Many people will be shocked to learn the leading cause of death at nursing homes is not heart attacks, strokes or even Alzheimer’s. It’s in fact infections. Infections are the leading cause of death and complications for nursing home residents. The troubling news is a recent five-year study suggests the problem is only getting significantly worse. The lead study author Carolyn Herzig, MS, project director of the Prevention of Nosocomial Infections & Cost-Effectiveness in Nursing Homes (PNICE-NH) study at Columbia Nursing recently published results from Medicare reports showing a steady but alarming increase in all reportable infections. She is quoted as saying “Unless we can improve infection prevention and control in nursing homes, this problem is only going to get worse as the baby boomers age and people are able to live longer with increasingly complex, chronic diseases.”
UTIs, short for urinary tract infections, far and away are the most common infection in nursing homes. Despite their increased prevalence, UTIs can normally be prevented by reducing the use of urinary catheters and increasing the frequency of assisted trips to the toilet or diaper changes for residents who are unable to use the bathroom. Families evaluating which nursing home to choose for a loved one should ask what protocols are in place to decrease catheter use, and they should also ask how the staff cares for residents with diapers, Herzig said. “Nobody wants to think about diapers, but even if your loved one enters the nursing home able to use the bathroom independently, they may need assistance down the line. Seeing how well toileting needs are met is one way to assess infection risk.”
In one nursing home case I recently deposed several nursing staff about the resident’s toileting program she was enrolled in on admission. The shocking revelation was not that there was a lack of documentation on the staff maintaining a schedule. Documentation mistakes can happen. I was more shocked by the fact that none of the staff knew their facility had a toileting program for their incontinent residents to minimize infections. Sadly, it was no surprise the resident later developed a urinary tract infection that became antibiotic-resistant and ultimately contributed to her death. This is just one of the little steps many facilities are aware can reduce simple infections from becoming lethal. However, due to understaffing or lack of accountability are not routinely implemented.
The second most common infection in these facilities is Pneumonia. Rates of these diagnoses climbed in prevalence by 11 percent, the study found. For pneumonia and other infections that can spread through the air or contact with contaminated surfaces, proper hand hygiene is essential for prevention. Residents, visitors, and staff should all have easy access to sanitizer or soap and water to clean their hands and be encouraged to do this frequently. “When you walk into a nursing home for the first time, you should easily spot hand sanitizer dispensers or hand-washing stations,” Herzig said. “If you don’t see this, it’s an indication that infection control and prevention may be lacking at the facility.”
The common misconception is that pneumonia, like the common cold, is simply unpreventable. While in many cases that is true, what we often find during our investigation of these cases is that once initial signs of the infection were identified the staff failed to take proactive measures to minimize the progression of the disease until ultimately it was too late. In a case, we recently brought against a Kissimmee facility the resident suffered from recurrent bouts of pneumonia. The facility should have been hyper-vigilant for any potential signs of a recurrence. However, the resident’s oxygen saturation showed a steady decline over a period of days and he became more lethargic potentially indicating another infection. Instead of contacting the physician right away the facility waited 5 days. By that time the resident required hospitalization and necessitated a ventilator. Tragically, he never recovered.
Not all infections are preventable. However, too many infections are a result of facility neglect. If your loved one died from an infection and you would like us to investigate if it was unavoidable or preventable please call and speak with us.
The study is titled: “Longitudinal Trends in Infection Rates in US Nursing Homes, 2006 – 2011.” Herzig is a doctoral student in epidemiology at Columbia’s Mailman School of Public Health. Co-authors from Columbia Nursing include Ph.D. student Catherine Crawford, RN; and Patricia Stone, Ph.D., FAAN, Centennial Professor of Health Policy and director of the Center for Health Policy. The authors declare no financial or other conflicts of interest. The project was supported by the National Institute of Nursing Research.