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Articles Posted in Infections

As Governor Gavin Newsom announced on May 4, 2020, California began to ease some of the restrictions in place starting Friday, May 8, 2020, introducing the state to the beginning of Phase 2 of California’s four-stage reopening plan. Reopening without the proper protective bulwarks can have dire ramifications. One crucial pillar of protection is the ability to file a law suit against industries who acted irresponsibly during the pandemic. Unfortunately, healthcare and insurance parties are lobbying against this, asking the Governor for blanket civil and criminal immunity for all healthcare providers, including nursing homes. On April 9, 2020, these groups asked to be pardoned from civil or even criminal liability for “any injury, death, or loss alleged to have resulted from any act, omission, or decision made related to providing or arranging services, including but not limited to acts, omission, or decisions undertaken because of lack of resources, absent proof by no less than clear and convincing evidence of willful misconduct as measured by a standard of care that incorporates all of the circumstances of the emergency.”

The Law Offices of Ben Yeroushalmi vehemently oppose this proposed executive order. Nursing homes with existing histories of understaffing and substandard care may use the pandemic and the blanket immunity as a free pass to continue operating under unsafe conditions, risking both their staff and elderly residents. We acknowledge and extend our gratitude to our frontline workers, doctors, nurses, nursing assistants, and those working behind the scenes to fight the spread of the coronavirus. And we stress that this is directed to the for-profit organizations, corporations, and the leaders who run these large chain businesses.

Blanket immunity creates leeway for large nursing home chains to get away with neglect and abuse toward their residents, elders who are often completely dependent on the their care, in a time when they are the most vulnerable. Nursing homes have been hard hit by the virus. Those which were already understaffed, undertrained, and unprepared for infections, face the exacerbated effects of  the virus, as low-paid and undertrained staff struggle to control the outbreaks. Yet it is not to the fault of these rank-and-file workers these facilities are not adequately staffed or prepared for COVID-19. Those who made the decisions to understaff their facilities unfortunately often did so before the pandemic, making them chillingly unprepared during the pandemic. At this time, these chains must equip their facilities with more staff and infection control training. Our elderly should still be cared for humanely, and the employees should be allowed to work in safe conditions. Removing the option of litigation means removing the consequential incentive to be held accountable for neglect and abuse that happens during the pandemic. It means depriving victims their civil right to have a judge and a jury of peers hear their case, to regain a degree of redress.

Life Care Center of Kirkland in Washington, the first long-term care facility in the United States with a wide-scale coronavirus outbreak, was recently charged with a $600,000 fine for deficiencies that enabled the virus’ spread. Additionally, due to the slew of deficiencies, they are at risk of losing their Medicare and Medicaid funding. Life Care Center—and its lack of infection control—is not the only facility of its kind. Facilities across the United States are at high risk of exposing one of the most vulnerable populations, the elderly and those who need 24/7 medical attention, to an onslaught of infections from COVID-19. At this critical juncture, where the actions of staff and infection procedures mean life or death for many, facilities and staff must respond swiftly with a stringent infection control plan.

Even with the best efforts in place, most long term care facilities are ill-prepared to admit and care for COVID-19 positive patients. Because nursing home and assisted living facility residents, due to their age, compromised immune systems and underlying health conditions, are already at risk of respiratory diseases such as influenza and pneumonia, they are particularly at risk of COVID-19 infection and possible death. Since facilities should already have infection prevention plans and strategies in place for existing infectious diseases, and because these strategies overlap with those recommended for COVID-19, these facilities should theoretically have been prepared to respond accordingly.

In addition to existing infection control plans, the CDC provided guidelines to draft and implement a COVID-19 Preparedness Checklist for skilled nursing homes and other long-term care facilities.  Some recommended strategies are to monitor and restrict visitors, test and identify active cases, isolate any active cases, and handle, store, process, and treat all patients and their belongings with the appropriate protective gear. Yet, regardless of existing plans, if not properly implemented, the likelihood of community spread of the virus remains too high to risk. Existing understaffing combined with the lack of preparation means staff, who are already spread thin, lack the time and resources for proper infection control, often leading to dire consequences. In fact, of the 320 fatalities in Los Angeles, 29% of them were found to be residents of nursing homes. And according to the LA Times, 89% of the long-term facilities with COVID—19 had already been cited for infection control violations in the past.

