NJ.com reported the tragic case of Anna Burkhart who developed a large, painful and deadly bedsore while in the care of staff at Oradell Health Care Center.  Burkhart was accepted by Oradell after she suffered a fractured right hip on Oct. 30, 2015.  Oradell either failed to notice or ignored the bedsore as it developed and grew.

Burkhart was kept in a hospital bed in Oradell for 100 days – until her insurance ran out.  Then Oradell discharged the woman, the family brought her home and discovered she was suffering from the sore on her sacrum or lower back.

They rushed her to the hospital, where doctors determined the bedsore, called a Stage 4 decubitus ulcer, had festered for so long that Burkhart had developed fatal sepsis.

The suit alleges “reckless indifference and deliberate disregard” and contends the center violated the New Jersey Nursing Home Responsibility and Rights of Residents Act.

“There was inadequate staff supervision, understaffing and the intentional underutilization of critical services,” the lawsuit states.

The Times News reported the lawsuit filed against White Oak Manor and White Oak Management for neglect of a wound after an amputation—larvae and maggots were growing in his body and he lost his remaining leg.

William Brooks was admitted to Burlington’s White Oak Manor on May 5, 2014, while recovering from an amputation below the right knee.  That July, after an infection sent him back to the hospital, Brooks had doctor’s orders for frequent cleaning and redressing a wound on his remaining foot. According to the suit, there was no record of that treatment being done in June or July of 2014.

A doctor was called in to evaluate Brooks when maggots were found in the wound on his left ankle. He was treated, but he ended having his left leg amputated below the knee.

The suit claims White Oak Manor and its staff were negligent in caring for Brooks, and he suffered physically, emotionally, financially and was disfigured because of it.

 

Rates of catheter-associated urinary tract infections (CAUTIs) dropped by 54 percent across more than 400 long-term care facilities that participated in a patient safety project funded by the Agency for Healthcare Research and Quality (AHRQ), according to a study published today in JAMA Internal Medicine.

The project adapted AHRQ’s Comprehensive Unit-based Safety Program (CUSP) for use in long-term care facilities. Previous AHRQ efforts to implement CUSP and other safety programs in hospitals have led to significant reductions in CAUTIs and bloodstream infections associated with central line catheters.

We continue to see the power of AHRQ tools to help front-line staff tackle safety problems, now in nursing homes as well as hospitals,” said Jeffrey Brady, M.D., M.P.H., director of AHRQ’s Center for Quality Improvement and Patient Safety. “This means that some of the most vulnerable members of society – those who reside in long-term care facilities and nursing homes – are less likely to be harmed as a result of infections.”

CAUTI is a type of healthcare-associated infection (HAI) that is common in long-term care facilities, where up to 10 percent of residents have urinary catheters. CAUTI can sometimes lead to severe illness and hospitalization and generates significant expenses for antibiotics and hospitalizations. The infections are generally treatable with antibiotics, but long-term or repeated use of antibiotics can increase the risk of other infections as well as lead to development of antibiotic resistance.

CUSP is designed to promote improvement in leadership, teamwork, communication and safety culture to facilitate consistent use of evidence-based practices for infection prevention.  During the project, CAUTI rates dropped from about 6.4 to 3.3 per 1,000 catheter days. Three-quarters of the facilities showed a CAUTI rate reduction of at least 40 percent, indicating that this approach could benefit a majority of long-term care facilities.

To help doctors, nurses and other leaders in all long-term care facilities prevent CAUTIs, AHRQ has released a Toolkit to Reduce CAUTIs and Other HAIs in Long-Term Care Facilities. This practical resource is based on the experiences of facilities that participated in the project. It includes checklists and other tools and educational materials to guide facilities that seek to apply infection-reduction programs.

AHRQ, part of the Department of Health and Human Services (HHS), works with other federal agencies, researchers, and providers to prevent and reduce HAIs and combat antibiotic-resistant bacteria. AHRQ’s mission is to produce evidence to make health care safer, higher quality, more accessible, equitable and affordable and to work within HHS and with other partners to make sure that the evidence is understood and used. For more information about AHRQ’s work to prevent HAIs, visit www.ahrq.gov/hais.

The Waco Tribune reported that a jury found that Jeffrey Place Rehabilitation Center officials were negligent in their care of a blind, diabetic Waco man and compensated the man’s family $450,000 in actual damages. Homer Byrd, a 79-year-old retired tractor mechanic, died in November 2015, only a month after being admitted to Jeffrey Place.

Jurors deliberated about 7½ hours over two days before siding with Greg H. Byrd and his wife, Kim, in their wrongful death lawsuit against the Waco nursing center and its parent company, Senior Living Properties LLC.

