California Elder Law Attorney Blog

A couple of new developments on the C. difficile front should be encouraging news to anyone who is familiar with this potentially deadly bacterial infection. You might also know it as CDI, or Clostridium difficile infection.

First, scientists from UCLA and the University of Texas have been looking at possible cellular defense mechanisms against the two toxins that are released into the gut whenever C. difficile germs are growing in number. The scientists believe that human cells in the gut are capable of releasing molecules that will knock down these toxins, and that the cells can put up a fight through a drug-induced process called protein s-nitrosylation.

The process is seen as a much-needed new therapeutic approach toward an infection that often resists treatment with antibiotics. As of August 2011, the research team was ready to conduct clinical trials on humans, after successful trials on animals.

Second, the fight against C. difficile continues with at least three different research projects that show the effectiveness of fecal microbiota transplants for those patients whose infections keep recurring. That's right -- fecal material is transplanted into the patient's body, usually by colonoscopy or by an infusion into the rectum.

Though it may sound unpleasant, the evidence suggests it can quickly stop C. difficile-related diarrhea and may eventually prove useful in reversing inflammatory bowel disease. The introduction of healthy fecal bacteria can restore balance to a digestive system wracked by CDI, the experts said.

The majority of C. difficile infections occur in hospital or nursing home settings, often because of poor hygiene. Overuse of antibiotics poses another problem, as the body loses the strains of bacteria that could normally fend off C. difficile.

In the United States, hundreds of thousands of people acquire C. difficile infections each year, with fatalities numbering between 15,000 and 20,000, according to an April 14, 2009, article in The New York Times. The symptoms include moderate to severe diarrhea, fever, nausea, loss of appetite, abdominal pain and, in some cases, colitis.

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Sepsis refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms says Elder Abuse Lawyer Steven Peck. Sepsis is also called bacteremia. Closely related terms include septicemia and septic syndrome.

Sepsis can originate anywhere bacteria can gain entry to the body; common sites include the urinary tract, the liver and its bile ducts, the gastrointestinal tract, and the lungs. Broken or ulcerated skin (bed sores, pressure sores and decubitus ulcers) can also provide access to bacteria commonly present in the environment. Invasive medical procedures, including dental work, can introduce bacteria or permit it to accumulate. Entry points and equipment left in place for any length of time present a particular risk. Heart valve replacement, catheters, ostomy sites, intravenous(IV) or arterial lines, surgical wounds, or surgical drains are examples. IV drug users are at high risk as well.

The most common symptom of sepsis is fever, often accompanied by chills or shaking, or other flu-like symptoms. A history of any recent invasive procedure or dental work should raise the suspicion of sepsis and medical help should be sought.

The presence of sepsis is indicated by blood tests showing particularly high or low white blood cell counts. The causative agent is determined by blood culture.

Identifying the specific cause ultimately determines how sepsis is treated. However, time is of the essence, so a broad-spectrum antibiotic or multiple antibiotics will be administered until blood cultures reveal the culprit and treatment can be made specific to the organism. Intravenous antibiotic therapy is usually necessary and is administered in the hospital.

Septic shock is a potentially lethal drop in blood pressure due to the presence of bacteria in the blood.

Septic shock is a possible consequence of bacteremia, or bacteria in the bloodstream. Bacterial toxins, and the immune system response to them, cause a dramatic drop in blood pressure, preventing the delivery of blood to the organs. Septic shock can lead to multiple organ failure including respiratory failure, and may cause rapid death. Toxic shock syndrome is one type of septic shock.

During an infection, certain types of bacteria can produce and release complex molecules, called endotoxins, that may provoke a dramatic response by the body's immune system. Released in the bloodstream, endotoxins are particularly dangerous, because they become widely dispersed and affect the blood vessels themselves. Arteries and the smaller arterioles open wider, increasing the total volume of the circulatory system. At the same time, the walls of the blood vessels become leaky, allowing fluid to seep out into the tissues, lowering the amount of fluid left in circulation. This combination of increased system volume and decreased fluid causes a dramatic decrease in blood pressure and reduces the blood flow to the organs. Other changes brought on by immune response may cause coagulation of the blood in the extremities, which can further decrease circulation through the organs.

