David N. Damick
“THE DARK UNDERBELLY OF DRUG-RESISTANT INFECTION” NURSING HOMES”
The head of one of the divisions at the Center for Disease Control has warned that skilled nursing facilities - particularly those with patients on ventilators - are breeding grounds for drug-resistant infections. As the New York Times reported, the infections include new ones that can be deadly. One such infection “Candida auris” [C.auris] is a variation on a much more common fungus that takes the opportunity to attack in hospital settings.
C. auris has caused the deaths of around half of the patients it has been found in since it was first found in the United States four years ago. And it is spread within hospitals, who are finding it difficult to eradicate. As pointed out by public health experts in the Times article, nursing homes and long-term care facilities are a dangerously weak link in the health care system. As we have long reported, this is in part because they are understaffed, and their staff are grossly under trained and ill-equipped to provide serious infection control.
Over and over again, we see elderly or ill patients sent to the hospital where infections are brought under control, only to return to the nursing homes where the infections return. This is a national - even a world wide - problem. The infected patients cycle in and out of the hospital and in and out of treatment with antibiotics, creating a perfect breeding ground for the growth and spread of diseases that resist the antibiotics we have.
“They are caldrons that are constantly seeding and re-seeding hospitals with increasingly dangerous bacteria,” said Betsy McCaughey, a former lieutenant governor of New York who leads the nonprofit Committee to Reduce Infection Deaths. “You’ll never protect hospital patients until the nursing homes are forced to clean up.”
As the NY Times article notes further that “a recent inquiry by the New York State Department of Health found that some long-term hospitals grappling with C. auris were failing to take basic measures, such as using disposable gowns and latex gloves, or to post warning signs outside the rooms of infected patients. At one unnamed facility, it said, “hand sanitizers were completely absent.” A study published in June in the Journal of Clinical Infectious Diseases found that patients and residents in long-term care settings have alarmingly high rates of drug-resistant colonization, which means they carry the germs on their skin or in their bodies, usually without knowing it, and can pass them invisibly to staff members, relatives or other patients.
Part of the problem throughout the United States is that insurance companies and Medicare push high-risk patients out of hospitals and into skilled or unskilled nursing homes. The nursing homes get reimbursed at a higher rate for these vulnerable patients, which only encourages the businesses with poor staffing or even more poorly equipped facilities to fill their beds. If you visit a family member or friend in a nursing facility, see for yourself if any of the staff actually use infection control as they move from room to room. The lack of training and cleanliness is a cause of death and suffering in nursing homes throughout the country in our experience. However, our office sees hospital-acquired infections almost as often, as they cut costs as well.