Sepsis in Nursing Homes: Abuse and Neglect
Oct 2, 2018 Abuse and Neglect
A four-year-old British girl named Sienna made headlines when she contracted sepsis as a result of trying on shoes without socks while she was back-to-school shopping with her mother. The toddler contracted a form of life-threatening bacteria, which doctors believe entered her body by means of a cut or bite on her foot. Fortunately, Sienna’s doctors were able to avoid surgery or amputation by draining the infection from her leg, and she is expected to make a full recovery. While stories like Sienna’s are rare, sepsis in nursing homes and hospitals is prevalent – to the point of being a serious public health concern.
What is Sepsis?
Sepsis is a health condition resulting from the body’s response to an infection, which can quickly and suddenly progress into a life-threatening stage of septic shock.
Our body is equipped with an immune system to serve as an internal first aid kit for infections ranging from the ordinary (acne) to the not-so-ordinary (influenza). When an infection attacks the human body, chemicals are released into the blood stream to fight the infection. Sepsis occurs when these chemicals in the blood stream trigger inflammatory responses throughout the body, which can cause organ damage or failure, dangerously low blood pressure, and death.
This is a progressive disease, which is typically observed in three stages:
- Severe sepsis
- Septic shock
Early intervention of sepsis is critical. In its beginning stages, sepsis is treatable with antibiotics, intravenous fluids and other organ support. As the disease worsens, conditions can lead to amputation or death. Approximately 30 percent of patients diagnosed with severe sepsis do not survive.
Signs of Sepsis
Those who have a serious infection and do not receive appropriate medical attention are at risk for developing sepsis. In addition to the presence of infection, some of the signs and symptoms include:
- Early symptoms of sepsis: Fever; rapid pulse or breathing; excessive sweating
- Symptoms of severe sepsis: Feeling faint, weak or confused; diarrhea; nausea or vomiting; lack of urine; muscle pain or extreme discomfort; shortness of breath
The acronym “TIME” is also used to reference the symptoms of sepsis, which stands for:
Temperature, Infection, Mental Decline, Extremely Ill.
Anyone who experiences signs or symptoms of sepsis should seek immediate medical attention. Because these symptoms can also be signs of other health problems, doctors will use a variety of tests to diagnose sepsis, including blood tests, urine tests, wound secretions, respiratory secretions and imaging scans.
Risk Factors and How Sepsis in Nursing Homes Happens
Infection happens by means that are both common and, at times, unique or unheard of. Because sepsis is triggered by the presence of any type of infection, persons who are at-risk for developing infection may be more prone to sepsis, including young children, elderly adults, and those who are immunosuppressed.
Sepsis in nursing homes and hospitals is commonly the result of skin or pressure ulcers (also known as bed sores) developed by extended periods of inactivity, such as lying in a bed or sitting in a wheelchair without being repositioned. Those with limited mobility are more likely to be deprived of proper blood flow to keep their skin healthy – particularly in bony areas such as the heels and tailbone. As a result, sepsis in nursing homes and hospitals occurs far too often. In the state of Illinois alone, about 6,000 hospitalized nursing home residents had sepsis each year from 2012 to 2016. One in five, or 20 percent, of these patients died.
Proper infection control can prevent the progression of a pressure ulcer or bed sore into a septic wound. A few simple measures to reduce the likelihood of pressure ulcers include:
- Keeping assisted living residents clean, dry and well-nourished
- Actively monitoring for signs of a skin infection, particularly in susceptible bony areas
- Repositioning residents with limited mobility once every two hours
- Protecting the skin from being rubbed by crutches, braces and other orthopedic devices
- Utilizing special mattresses in conjunction with regular repositioning
- Applying special creams on areas of the skin with limited blood flow
When a bed sore has formed, it is important for the patient or resident’s care team to take frequent, regular measurements of the size and characteristics of the wound for their medical record. These measurements will help indicate if the infection progresses or improves – and may also be necessary documentation for an abuse or neglect lawsuit. Treatment for infection control should be administered, in addition to continuing preventative measures such as repositioning, special ointments, and keeping the skin clean and dry.
Is Sepsis in Nursing Homes a Sign of Abuse or Neglect?
Infections, including pressure ulcers, can be prevented or treated before turning in to sepsis. When sepsis does occur, its presence may be indicative of improper or insufficient care.
One common example of neglect is experienced at nursing homes and hospitals. When nursing staff are stretched thin or understaffed, the recommend time table to reposition residents regularly, at a rate of once every two hours, is likely to be lapsed. While the federal government has conducted studies and released recommendations about how much total nursing time an assisted living resident should receive daily, there is no federal regulation to serve as the standard.
In 2008, the Centers for Medicare & Medicaid Services (CMS) issued its guidance for “Never Events,” which are hospital-acquired conditions that indicate serious errors in medical care:
“Never Events [are] errors in medical care that are of concern to both the public and health care professionals and providers, clearly identifiable and measurable … and of a nature such that the risk of occurrence is significantly influenced by the policies and procedures of the health care organization.”
Pressure ulcers are observed in four stages, with Stages III and IV defined as “Never Events.” Whether as a result of understaffing in a nursing home or carelessness, septic sores can be life-threatening. If you notice pressure ulcers on a loved one in assisted living, it is important to speak with the care providers about your concerns immediately. If you suspect these sores are a result of improper care, you should consult an attorney specializing in abuse and neglect.
Filing a Sepsis Lawsuit
Infections can happen by everyday means. When sepsis enters the picture, swift measures need to be taken to prevent an unnecessary loss of life. Sepsis is particularly threatening to vulnerable seniors, who are immunosuppressed and may be receiving inadequate care in a nursing home or assisted living facility.
The personal injury attorneys at Padberg Appelbaum Knepper (PC&A) have represented multiple claims of nursing home abuse to a positive resolution, including cases where the health care provider negligently allowed a patient to develop Stage III or IV infections. In one recent case, an elderly woman developed Stage IV bed sores due to the failure of the nursing home staff to provide basic hygiene care and repositioning throughout the day. The woman contracted sepsis and died because of the negligence she suffered at the hands of nursing home staff.
PC&A attorneys have also successfully resolved cases where health care providers have failed to diagnose and treat infections that led to sepsis – resulting in loss of use of a limb or limbs, loss of limb, or death. In one such case, a woman was treated in an Emergency Room twice during a 10-day period for pain in her leg. Radiologists reading the X-rays noted potential infection and requested additional testing, but the E.R. failed to notify the patient of their concerns. The patient was discharged on both occasions without follow-up imaging and developed sepsis, resulting in multiple surgeries and complete loss of use of her leg.
If you or a loved one suffered from sepsis in nursing homes or a hospital, the law office of Padberg Appelbaum Knepper may be able to help. Contact us today for a free consultation with one of our experienced St. Louis abuse and neglect attorneys.