Nursing Home Infections
Infections and sepsis are prevalent in nursing homes and may be life-threatening for people aged 65 and older. Nursing home operators and staff must be devoted to the care of their residents and meticulous in the cleanliness of the facility. Failure to provide a reasonable standard of care constitutes negligence and may be fatal for your loved one.
The Centers for Disease Control and Prevention estimates that 1 million to 3 million serious infections occur each year in nursing homes, assisted living facilities, and skilled nursing facilities.
Nursing home infections are associated with high mortality and morbidity rates, rehospitalization, extended hospital stays, and significant health care expenses, according to an article in the journal Aging Health.
The Impact of Infections
More than 1.5 million people live in nursing homes in the United States, 88 percent of whom are age 65 or older and 45 percent of whom are age 85 or older, according to a National Nursing Home Survey by the U.S. Dept. of Health and Human Services.
Older people are at an increased risk for infections. These can be life-threatening, especially when they lead to sepsis.
Sepsis is the body’s extreme reaction to an infection, and it is a medical emergency. In people with sepsis, there is an inflammatory response that involves the whole body, which causes damage to multiple organ systems. According to the CDC, “Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.”
Symptoms of sepsis include:
- Low blood pressure
- Fever and chills
- Shortness of breath
- Pain and discomfort
If a nursing home resident exhibits any of these symptoms, staff should get them medical care immediately.
Risk Factors for Infection
Among those most at risk for sepsis are people aged 65 and older, people with weak immune systems or chronic illnesses, and those who have been hospitalized for recent severe illness. Nursing home residents are likely to belong to at least one of these groups and, therefore, are vulnerable to sepsis. They also often have additional risk factors that predispose them to infections, including:
- Recent admission to an acute care facility
- Functional impairment
- Multiple diseases or medical conditions
- The presence of internal devices such as feeding tubes and urinary catheters
The recurring use of antibiotics to fight infections in nursing homes has led to the emergence of antibiotic-resistant diseases in these facilities.
Common Nursing Home Infections
There are many different types of infections that are common in nursing homes. The specific type of infection that a particular person develops can often be linked to their health conditions and medical needs. For example, patients who require urinary catheters are more likely to develop urinary tract infections.
Urinary Tract Infections
The most commonly reported infection in nursing homes is urinary tract infections (UTIs). Patients with urinary catheters are at a greater risk of contracting UTIs, although nursing home residents without catheters also contract UTIs. Changes in organ function and limited mobility can make these infections particularly dangerous for older people.
Pneumonia is the second most common nursing home infection, and it is the most deadly. About 10 percent to 30 percent of nursing home residents who contract pneumonia die within 30 days, according to an article in American Family Physician.
Early diagnosis and treatment are vital to improving survival rates; however, pneumonia often presents with atypical symptoms in nursing home patients, making diagnosis challenging. For example, older adults are less likely to develop a fever, chills, or myalgia than younger patients are.
A 2021 review published in StatPearls states that “nursing home-acquired pneumonia occurs in an estimated 1-2 patients for every 1000 days of nursing home residence.”
Pneumonia is most often caused by bacteria, and Streptococcus pneumoniae is one of the most common strains found in nursing homes. Viruses also sometimes cause pneumonia in nursing homes.
One common type of pneumonia in nursing homes is aspiration pneumonia, in which food, beverages, or even a person’s own bodily fluids enter the respiratory tract, leading to an infection. This type of pneumonia is linked with poor dental hygiene, which is common among older adults; in fact, a study published in the journal Gerontology shows that more than half of nursing home residents have oral health needs. A Japanese study published in the Journal of Dental Research showed significantly higher mortality rates among those with periodontal disease who contracted pneumonia.
Gastroenteritis is an infection of the digestive tract. Both viral and bacterial gastroenteritis are common, and often cause symptoms like diarrhea among nursing home residents. Because older adults produce less gastric acid, they are at a higher risk for gastroenteritis.
Researchers from the University of Liverpool stated that norovirus “was detected in 64% of outbreaks with a pathogen identified” in their study of 566 care home gastroenteritis outbreaks from July 2016 to July 2018.
Another cause of severe diarrhea is Clostridium difficile, also known as C.diff. The use of antibiotics increases the risk of C.diff. This is because this bacterium itself is difficult to kill with antibiotics, and so antibiotics remove competition from other bacteria in the gut while leaving C.diff itself unaffected. If facility health care workers fail to contain the pathogen, C.diff infections can spread rapidly. Treating this infection tends to be challenging, because it’s unaffected by many types of antibiotics.
Nursing homes repeatedly report influenza outbreaks. About 6 percent to 28 percent of residents get the flu in these outbreaks, according to a CDC Morbidity and Mortality Weekly report. Diagnosis can be tricky because older people often do not have the same symptoms as younger people do. Immunizing older adults and using neuraminidase inhibitors to treat influenza can save lives.
Skin And Soft Tissue Infections
Physiologic changes to the skin — including slower wound healing, atrophy of the epidermis and dermis, and dry, itchy skin — make older adults susceptible to skin and soft tissue infections.
Skin infections common in nursing homes include:
- Necrotizing fasciitis
- Infected pressure ulcers (Bedsores)
- Diabetic wound infections
- Vascular ulcers
- Herpes zoster (Shingles)
The infections can be severe. For example, frail adults with pressure ulcers are at risk of developing sepsis.
Nursing Homes Owe Residents a Standard of Care that Prevents Infection
In order to prevent them from spreading, infections must be discovered quickly. Infected people need to be isolated from others and treated promptly so that the infection doesn’t get passed to others. Unfortunately, nursing home staff are often slow to notice symptoms that could indicate a serious infection.
Some nursing homes fail to comply with standard precautions, thus putting residents at greater risk of infection. In particular, the CDC has warned of the increased risk of spreading blood-borne pathogens when nursing home staff fail to properly handle glucose monitoring supplies.
The overuse of antibiotics is also problematic, because it creates conditions conducive to C.diff. Frequent use of antibiotics also promotes the development of antibiotic resistance among all types of bacteria. To prevent antibiotic-resistant infections, nursing homes should use antibiotics only when necessary.
Nursing homes in the United States that accept Medicare and Medicaid must have structured infection prevention and control programs lead by a trained infection-control medical expert. The programs include a system for ongoing data collection, outbreak control, hand hygiene programs, resident care programs that decrease the risk factors, staff education, and antibiotic stewardship.
Help Is Available
Nursing home infections can be devastating to older adults and their families. Families trust nursing homes to care for their loved ones and to keep them safe. Unfortunately, not all nursing homes follow infection prevention and control protocols as rigorously as they should.
If a family member has developed a serious infection in a nursing home, contact us. Our compassionate advocates can help you obtain any money you’re entitled to for medical expenses or pain and suffering.
Dr. Patricia Shelton, MD
Dr. Patricia Shelton, MD, is a medical content creator. She holds a Doctor of Medicine degree and a Bachelors degree in neuroscience, both from the University of Washington in Seattle. Her career is now focused around medical communications. She primarily writes content for health-related websites, but has also written test prep materials, white papers, court documents, and more. She also teaches anatomy and physiology at the college level for the National Institutes of Health, as well as at the general public level in yoga teacher training programs. Her book, The Yoga Doctor, was published in 2015.