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.

Healthcare workers frequently contaminate their gloves and gowns during every day care of nursing homes residents with drug resistant Staphylococcus aureus or MRSA, according to a new study published online in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

“We know that healthcare workers serve as a vector for MRSA transmission from one resident to another in settings such as nursing homes,” said Mary-Claire Roghmann, M.D., lead author of the study. “The use of barrier precautions, such as gowns and gloves, limit this transmission, but guidance on when to use them is limited. The goal of our research was to determine the most important times to wear gowns and gloves in nursing homes by measuring the risk of MRSA contamination during different types of care.”

High-risk activities linked to glove or gown contamination included dressing residents, transferring residents, providing hygiene such as brushing teeth or combing hair, and changing linens and diapers. Healthcare workers do not wear gowns during much of this care because they don’t anticipate that their clothing will come into contact with body secretions during this care.

“This research is particularly important since residents in these communities require a lot of assistance from their healthcare workers. New MRSA acquisition in nursing homes is substantial. Our study, for the first time, defines the type of care that increases the risk of transmission and suggests modifications to the current indications of gown and glove use,” said Roghmann.