Septic shock is seen most often in patients with suppressed immune systems, and is usually due to bacteria acquired during treatment at the hospital. The immune system is suppressed by drugs used to treat cancer, autoimmune disorders, organ transplants, and diseases of immune deficiency such as AIDS. Malnutrition, chronic drug abuse, and long-term illness increase the likelihood of succumbing to bacterial infection. Bacteremia is more likely with preexisting infections such as urinary or gastrointestinal tract infections, or bed sores, pressure sores and decubitus ulcers. Bacteria may be introduced to the blood stream by surgical procedures, catheters, or intravenous equipment.

Septic shock is usually preceded by bacteremia, which is marked by fever, malaise, chills, and nausea. The first sign of shock is often confusion and decreased consciousness. In this beginning stage, the extremities are usually warm. Later, they become cool, pale, and bluish. Fever may give way to lower that normal temperatures later on in sepsis.

Other symptoms include:

•Rapid heartbeat
•Shallow, rapid breathing
•Decreased urination.
•Reddish patches in the skin.

Septic shock may progress to cause "adult respiratory distress syndrome," in which fluid collects in the lungs, and breathing becomes very shallow and labored. This condition may lead to ventilatory collapse, in which the patient can no longer breathe adequately without assistance.

Diagnosis of septic shock is made by measuring blood pressure, heart rate, and respiration rate, as well as by a consideration of possible sources of infection. Blood pressure may be monitored with a catheter device inserted into the pulmonary artery supplying the lungs. Blood cultures are done to determine the type of bacteria responsible. The levels of oxygen,carbon dioxide, and acidity in the blood are also monitored to assess changes in respiratory function.

Septic shock is treated initially with a combination of antibiotics and fluid replacement. The antibiotic is chosen based on the bacteria present, although two or more types of antibiotics may be used initially until the organism is identified. Intravenous fluids, either blood or protein solutions, replacethe fluid lost by leakage. Coagulation and hemorrhage may be treated with transfusions of plasma or platelets. Dopamine may be given to increase blood pressure further if necessary.

Respiratory distress is treated with mechanical ventilation and supplemental oxygen, either using a nosepiece or a tube into the trachea through the throat.

Identification and treatment of the primary infection site is important to prevent ongoing proliferation of bacteria.

Septic shock is most likely to develop in the hospital, since it follows infections which are likely to be the objects of treatment. Because of this, careful monitoring and early, aggressive therapy can minimize the likelihood of progression. Nonetheless, death occurs in at least 25% of all cases.

The likelihood of recovery from septic shock depends on may factors, including the degree of immuno suppression of the patient, underlying disease, promptness of treatment, and type of bacteria responsible. Mortality is highest in the very young and the elderly, those with persistent or recurrent infection,and those with compromised immune systems.

The risk of developing septic shock can be minimized through treatment of underlying bacterial infections, and prompt attention to signs of bacteremia.

Continue reading "Sepsis Infection Can Cause Septic Shock a Potentially Lethal Drop In Blood Pressure Due to the Presence of Bacteria In the Blood indicates Elder Abuse Lawyer Steven Peck" »

The number of hospital patients with pressure sores, also called decubitus ulcers or bed sores, rose from 480,000 cases in 2007 to 655,000 cases in 2010 a substantial increase says California Elder Abuse Lawyer Steven Peck of the Peck Law Group.

Pressure sores typically result from prolonged periods of uninterrupted pressure on the skin, soft tissue, muscle, and bone. Vulnerable patients include the elderly, stroke victims, patients with diabetes, those with dementia, and people who use wheelchairs or are bedridden any patient with impaired mobility or sensation.