Testimony from the five-day trial showed that Byrd, a diabetic on dialysis, developed an infected big toe that turned gangrenous, which led to Byrd’s right leg being amputated just above his knee and, ultimately, to his death.

Jeffrey Place staff breached the ordinary standard of care by failing to promptly discover and treat the infected toe. Nurses testified they noticed the toe, but not until the wound had turned black, had a foul odor and was 4 centimeters by 5 centimeters.

 

The awards include $100,000 for pain and mental anguish suffered by Homer Byrd before his death, $75,000 for Greg Byrd’s loss of his father’s companionship and love and $75,000 for Greg Byrd’s mental anguish over his father’s death. The jury awarded $200,000 in deterrent damages so this type of neglect doesn’t happen again.

 

“Due to the evidence we saw, it was just gross negligence,” juror Crocker said. “There was a lot more that could have been done for this man, and it was just absolute refusal to see a problem that is blatantly obvious.”

 

Every year, hundreds of thousands of Americans are sickened and tens of thousands die from infections by antibiotic-resistant bacteria and C. difficile, a pathogen linked to long-term antibiotic use. Timely reporting of outbreaks of these infections is essential to stopping the spread of disease and saving lives, public health experts and patient advocates say. Reuters assembled one of the most comprehensive counts yet – identifying at least 300 superbug outbreaks around the nation from 2011 to 2016. The number of people affected was impossible to determine because many reports didn’t include a count of the infected or the dead.

MSN reported the fascinating and tragic facts related to “Superbug” outbreaks.  One example was at Casa Maria nursing home in January 2014.  A resident of the nursing home was diagnosed with Clostridium difficile, a highly contagious and potentially deadly “Superbug” characterized by fever, abdominal cramps and violent diarrhea caused by unsanitary conditions that plague hospitals, nursing homes and other healthcare facilities.

By the end of February, six more Casa Maria residents were suffering from the infection.  Under New Mexico regulations, healthcare facilities must report a suspected outbreak of C. difficile to the state Health Department within 24 hours.

Casa Maria did not contact authorities until March 4, 2014.  By then, nine of the nursing home’s 86 residents had active infections.  By June, fifteen residents had been infected, and eight were dead. The public was never informed — until now.

The outbreak and the way it was handled exposed dangerous flaws in U.S. efforts to control the spread of superbug infections. An examination of cases across the country reveals a system that protects the healthcare facilities where superbugs thrive, while leaving patients, their families and the broader public ignorant of potentially deadly threats.

The United States lacks a unified nationwide system for reporting and tracking outbreaks. Instead, a patchwork of state laws and guidelines, inconsistently applied, tracks clusters of the deadly infections that the federal government 15 years ago labeled a grave threat to public health.

Most states require that hospitals, nursing homes and other healthcare facilities report suspected outbreaks of infectious disease, drug-resistant or otherwise, within one business day or less of identifying the problem so that health officials can intervene to halt their spread.

 

 

 

 

Many state health officials say disclosing information about outbreaks to the public or punishing facilities risks dissuading hospitals and nursing homes from reporting. They say they see themselves as collaborators with healthcare facilities. The collaborative approach fails the public.

 

Reuters showed that hospitals and nursing homes do not alert each other when they transfer an infected patient, which can allow contagion to spread among multiple locations.  Reuters documented cases in which infected patients were transferred, sometimes multiple times, without any of the receiving facilities being notified.

 

A Reuters analysis of death certificates found that from 2003 to 2014, annual superbug-related deaths at long-term care facilities increased 62 percent, from about 1,400 to almost 2,300.

 

 

 

 

 

 

 

McKnight’s had a great article on the Centers for Disease Control and Prevention’s recent report on sepsis in Vital Signs.  Sepsis is a complication caused by the body’s overwhelming and life-threatening response to infection. It can lead to tissue damage, organ failure, and death. Sepsis is a medical emergency.

Many clinicians are missing the signs of sepsis according to the Centers for Disease Control and Prevention.  In a Vital Signs report published, the CDC found that 7 out of 10 people with sepsis had either recently used healthcare services or had chronic diseases that required frequent medical care. Nearly 80% of patients develop sepsis outside of the hospital setting.

Those statistics mean healthcare providers play a “critical role” in recognizing sepsis early on, and protecting people from infections that can lead to the condition, the CDC said. That role is even bigger for long-term care providers, since adults age 65 years and older and those with chronic medical conditions are more likely to get sepsis.

When sepsis occurs, it should be treated as a medical emergency,” said CDC Director Tom Frieden, M.D. He urged families, doctors and nurses to watch and ask “could this be sepsis?”

