In June 2019, a New Jersey nursing home case in which 11 children died due to a disease outbreak the previous year reached a resolution. In the fall of 2018, adenovirus infected 36 residents and one staff member. This disease displays flu-like symptoms but is significantly harder to treat. The home’s insufficient disease control and sanitation procedures contributed to the spread of adenovirus.
Under recommendations from the state health commissioner, the resolution is meant to prevent an incident of this degree from happening again. At this location, vulnerable patients, including children dependent on ventilators, were not given the attention they needed and parents unnotified of the incident until their children passed away. An investigation further found the home had no infection-control processes and no hand-washing protocols for staff members.
The recommendations for this condition, similar to gastrointestinal viruses, influenza and respiratory infections, involve quarantining sick residents from the rest of the home and having a dedicated group of staff members for care. While this incident in Wanaque, NJ illustrates how widespread negligence can have fatal consequences, it’s far from the only example. In July 2019, a respiratory illness outbreak at an assisted living facility in Springfield, VA affected 54 of 263 residents, with two deaths and 18 hospitalizations.
It’s never an easy decision to put our loved ones in a nursing facility, but you trust your loved one will receive the care he or she needs. Unfortunately, disease outbreaks can happen, especially around flu season. Here’s how and why these incidents occur.
Shared Space
A cold or cough can quickly spread in shared spaces like nursing homes, as residents and staff members share air, food and equipment. As Nursing Times pointed out, the population makes this situation unique: Elderly adults and others requiring specialized care are more vulnerable to infections. Also, diseases that a healthy adult could get over can be deadly to those with compromised immune systems.
However, not all diseases are as easily identifiable. No-infection outbreaks, or organisms that get shared between residents without causing an infection initially, have been known to occur. Symptoms arise later and tend to involve a greater percentage of the home’s population.
Within the nursing home, certain practices and conditions encourage the spread of infectious diseases, including:
- Improper sterilization and disinfection practices.
- Excessive antibiotic use.
- Failing to isolate infected residents or requiring staff to work with both populations of patients.
- Direct physical contact between patients or staff and patients, especially at homes without direct hand-washing procedures.
- Droplets from sneezing or coughing land on other residents or a shared surface. Airborne dissemination causes the disease to spread even further.
- Airborne infections, especially when healthy and infected individuals share the same space.
- Shared food and water get contaminated.
- Viruses can survive for up to seven days and certain bacteria, including S pyogenes and MRSA, can live up to several months.
- Residents who have a wound or use an invasive device have a higher risk of picking up MRSA.
In many instances, an outbreak is rarely restricted to a single facility. Particularly where the flu is concerned, the condition may cover an entire region. Contributing to the spread, visitors, residents and staff members come and go. This may bring in diseases from the community or pass one condition onto another facility, if a resident requires a different kind of care.
Common Diseases in Nursing Homes
Although a range of diseases can strike nursing facilities, outbreaks frequently involve:
- Respiratory infections, including influenza
- Gastrointestinal infections, including norovirus
- Streptococcus
- Staphylococcus aureus (MRSA), which may be responsible for a range of skin, blood and urinary tract infections
- Salmonella
For these conditions, vaccination might slow but doesn’t completely stop the spread. In fact, patients who received flu shots may still pick up a different strain during an outbreak. Especially for the flu, symptoms often present differently in elderly populations, which often leads to delays in diagnosis and allows the outbreak to spread further.
Preventing the Spread
A facility’s response may quite literally be the difference between life and death. Based on recommendations from the Department of Health and Human Services and Centers for Disease Control and Prevention:
- A facility must have a surveillance plan in place to identify an illness, then prevent it from spreading to other residents and staff. Once two cases are confirmed within 72 hours, the staff should actively implement control measures.
- Any staff member who appears ill should be evaluated by the facility’s health nurse and remain at home until the condition passes. Anyone with a communicable disease or infectious lesions must be prohibited from contact with residents, equipment and food.
- Staff members should have up-to-date immunization for MMR, varicella and zoster. Records should further indicate status and if the employee has refused any vaccines.
- Infected residents should be cared for by the same group of staff members, who should adhere to strict hygiene principles preventing transmission. If influenza has spread, all affected residents should be given antiviral drug chemoprophylaxis.
- Residents should be encouraged to get flu and pneumococcal vaccines and medical records should clearly indicate immunization status. During the season, residents should further undergo influenza testing, especially if they display signs of a respiratory infection.
- Staff members should be on the lookout for atypical symptoms. For instance, a resident infected with the flu might not have a fever but display certain behavioral changes.
- Outbreaks must be reported to the local health department or the Department of State Health Services.
- To further prevent pathogens from spreading, staff must wear gloves and a gown if their clothing will come in contact with respiratory droplets and change these items if they come in contact with an infected individual.
- All staff members must practice adequate hand hygiene, especially after touching residents, any droplets or being in their environment.
- It’s recommended that staff coming in contact with infected residents wear a face mask. Immediately after use, the face mask must be disposed of in a proper waste container.
- If an affected resident is being transferred, staff should update all personnel beforehand.
Was your loved one the victim of an outbreak in a nursing home? To hold the facility and staff members responsible for negligence, contact Trantolo & Trantolo. To start your claim, give us a call today.
