young are particularly susceptible to complications related to norovirus and can easily become dehydrated when the symptoms are not identified and timely treated.

Related:

CDC: Norovirus Q & A

Food Safety

Elderly Nursing Home Patients Are Particularly Susceptible To Illness Related To Contaminated Food

60 Nursing Home Patients Sickened By Norovirus

A Hepatitis B outbreak at Glen Care of Mount Olive (North Carolina), an assisted living facility, has claimed the lives of four elderly residents.  Another younger patient, still remains hospitalized for medical complications related to hepatitis B.

As officials from the department of health look into how these assisted living residents contracted this strain of hepatitis, they are asking officials at the facility to vaccinate other residents to prevent further hepatitis outbreaks.

Hepatitis B is far more contagious than other strains of hepatitis and can survive on surfaces longer than other viruses .  While fairly uncommon amongst patients in nursing homes and assisted living facilities, hepatitis can be particularly deadly for elderly people with compromised immune systems.

Symptoms of hepatitis include:

• Fever
• Extreme fatigue
• Loss of appetite
• Vomiting
• Dark urine 
• Yellowish skin

Hepatitis B is generally thought to be transmitted via sexual contact or dirty medical equipment.  Dirty conditions in medical facilities is believed to contribute to the more than 12,000 cases of Hepatitis B contracted on an annual basis by health care workers. 

Once infected with Hepatitis B, there are four FDA approved medications that can be used for treatment.  The approved medications include:

• Alfa Interferon
• Lamivudine
• Adefovir dipivoxil
• Baraclude

As officials from the North Carolina Department of Health continue to seek the source of this Hepatitis B outbreak at an assisted living facility, my guess is that the investigation will ultimate demonstrate that sanitation problems at the facility caused or certainly contributed to this outbreak.

Related:

State investigating hepatitis deaths at assisted living center WRAL.com, October 19, 2010

Hepatitis B, E Medicine Health

Hepatitis B, Treatment & Drugs, Mayo Clinic

Medical Facilities Can Reduce The Incidence Of Infection By Taking Some Basic Precautionary Steps

When a family member or loved one goes to the hospital for medical treatment, we expect them to get better, not worse. However, hospital infections are a very real and very dangerous problem. Illinois recently published information showing infection rates at Illinois hospitals in an attempt to increase transparency about safety and also hold medical institutions accountable. 

You can check your hospital’s infection rate at the Safe Patient Project website, or the Illinois Hospital Report Card. (See “States Move to More Transparency Regarding Medical Malpractice & Hospital Errors”) Many of the same infections that pose serious problems at hospitals are also problems at nursing homes. 

Research is showing that many hospital infections can be prevented through proper procedures. Dangerous germs and pathogens can be transferred from many sources (patient’s skin, doctor’s hands, clothing, scrubs, coats, the medical equipment itself) to the patients or to medical equipment including catheters. This research is spurring hospitals to make improvements, with the rates of some common hospital infections being cut in half. 

Infections involving central lines (a catheter or tube that is placed in blood vessels to deliver medication and fluids) are one common hospital infection. These infections can be fatal. In the United States, about 80,000 hospital patients suffer infections involving their catheters every year, and about 30,000 of these patients actually die. (See “Never Event #2: Infection in Central Venous Catheters”) 

Despite these numbers, there is some hope. The Johns Hopkins Hospital published research in 2005 showing that over 100 ICUs in Michigan almost eliminated CLABSIs by following a list of simple procedures. These procedures included: focusing on patient safety, medical staff working closely together, washing hands, using gloves, masks, and gowns, draping patients with coverings, and cleaning sites where catheters were inserted. 

Simple steps such as fully draping the patient as opposed to only draping the area where the catheter would be inserted decrease the infection rate. The culture at hospitals also needs to change so nurses and other staff members feel able to speak up if the checklist is not being followed. This is a dramatic change for many hospitals where nurses fall much lower in the hierarchy. 

The Illinois Hospital Report Card and Consumer Guide to Health Care provides information on hospital infections, including central line-associated bloodstream infections (CLABSIs). Last year in Illinois, 44 hospitals list zero CLABSIs in their ICUs, while some hospitals still listed high infection rates (see Table showing central-line infections). The state tracks the number of bloodstream infections associated with central lines or catheters used in medical, surgical, or combined medical/surgical intensive care units (ICUs). 