The CDC urged providers to follow infection control requirements, educate patients and families about sepsis, act fast if symptoms are identified and know the signs and symptoms.

Healthcare providers can

  • Prevent infections. Follow infection control requirements (e.g., hand hygiene) and ensure patients receive recommended vaccines (e.g., flu and pneumococcal).
  • Educate patients and their families. Stress the need to prevent infections, manage chronic conditions, and seek care if signs of severe infection or sepsis are present.
  • Think sepsis. Know sepsis signs and symptoms to identify and treat patients early.
  • Act fast. If sepsis is suspected, order tests to determine if an infection is present, where it is, and what caused it. Start antibiotics and other medical care immediately. Document antibiotic dose, duration, and purpose.
  • Reassess patient management. Check patient progress frequently. Reassess antibiotic therapy 24-48 hours or sooner to change therapy as needed. Be sure the antibiotic type, dose, and duration are correct.

The agency is also taking steps to increase awareness of sepsis among clinical professionals, aligns infection prevention, chronic disease management and antibiotic use, and develop sepsis tracking programs to measure the impact of successful interventions.

 Graphic: Healthcare providers are key to preventing infections and illnesses that can lead to sepsis.

Health Day had an interesting article about a recent study about urinary tract infections (UTIs).   A team from New York City’s Columbia University School of Nursing surveyed 955 nursing homes in 2014. The researchers also analyzed data from the Centers for Medicare and Medicaid Services.

They found that in any given month, for over 88,000 nursing home residents in the study, an average of 5.4 percent of them — more than 4,700 people — had suffered a UTI.  This research finds the infections are common in nursing homes, often due to a lack of proper prevention and use of catheters. In fact, in the Columbia study, nursing home residents with catheters were four times more likely to get a UTI than those without catheters.  UTIs in nursing home residents can often have serious effects, including delirium, debilitating falls and even fatal blood infections.

“It is obvious, based on this random survey of nursing homes, that there is a lack of education and inconsistent practices that can raise the risk for infection,” Donna Armellino, a nurse and vice president of infection prevention at Northwell Health, in Lake Success, N.Y said.  UTIs often occur “when bacteria enters the urinary tract through the urethra and move up the tract to infect the bladder or kidneys,” she explained. “This infection is often related to an inserted device referred to as an indwelling urinary catheter.”

“UTIs in the elderly can have a significant health impact by leading to a confused delirious state or — if undiagnosed — leading to dehydration or infection in the bloodstream,” explained Dr. Paula Lester, a geriatrician at Winthrop-University Hospital, in Mineola, N.Y.

Many nursing home residents suffer from dementia, or have conditions that rob them of their ability to communicate, therefore caregivers must be properly educated and trained to prevent UTIs, and recognize the signs and symptoms such as painful urination, foul odor of urine or increased frequency of urination of a UTI.

The findings were presented this month at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC), in Charlotte, N.C.  Read more about APIC at Eureka Alert.

Nursing homes typically have four main ways of lowering UTI rates.

  1. Nursing homes that used portable bladder ultrasound scanners to confirm that a patient had voided all urine were 10 percent less likely to have high rates of UTIs not associated with catheter use.  Unfortunately, only about one in every five facilities surveyed had this policy, the researchers found.
  2. Regularly cleaning the urine collection bag attached to the resident’s leg. That step cut catheter-linked UTI rates by 20 percent.  However, only 44 percent of facilities had this policy in place.
  3. Nursing homes with “infection preventionists” on staff — who also took a national course through APIC — were also 20 percent less likely to have high rates of UTIs, the study found.  But again, only 9 percent of the nursing homes in the study had such staff.
  4.  Prevent UTIs by make sure the patient is mobile when possible, has “regular toileting” and is kept clean and dry.

According to Armellino, other things to look for if you visit an infirm loved one in a nursing home include:

  • Making sure that urinary catheters are inserted “only when clinically needed,” assessed daily and removed when no longer necessary.
  • Urine collection bags are kept below the bladder.
  • Urine flows freely in the drainage tube.
  • The device is “secured to the leg to minimize movement.”
  • Patients are washed frequently with soap and water.
  • Staff members use proper hand hygiene before and after touching the catheter device.

 

USA Today and Fox News both reported the dangers of overusing antibiotics in nursing homes.  Antibiotics are prescribed incorrectly to ailing nursing home residents up to 75% of the time, the nation’s public health watchdog says.  The CDC last month advised all nursing homes to do more – immediately – to protect more than 4 million residents from hard-to-treat superbugs that are growing in number and resist antibiotics.