The novel coronavirus, COVID-19, has left unprecedented marks on society, triggering stay-at-home orders, shelter-in-place orders, ceasing all in-office activities for non-essential businesses, implementing social distancing measures, to mention a few. The airborne respiratory disease is highly contagious and unfortunately, fatal to a percentage of its victims. And as novel as it is, from the limited research we have thus far, one thing is clear: The most vulnerable, with the highest risk of fatalities, are those 65 years and older, those with underlying health conditions, and those residing in long term care facilities. The unfortunate truth for those who live in skilled nursing facilities is that often times, they check off on all of these traits. Skilled nursing facilities are for seniors or dependent adults who have more complex medical conditions and need all-around, 24/7 skilled nursing care.

Despite clear knowledge that the elderly, residents in skilled nursing facilities, those with compromised immune systems and underlying medical conditions are disproportionately endangered by COVID-19, on March 30, 2020, the California Department of Public Health (CDPH) released an absurd All Facilities Letter (AFL)  mandating the admission of COVID-19 positive patients into skilled nursing facilities.

This AFL follows a series of AFLs warning facilities of what is to come, of the potential of an influx of COVID-19 cases, and of the necessary procedures and precautions facilities should implement to protect its residents. One of these AFLs, dated March 20, 2020 states all skilled nursing facilities in California must take precautionary measures to protect their elderly residents from COVID-19 by preventing the initial introduction of the virus in their facility. What is counterintuitive, contradictory, and outrageous of the mandated admission of confirmed COVID-19 patients, then, is this: they claim to want to protect those most at risk of COVID-19 then proceed by implementing the opposite. This CDPH directive directly and carelessly puts the most vulnerable populations in the frontlines of infection and potential death. The existing examples of nursing home COVID-19 outbreaks demonstrate the grim truth: most nursing homes are egregiously unprepared for infection control, let alone readily equipped to handle a wave of COVID-19 positive admissions.

The prevalence of chronic wounds located in the lower extremity area is high among older adults.  Not only can they be extremely deleterious and pose major health risks, they also increase socioeconomic burden because of the high expenses of wound care, long duration of healing time, increased complication rate and negative effect on patients’ and loved ones’ quality of life.  Chronic wounds are related to heightened mortality and significant morbidity because of infection, loss of ability to perform daily activities, pain, and psychosocial issues. Health care clinicians must be trained to identify and diagnose wounds, as well as provide proper management of their etiology. The four most common chronic wounds are venous leg ulcers, diabetic foot ulcers, pressure ulcers, and arterial ulcers.  Although there have been recent advances in wound care, care providers are still struggling to provide the best quality of care in this area, especially for elderly people living in nursing homes and assisted living facilities.

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A recent study exploring the effectiveness of twenty-four-hour reports in infection prevention and control showed that they are essential components. Infections are known to be highly prevalent among nursing home residents and can lead to morbidity and mortality. This fact is unsurprising, considering that residents are constantly clustered in constrained living environments and frequently perform daily activities in groups. Residents with impaired cognitive functioning may have difficulty engaging in fundamental hygiene practices. Far too many caregivers receive deficient training and lack the knowledge necessary to implement basic infection control. Because residents are physiologically aged and often carry comorbid diseases, not only do site-specific infections develop easily, they are also difficult to diagnose. Consequently, identification and treatment can be delayed.

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Summerlin Hospital, located in Las Vegas, is currently being sued by former patients, visitors, and employees for negligence. Those bringing suit are claiming that the hospital failed to take precautionary measures, endangering the health and lives of staff, patients, and others by exposing them to a woman and at least one baby infected with tuberculosis. Tuberculosis is a common, yet potentially lethal disease which generally attacks the lungs and other parts of the body. It is contagious and may be spread through the air when someone with a tuberculosis infection transmits respiratory fluids into the air by sneezing, speaking, singing, or coughing. Due to its contagious nature, those who are in close or frequent contact with an individual with tuberculosis will be at a high risk of contracting the infection themselves.