Patients aged 65 and older accounted for 72% of all hospitalizations during which pressure sores were noted. About 19% of such stays were for patients 45 to 64 years of age.

On average, patients admitted to hospitals primarily for treatment of pressure sores stayed nearly 13 days. But length of stay varied by age patients aged 18 to 44 accounted for the longest average stay (14 days), and those aged 85 and older had the shortest stays (10 days).

Nearly 9 of every 10 hospital stays involving pressure ulcers were covered by government health programs 66% by Medicare and 23% by state Medicaid programs.

Hospital charges for stays principally for treatment of pressure ulcers averaged $37,800, but average charges varied by payer, for example, the average charge to Medicaid was $39,100 while the average bill to the uninsured was $25,600.

The 10 most common principal reasons for hospitalizations during which it was noted that patients also had pressure sores were septicemia; pneumonia; urinary tract infections; aspiration pneumonitis; congestive heart failure; rehabilitation care; fluid and electrolyte disorders; complication of device, implant, or graft; respiratory failure; and diabetes mellitus with complications.

Continue reading "Hospitalized Patients With Bed Sores, Pressure Sores and Decubitus Ulcers Is Increasing At An Alarming Rate Says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

During your research of proper skilled nursing facilities for your elderly or disabled family member, you may have learned about nursing home abuse. One issue that results from abuse and neglect is infections . Infections can occur through lack of proper hygiene, improper food safety, and building safety. There are two highly common infections that are seen in nursing homes : MRSA and VSRA. These are not the only two infections and health problems. Focus are on these two because they are the more common issues.
MRSA stands for Methicillin-resistant Staphylococcus aureus. It is a bacterium that is highly difficult to treat once a patient is infected. It is known by other names like Oxacillin-resistant Staphylococcus aureus and multidrug-resistant Staphylococcus aureus. By definition it means the strain is resistant to antibiotics like penicillin. It is found in hospitals and skilled nursing facilities (SNFs) because these individuals may have open wounds or susceptible immune systems.

Continue reading "Be Vary Wary of Infections In Long Term Skilled Facilities" »

Lower urinary tract infections (UTIs) are a major cause of morbidity and mortality for adults in long-term care (LTC).1 Community studies have shown prevalence rates of bacteriuria to be 11% in the elderly, 18% for those living in congregate living arrangements, and 25-50% for residents in nursing home environments. In fact, the most common cause of bacteremia in LTC residents is due to UTIs.

The prevalence of UTI increases in both sexes with age, resulting in a female-to-male ratio of 2:1 in the elderly population. The annual incidence of symptomatic bacterial UTIs is estimated to be as high as 10%. For asymptomatic bacteriuria, the estimated cumulative prevalence is 30% in women and 10% in men. Interestingly, the female-to-male ratio in the incidence of UTI narrows in the elderly population, which is thought to be related to the fact that with increasing age, men develop an increase in residual urinary volume after voiding, which increases their risk of bacteriuria and UTI; women engage in less sexual activity with age, and thus have one less predisposing risk factor for introduction of bacteria into the urinary tract.

Continue reading "Urinary Tract Infections Are a Major Cause of Morbidity and Mortality in Long Term Care Facilities" »

Pressure ulcer litigation is a growing concern for nursing homes. The incidence of a pressure ulcer alone is used as defacto evidence of neglect on the part of a nursing home. These cases rely on disparate medical records from all treating facilities, testimony of employees of record (when available), and the interpretation of events by expert witnesses. A neat linear format is created by this attenuated reconstruction of events. However, a confluence of factors can lead to the occurrence of a pressure ulcer. Additionally, limited evidence is available regarding the effectiveness of specific prevention strategies. Knowing the outcome in a case being litigated, plus the limitations described above, weakens one's ability to objectively judge whether reasonable prevention strategies were employed in a timely manner or even whether prevention was possible.

