Soft tissue infections occur often in the elderly because of skin integrity (strength and durability) become compromised with age. Skin and soft tissue infections, also called SSTIs, is the third most common infection in nursing homes.
Soft Tissue Infections and Nursing Home Abuse Explained
Nursing home abuse can be defined as mistreatment of a resident that is intentional or neglectful. U.S. estimates indicate that one out of 10 older adults experiences abuse or neglect by a caregiver each year.
The best way to prevent abuse is through frequent screening, which can include looking the body over for areas on the skin that look like bruising, rash or irritation. Regularly examining your loved one can help prevent neglect that results in illnesses such as soft tissue infections. Untreated pressure ulcers or wounds can become infected, leading to soft tissue infections and other severe health complications in elderly residents.
Over the next 20 years, the geriatric proportion of the U.S. population is projected to increase from 12% to 31%.
Causes of Soft Tissue Infections in Nursing Homes
When residents aren’t properly treated or are abused or neglected, they can develop soft tissue infections, or SSTIs (skin and soft tissue infections). There are two common soft tissue infections in nursing homes: cellulitis and pressure ulcers.
Cellulitis is a bacterial infection of the skin and tissues beneath the skin. Cellulitis can appear suddenly or occur where there was a cut or wound. The most common areas cellulitis occurs are the head, neck, arms, shins and feet. Cellulitis is not contagious and does not occur more frequently in men or women.
Symptoms of cellulitis include:
- Skin that feels warm to the touch
If the infection worsens, symptoms become more severe and the resident can develop:
- Delirium (confusion)
- Swollen lymph nodes
Pressure ulcers are the most common form of soft tissue infection in nursing home abuse. They occur when the resident remains in one position for too long without being moved. Pressure ulcers, or bedsores, occur on lower body parts most of the time.
Pressure ulcers are so common that the Centers for Medicare and Medicaid Services (CMS) created specific guidelines to reduce the amount of pressure ulcers occurring.
The regulation created states that a facility must do the following:
- Ensure that a resident who enters a facility without pressure ulcers does not develop pressure ulcers unless the individual’s clinical condition demonstrates that pressure ulcers were unavoidable
- Promote the prevention of pressure ulcer development
- Promote the healing of pressure ulcers that are present (including the prevention of infection)
- Prevent the development of additional pressure ulcers
The best way to protect your loved one from skin infections is through regular inspections of the skin, ensure proper nutrition and hydration, managing moisture and minimizing pressure (staying in bed or in one spot for more than 2 hours at a time).
Approximately 20-25% of nursing home residents suffer from pressure ulcers and 65% of pressure ulcers lead to infection.
Types of Soft Tissue Infections
There are different types of soft tissue infections that vary depending on the cause of the infection and where it develops.
The different types of skin and soft tissue infections include:
- Erysipelas involves the dermis, most commonly involves the legs. A classic sign is the orange-peel (peau d’orange) appearance of the infected skin.
- Necrotizing fasciitis involves a particularly destructive infection causing rapidly advancing deep tissue necrosis (death of skin cells). A variety of underlying conditions that include prior injury, surgery, irradiation, cancer, diabetes mellitus, alcoholism and malnutrition lead to necrotizing fasciitis.
- Impetigo manifests with honey-colored crusted erosions. The need for pathogen identification is especially important if other household members are also infected so that therapy is curative and re-infection by a family member does not occur.
- Folliculitis usually occurs on body surfaces with short, coarse hair such as the scalp, neck, beard area, axillae, buttocks and limbs. A furuncle or boil is the manifestation of a deeper infection of the hair follicle.
- Herpes zoster (also known as shingles) is caused by reactivation of latent varicella zoster virus (VZV) or chickenpox. After a chickenpox infection, VZV remains latent in an individual’s dorsal root and cranial nerve ganglia even for decades. Reactivation often happens for no apparent reason. Outbreaks of zoster have been associated with stress and immune suppression.
- Onychomycosis is a fungal nail infection found more frequently in the elderly and more often in males than females. The prevalence of fungal nail infections was about 18& in the 60-79 years age group. Increasing age, male gender, diabetes mellitus, family history of onychomycosis, psoriasis, concurrent intake of immunosuppressive drugs and peripheral vascular disease are associated with a greater risk of onychomycosis.
Monitoring and treating Soft Tissue Infections
It’s important to be aggressive in monitoring your loved one for skin and soft tissue infections because the integrity of skin decreases with age.
Factors that contribute to an increased risk of soft tissue infections include:
- Slowing immune system
- Decreased function of sweat glands
- Skin thinning
- Low skin moisture content
Some diseases can make skin and soft tissue infections worse. Diabetes and hypertension are a few examples where decreased blood flow can slow healing of a cut or sore that may lead to a skin and soft tissue infection.
Physical issues that result from soft tissue infections can be short-term or long-term depending on how quickly the infection is caught and treated. Most skin and soft tissue infections are treated with an oral antibiotic and/or a topical cream or lotion.
Public Examples of Soft tissue Infections in Nursing Homes
When nursing homes neglect their residents to the point where they develop soft tissue infections, residents and their families can seek legal compensation. Below are some past examples of legal cases involving nursing home abuse or neglect that lead to soft tissue infections in residents.
Stage 4 Bedsore, Tennessee 2014
The nursing home resident entered the nursing home with no skin breakdown and in less than three months entered a local hospital with stage 3 pressure sores to both his left and right heel and a stage 4 pressure sore to the sacrum (the area right above where the fold in the rear end stops).
The resident was also clinically dehydrated with significant weight loss of 24 pounds. The resident nearly died at the hospital but ultimately was able to recover and his wounds all began to show significant signs of healing when he died a number of months later. This case was settled in mediation for undisclosed amount.
Stage 4 Bedsore, Virginia 2010
A nursing home resident obtained a large stage 4 bedsore to his sacral area that becomes infected, ultimately leading to his death. His family was never notified about the size or development of the bedsore. An investigation ensued and after experts were obtained, a complaint was filed and the defendant nursing home asked for immediate mediation.
During mediation, the defendant indicated they failed the family, apologized and showed willingness to resolve the claim. The case was resolved at mediation for a confidential amount.
A record $2.8 million pressure sore settlement was reached against a nursing home and physician for a 59-year-old resident who developed multiple painful and infected bedsores. The sores took four years to heal.
Other examples of cases involving soft tissue infections in nursing homes include:
- $420,000 settlement against a nursing home and hospital for an infected stage 4 pressure ulcer
- $350,000 settlement against a nursing home for the development of a pressure ulcer which required surgical amputation
- $200,000 settlement against a nursing home for the development of a stage 3 heel pressure ulcer
Nursing Home Abuse and Soft Tissue Infection Legal Help
It’s important to remember that the most valuable nursing home abuse detection tool is consistent awareness by loved ones or family. Staying current with your loved ones medical needs and ailments is the best proactive approach to becoming aware of nursing home abuse.
Skin and soft tissue infections that result from nursing home abuse are serious. Infections can lead to further health issues and in the worst cases, death. If you believe your loved one has suffered from a skin and soft tissue infection resulting from nursing home abuse or neglect, please complete our free case evaluation here.