In this case, the infected woman gave birth to twin daughters at the hospital. Despite exhibiting symptoms of tuberculosis, the woman was allowed continued visitation after being discharged in order to see her babies. The woman and both babies have since passed away from the disease, and the woman was diagnosed with tuberculosis in an autopsy. This lawsuit follows another lawsuit filed by the woman’s family, which alleges that the hospital failed to see and address signs that could have saved the woman’s life. Those bringing this claim are alleging that the hospital was negligent in its failure not only recognize and diagnose the woman’s tuberculosis, but in its failure to take basic precautionary measures. The lawsuit alleges that the hospital not only failed to warn people of a potential exposure to the infection, but also failed to follow isolation procedures.

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Lysostaphin is a natural enzyme that functions as an antibacterial against staphylococcal infections including Staphylococcal aureus and Staphylococcal epidermidis. It is effective against combating these infections because it attacks the bacterial cellular wall of staphylococci, and is capable of destroying the bacterium within minutes. Staphylococcal aureus infections, particularly MRSA (methicillin-resistant Staphylococcal aureus), are a continuing concern within healthcare settings. This is because they are responsible for a large portion of infections which arise from implantable devices such as catheters, which act to provide a pathway for MRSA to travel into the body. While anyone may contract a staphylococcal infection, they are of particular concern within certain groups such as those residing in nursing homes. The elderly population is generally at higher risk due to their vulnerable state and weakened immune systems. Contraction of such infections not only lead to skin infections, but when the bacteria enters the bloodstream, it may spread into other organs, infecting them, and may also lead to sepsis, pneumonia, and other severe complications including death.

MRSA bacterial cells are capable of forming a community of bacterial cells, known as biofilms, on medical devices and damaged tissue, thereby surviving and spreading infection. Unfortunately, the biofilms that form on such devices are generally antibiotic resistant, and it becomes increasingly difficult to treat the infection. As a result, the device will either have to be removed or replaced via surgery, and the patient will require an intensive antibiotic treatment plan. However, subjecting the patient to this type of invasive procedure heightens their risk for further complications. Additionally, despite this course of action, infection reoccurrence is still relatively high due to the increasing antibiotic-resistant nature of the bacterium. Therefore, lysostaphin has been studied and considered as an alternative anti-staphylococcal treatment. This is because lysostaphin has been known to effectively destroy staphylococcal bacterial cells, and has been demonstrated to be particularly effective against MRSA.

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All elderly individuals residing in nursing homes are highly susceptible to healthcare-associated infections (HAIs), a significant cause of fatalities and needless suffering. Common healthcare-associated infections include urinary tract infections, skin infections such as pressure ulcers, pneumonia, influenza, scabies, and methicillin-resistant Staphylococcus aureus (MRSA). These infections are known as healthcare-associated infections (HAIs) because they are typically acquired by patients who are receiving treatment for an initial ailment while at a healthcare setting, such as a nursing home, urgent care center, or hospital.

According to the Centers for Disease Control and Prevention (CDC), about 1 in every 20 hospitalized patients will acquire a healthcare-associated infection during their stay. These patients, particularly those who are elderly, are already in a much weakened clinical condition. Therefore, they are at a higher risk of contracting an HAI resulting in complications and even death. Thus, it is extremely important that these patients receive high-quality and safe care within these facilities. Caretakers must be aware of an elderly patient’s susceptibility to HAIs and therefore should take preventative measures to protect against them.

Generally, when an HAI is detected, the cause of the infection must be identified by healthcare providers. After, they will need to assess which antibiotic treatment, duration, and dosage will be proper in an individual patient’s case. However, caretakers should not rely on antibiotics to fix the problem. Rather, they should first implement preventative practices to avoid the infection from arising in the first place, as many of these infections are preventable.

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