Health officials and health-care executives, concerned by a rise in dangerous drug-resistant infections, are turning more attention to nursing homes, where antibiotics are some of the most frequently prescribed medications.  Up to 70 percent of nursing home residents receive one or more courses of antibiotics every year for urinary tract infections, pneumonia, cellulitis and other suspected conditions, according to researchers. Yet up to 75 percent of those prescriptions are given incorrectly—either unnecessarily or the prescription is for the wrong drug, dose or duration, the Centers for Disease Control and Prevention says.

The reasons vary — wrong drug, wrong dose, wrong duration or just unnecessarily – but the consequences are scary, warns the Centers for Disease Control and Prevention.  Overused antibiotics over time lose their effectiveness against the infections they were designed to treat. And some antibiotics actually cause life-threatening illnesses on their own.  One of the biggest culprits, researchers say: misdiagnosed urinary tract infections. Only a quarter to a third of people in nursing homes who are diagnosed have actual symptoms, according to several studies. Most have only vague symptoms like confusion or bacteria in their urine that aren’t actually causing an infection, says David Nace, director of long-term care and flu programs at the University of Pittsburgh. UTIs are “the poster child of inappropriate antibiotic use,” he says.

Antibiotic-resistant infections threaten everyone, but elderly people in nursing homes are especially at risk because their bodies don’t fight infections as well. The CDC counts 18 top antibiotic-resistant infections that sicken more than 2 million people a year and kill 23,000. Those infections contribute to deaths in many more cases.

The CDC is launching a public education campaign for nursing homes aimed at preventing more bacterial and viral infections from starting and stopping others from spreading. A similar effort was rolled out for hospitals last year. “One way to keep older Americans safe from these superbugs is to make sure antibiotics are used appropriately all the time and everywhere, particularly in nursing homes,” said CDC Director Tom Frieden in announcing the initiative.

Here’s why that worries the CDC: Every time someone takes antibiotics, sensitive bacteria are killed but resistant bacteria survive and multiply – and they can spread to other people. Repeated use of antibiotics promotes the growth of antibiotic-resistant bacteria. Taking antibiotics for illnesses the drugs weren’t made to treat – such as flu and common colds – contributes to antibiotic resistance.

Antibiotics also wipe out a body’s good infection-fighting bacteria along with the bad. When that occurs, infections like Clostridium difficile can get out of control. C. diff. leads to serious diarrhea that each year puts 250,000 people in the hospital and kills 15,000. If precautions aren’t taken, it can spread in hospitals and nursing homes.

 

 

In addition to fostering antibiotic resistant bacteria and causing C. diff infections, antibiotics also can produce allergic reactions and interfere with other drugs a nursing home resident is taking. Those risks aren’t always fully considered, says researcher Christopher Crnich, who has published articles on antibiotic overuse. He is a hospital epidemiologist at William S. Middleton Veterans Hospital in Madison, Wis.

 

 

 

The Oregonian reported the horrific and tragic case of a 60-year-old man who says Oregon City Health Care Center and its parent company, Prestige Care Inc., ignored his repeated complaints about a painful catheter infection claiming his penis became so infected that surgeons were ultimately forced to remove it.  The man’s lawsuit alleges that staff at the Oregon City Health Care Center committed “gross negligence” that led to gangrene and life-threatening septic shock.

The man had arrived at the nursing home on Dec. 26, 2013, to recover from a kidney infection. He continually complained about pain and bleeding around his catheter, but staff at the nursing home failed to address the problem, the suit says.  By Jan. 20, 2014 — 25 days into his stay — the pain had become so bad that the man discharged himself from the nursing home against the staff’s advice, the suit states. The man sought medical care at Providence St. Vincent Medical Center, where doctors immediately treated him for sepsis, according to the lawsuit.

So far, he has incurred up to $2 million in medical bills, lost wages and other economic damages, the suit claims. He also seeks $6 million for pain and suffering. His wife seeks $1 million for loss of “affection, society, assistance and companionship of her husband.”

The Oregon Board of Nursing has proposed revoking both nurses’ licenses for their treatment in this case and another. The nurses are contesting the move.

CMS’s proposed rule would require nursing home staff to be properly trained on how to care for dementia patients and how to prevent elder abuse and would require facilities to consider the health of residents when making decisions on the kinds and levels of staffing a facility needs.

The rule would require facilities to improve how they plan their care, provide more food choices for residents and allow dieticians and therapy providers the authority to write orders in their areas of expertise when a physician delegates the responsibility and when state licensing laws allow it.

Nursing home facilities would also be required to update their infection prevention and control programs. The rule would force facilities to name an infection prevention and control officer and create an antibiotic stewardship program with protocols and a system to monitor antibiotic use.

The proposed rule also aims to strengthen the rights of nursing home residents by placing limits on when and how binding arbitration agreements can be used.