For nursing homes, a different kind of infection and unvaccinated staff raise alarms
Alarms are sounding yet again that the nation’s nursing homes and other long-term care facilities may need to increase important infection control measures and reexamine what’s going on with the staff they need to safeguard patients.
Details are still emerging. But federal officials say they have sufficient evidence to report a new outbreak of Candida auris, aka C. Auris, highly drug-resistant fungus, in a nursing home in Washington, D.C., and at two Dallas-based hospitals.
This “superbug” is considered a menace because infected patients do not respond to treatment with three major drug groups. This outbreak also has experts’ attention because it shows signs of a different way of spreading — patient-to-patient transmission.
As the Associated Press reported:
“’This is really the first time we’ve started seeing clustering of resistance’ in which patients seemed to be getting the infections from each other, said … Dr. Meghan Lyman [of the federal Centers for Disease Control and Infection]. The fungus, Candida Auris, is a harmful form of yeast that is considered dangerous to hospital and nursing home patients with serious medical problems. It is most deadly when it enters the bloodstream, heart, or brain. Outbreaks in health care facilities have been spurred when the fungus spread through patient contact or on contaminated surfaces.”
The CDC detected these unconnected outbreaks in facilities it did not identify earlier this year and the agency said it has blamed one death in Washington, D.C., and two in Texas on the fungal outbreak.
The New York Times, before the coronavirus pandemic, had chronicled how overuse of antibiotics, the dearth of new ones, and institutions’ issues with infection control had led to the rise of superbugs, including C. Auris. The newspaper found this:
“For decades, public health experts have warned that the overuse of antibiotics was reducing the effectiveness of drugs that have lengthened life spans by curing bacterial infections once commonly fatal. But lately, there has been an explosion of resistant fungi as well, adding a new and frightening dimension to a phenomenon that is undermining a pillar of modern medicine. ‘It’s an enormous problem,’ said Matthew Fisher, a professor of fungal epidemiology at Imperial College London, who was a co-author of a recent scientific review on the rise of resistant fungi. ‘We depend on being able to treat those patients with antifungals.’ Simply put, fungi, just like bacteria, are evolving defenses to survive modern medicines.”
The peril posed by superbugs is severe and growing, the newspaper reported:
“In the United States, two million people contract resistant infections annually, and 23,000 die from them, according to the official CDC. estimate. That number was based on 2010 figures; more recent estimates from researchers at Washington University School of Medicine put the death toll at 162,000. Worldwide fatalities from resistant infections are estimated at 700,000.”
Nursing home staff: Unvaccinated and lacking
Hospitals and other caregiving institutions have tried to keep quiet superbug outbreaks and other serious infection-control breaches. They have, however, become glaring problems in nursing homes and other long-term care facilities during the pandemic, with increasing scrutiny on issues involving their staff and their numbers, as well as their lapses in safeguarding patients.
Experts, for a while, had been cheered by the plunge in coronavirus deaths and infections in nursing homes, mostly due to aggressive campaigns to vaccinate their aged, ill, and injured residents.
The facilities, at the same time, had encouraged their staff to protect themselves, residents, and their loved ones by getting coronavirus shots, too. This met with greater than expected resistance, however.
Many of the workers are overworked, highly stressed, poorly trained, and under paid. Nursing homes’ chaotic responses to the pandemic gave their staff little reason to trust owners and operators. Many of the workers, struggling to get by, already worked multiple jobs, often at several different facilities. They did not want to lose time getting vaccinated or dealing with the shots’ side-effects.
Nursing homes have struggled to keep staff, which they lost in high numbers during the pandemic. So, they have not mandated vaccinations for health workers, as some experts have encouraged them to do so, as Pro Publica, the Pulitzer Prize-winning investigative news site reported.
Now, as a result, the Associated Press reported:
“Nationally about 59% of nursing home staff have gotten their shots, about the same as the overall percentage of fully vaccinated adults — but significantly lower than the roughly 80% of residents who are vaccinated, according to Medicare. And some states have much lower vaccination rates of around 40%.”
But as the news agency also found:
“Lagging vaccination rates among nursing home staff are being linked to a national increase in Covid-19 infections and deaths at senior facilities and are at the center of a federal investigation in a hard-hit Colorado location where disease detectives found many workers were not inoculated.”
Nursing homes and their residents suffered a disproportionate toll during the pandemic, and any upticks in deaths and infections is concerning, the AP reported:
“It’s estimated that nursing home residents represent about 1% of the U.S. population, but they account for about 22% of Covid-19 deaths — more than 133,400 people whose lives have been lost … But Covid-19 [also] has not been wiped out. As of the week ending July 4, there were 410 [nursing home] residents sickened nationwide and 146 who died.”
Nursing home owners and operators, by the way, may have increased their residents’ coronavirus risks by trying to hold down staffing costs, using fewer, full-time staff receiving employee benefits, and relying on more, cheaper part-time health workers, new research has found. This personnel practice may, at least on paper, make facilities appear to have more staff — and that would seem beneficial for patient care
But researchers found that increased use of part-time staff caused greater churn in facilities — simply more people going in and out of the building. This increased chances, especially in areas of high community spread, that residents were exposed to coronavirus-carrying health workers.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by neglect and abuse in nursing homes and other long-term care facilities.
The pandemic became an unacceptable and deadly look for us all at the many ways that nursing home owners and operators pursued profits at the expense of residents and their loved ones. They claimed they did the best they could under dire and unforeseen circumstance.
But even as taxpayers have dumped billions of dollars to shore up the needed facilities, where is the accountability for the debacle that occurred with them — yes, including with the shambolic regulatory response to a mass incident responsible for roughly a third of all deaths in this country due to the coronavirus?
Critics love to slam malpractice lawyers and the civil justice system. But many nursing home residents and their families, struggling still with the consequences of the pandemic, are thinking hard as to whether their best recourse may be lawsuits to search for justice for wrongs done to them.
We have much work to do to learn what problems still plague nursing homes, what went wrong with them and other long-term care facilities during the pandemic, and to fix the systemic problems, as well as to provide a reckoning to those who allowed tens of thousands to die and millions to suffer infection with the coronavirus.