Pressure ulcers are a phenomenon, not a disease or even a discrete medical condition. Pressure ulcers - skin breakdown that occurs entirely as a result of exposure to a toxic combination of physical forces, such as pressure and shear - are more accurately described as an injury as used by the Institute of Medicine (IOM). Experienced clinicians know that this type of pressure ulcer is the exception rather than the rule. Instead, the incidence of pressure ulcers in nursing homes is more accurately described as an event, often associated with medically complicated residents who usually are frail and immobilized. Clinicians must continue efforts to understand pressure ulcers, learn which can be avoided, and find better ways to treat them. Criminalizing this event will never provide an environment that encourages funding of the basic research needed to comprehensively understand their natural history nor will it help people at risk for developing pressure ulcers or those responsible for patient care.

The Current Nursing Homes Oversight Environment

The nursing home industry ranks high on the list of the most regulated industries by both state and federal oversight agencies. The federal government is a major stakeholder in the nursing home industry. In the year 2000, the federal government paid nursing homes an estimated $39 billion. Through the Centers for Medicare and Medicaid Services (CMS), the federal government performs an increasingly coordinated oversight role.

Continue reading "Bed Sores, Pressure Sores & Decubitus Ulcer Litigation is A Major Concern for Nursing Homes Says California Nursing Home Abuse and Neglect Attorney Steven Peck " »

Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization dedicated to the prevention and treatment of pressure sores, has defined each stage as follows:

* Stage I. A pressure sore begins as a persistent area of red skin that may itch or hurt and feel warm and spongy or firm to the touch. In blacks, Hispanics and other people with darker skin, the mark may appear to have a blue or purple cast, or look flaky or ashen. Stage I wounds are superficial and go away shortly after the pressure is relieved.
* Stage II. At this stage, some skin loss has already occurred -- either in the outermost layer of skin (the epidermis), the skin's deeper layer (the dermis), or in both. The wound is now an open sore that looks like a blister or an abrasion, and the surrounding tissues may show red or purple discoloration.
* Stage III. By the time a pressure ulcer reaches this stage, the damage has extended to the tissue below the skin, creating a deep, crater-like wound.
* Stage IV. This is the most serious and advanced stage. A large-scale loss of skin occurs, along with damage to underlying muscle, bone, and even supporting structures such as tendons and joints.

If you use a wheelchair, you're most likely to develop a pressure sore on:

* Your tailbone or buttocks
* Your shoulder blades and spine
* The backs of your arms and legs where they rest against the chair

When you're bed-bound, pressure sores can occur in any of these areas:

* The back or sides of your head
* The rims of your ears
* Your shoulders or shoulder blades
* Your hipbones, lower back or tailbone
* The backs or sides of your knees, heels, ankles and toes

Continue reading "Los Angeles Bed Sore Litigation Lawyer Talks About Stages and Symptoms of Bed Sores, Pressure Sores and Decubitus Ulcers" »

More and more people die of thirst, malnutrition and from the complications of Bed Sores every single day in hospital wards in California and all around the United States says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Dehydration contributes to the death of thousands ­hospital patients every year, the latest figures reveal.

Thousands more die malnourished, because of ­infections and as a result of crippling bedsores.

Continue reading "Elderly Patients Die of Dehydration, Malnourishment and Bed Sores Daily In Hospitals all Across the United States " »

The analysis of death certificates of care home residents exposes an appalling record of neglect that will make all decent people angry.

Thousands if not tens of thousands of elderly people die every year in the United States of dehydration, malnutrition,and bedsores also known as pressure sores and decubitus ulcers. MRSA and Clostridium difficile known as "superbugs", that thrive where standards of cleanliness are not maintained. also cause many deaths of nursing home and long term care facility residents says Los Angeles Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Continue reading "Nursing Homes and Long Term Care Facilities Should Not Be A Death Sentence " »