In Illinois, nine hospitals displayed high infection rates in 2009, which calls into doubt whether patients at these hospitals are receiving adequate care. Thorek Memorial Hospital in Chicago had 22 CLABSIs, which is the highest of all medical centers in Illinois, with an infection rate 13 times higher than the U.S. average. The hospital’s administration said that the hospital is conducting an independent review and has taken steps to reduce infections. 

• Swedish American Hospital in Rockford had 15 infections
• Norwegian American Hospital in Chicago had 12 infections
• Roseland Community Hospital in Chicago’s South Side had 10 medical/surgical ICU infections
• St. Bernard Hospital & Health Care Center in Chicago’s Englewood neighborhood, also had 10 infections
• Mercy Hospital & Medical Center in Chicago had 9 infections
• St. James Hospital and Health Centers had 7 ICU medical/surgical ICU infections
• Skokie Hospital had 5 infections in 2009.  

Many of these hospitals are increasing training and taking steps to reduce infections. However, we will have to wait until next year to see whether these steps result in fewer infections. 

On the other end of the spectrum, are several Chicago-area hospitals that have reduced their number of central line infections to almost zero. These numbers show that some area hospitals are doing something right. However, it also raises more questions about what are the other hospitals doing wrong? The following hospitals had zero ICU infections in 2009: 

• Adventist Bolingbrook Hospital
• Adventist GlenOaks Hospital
• Adventist Hinsdale Hospital
• Centegra Hospital-Woodstock
• Trinity Regional Health System. 

While several other hospitals had very low infection rates:

• Central DuPage Hospital in Winfield had 1 infection in one of their ICUs and 0 in their other ICU
• Loyola University Medical Center in Maywood had 2 infections
• Northwestern Memorial Hospital had 1 surgical infections and 6 medical infections
• Adventist La Grange Memorial Hospital had 3 medical/surgical ICU infections. 

Nursing home residents are also susceptible to many of the same infections that are common in hospitals. (See “MRSA in Nursing Homes on the Rise Amongst Residents and Staff” and “Nursing Homes – The Perfect Breeding Grounds for MRSA”) Nursing home residents might even be at higher risk for infections, especially central line infections because they require more frequent and longer-term use of central lines because of the high incidence of serious health problems. Still, there are steps that you can take to reduce the risk of infection at a hospital or nursing home:

• Require that caregivers wash their hands or wear sterile gloves before touching catheters or the area around catheters
• Ask how long the catheter or central line needs to be in place, then ensure that they are removed when no longer necessary
• Notify a nurse or doctor if bandages come off or get dirty
• Tell a nurse or doctor if the skin around your catheter becomes sore or red
• Do not let anyone touch your catheter or central line unless medically necessary
• Ask questions
• Use hand sanitizer when entering and leaving a facility

Hospitals and Nursing Homes with high infection rates raise questions about the quality of care. Hopefully, with increased reporting of infections and accountability, these numbers will go down. Nursing homes should take the same steps to reduce infections as hospitals have done in order to protect the health and safety of their residents. If you or a loved one suffered from a preventable infection at a hospital or nursing home, you may be entitled to compensation. 

Thanks to Heather Kiel, J.D. for her assistance with this Nursing Homes Abuse Blog Entry.

Sources:

Illinois Hospital Report Card and Consumer Guide to Health Care

Chicago Tribune: Tracking Hospital Infections
Chicago Tribune: What you can do to protect yourself from hospital infections

Chicago Tribune: Central Line Infections in Illinois Hospitals

Chicago Tribune: Illinois Hospitals Achieve Low Infection Rates

Chicago Tribune: Illinois Hospitals Address High Infection Rates

Nursing Homes Abuse Blog: Never Event #2: Infection in Central Venous Catheters

Nursing Homes Abuse Blog: States Move to More Transparency Regarding Medical Malpractice & Hospital Errors

Nursing Homes Abuse Blog: MRSA in Nursing Homes on the Rise Amongst Residents and Staff”

Nursing Homes Abuse Blog: Nursing Homes – The Perfect Breeding Grounds for MRSA

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)

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).

'Sepsis' is a bacterial infection in the bloodstream or body tissues commonly found in people with advanced bed sores (also referred to as pressure ulcer, decubitus ulcer or pressure ulcer).  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