Wound Care and Sepsis
Nursing Home Resident Wound Care Lawyer
Wound Care and Sepsis Attorney Kenneth LaBore. A serious form of elder abuse is wound infection sepsis due to improper wound care, monitoring and assessment. Often the failure to provide proper wound hygiene and cleansing, a lack of regular bandage changes, failure to use appropriate interventions lead to preventable infections which if left untreated can result in large wounds, infections, sepsis and death.
Infections Can Result In Sepsis, Amputation And Death
Treating the wound and preventing infection due to a worsening and growing wound base is a critical job for nursing staff. The failure to identify a change in the wound at a time when it is treatable is neglect. A resident must be sent to a hospital or have additional evaluation whenever there is a change in condition (worsening of the wound). A wound hospital can properly assess the nature and severity of the wounds and provide medical treatments such as antibiotics, wound cleaning, wound closure, nutritional supplements and support, wound vacs., etc.
According to Johns Hopkins, “severe sepsis is also called septicemia or blood poisoning. It happens when drug-resistant bacteria overwhelm the body and spread throughout the bloodstream. Sepsis can affect blood flow and cause tissue to die, especially in the toes, fingers, hands and feet. Severe sepsis can be deadly if antibiotic medicines cannot control the infection”.
Contact An Experienced Wound Care Attorney
For a free consultation to discuss your concerns about a pressure ulcer, wound care or other source of infection contact attorney Kenneth LaBore to discuss your case at 612-743-9048.
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Answer: A serious form of elder abuse is wound infection sepsis due to improper wound care, monitoring and assessment. Often the failure to provide proper wound hygiene and cleansing, a lack of regular bandage changes, failure to use appropriate interventions lead to preventable infections which if left untreated can result in large wounds, infections, sepsis and death.
Answer: Prior to May 2023 even the most serious wounds and infection or sepsis injuries which eventually lead to death were not eligible for pain and suffering damages under the Minnesota wrongful death statute, Minn. 573.02. Thankfully, the law was changed to now allow ‘all damages’ including pain and suffering of the deceased and claims for some injuries which occurred prior to death but are not the cause of the death.
Answer: Treating the wound and preventing infection due to a worsening and growing wound base is a critical job for nursing staff. The failure to identify a change in the wound at a time when it is treatable is neglect. A resident must be sent to a hospital or have additional evaluation whenever there is a change in condition (worsening of the wound). A wound hospital can properly assess the nature and severity of the wounds and provide medical treatments such as antibiotics, wound cleaning, wound closure, nutritional supplements and support, wound vacs., etc.
According to Johns Hopkins, “severe sepsis is also called septicemia or blood poisoning. It happens when drug-resistant bacteria overwhelm the body and spread throughout the bloodstream. Sepsis can affect blood flow and cause tissue to die, especially in the toes, fingers, hands and feet. Severe sepsis can be deadly if antibiotic medicines cannot control the infection”.
Answer: The Freedom from Abuse, Neglect and Exploitation laws, 42 CFR 483.25, governing nursing homes consider pressure ulcers to Be “AVOIDABLE” and therefore preventable:
Pressure ulcers / sores. Based on the comprehensive assessment of a resident, the facility must ensure that — (1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and (2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.
Answer: Bed sores also referred to as decubitus ulcers and pressure sores, are areas of damaged skin and tissue that develop due to a reduction in circulation often accompanied by excessive periods of unrelieved pressure on the affected area. In order to properly track the care provide for a pressure sore, it is essential that the staff understand the correct way to identify and chart the stages of pressure wounds and images of the wounds.
Pressure Ulcer Stages Revised by NPUAP
NPUAP Stage 1 Pressure Ulcer Injury: Non-blanchable erythema of intact skin Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury.
Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. These injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel. This stage should not be used to describe moisture associated skin damage (MASD) including incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), medical adhesive related skin injury (MARSI), or traumatic wounds (skin tears, burns, abrasions).
Stage 3 Pressure Injury: Full-thickness skin loss Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds. Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.
Stage 4 Pressure Injury: Full-thickness skin and tissue loss Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.
Unstageable Pressure Injury: Obscured full-thickness skin and tissue loss Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed. Stable eschar (i.e. dry, adherent, intact without erythema or fluctuance) on the heel or ischemic limb should not be softened or removed.
Lastly, here are some additional resources for pressure ulcers information from the Minnesota Department of Health.
The result of wound care neglect amputation can happen when the wound is not properly monitored, and changes of condition are not reported to the physician and family or the patient sent to the emergency room. Nursing homes and assisted living providers often have wound care nurses come in from outside the facility to provide weekly or biweekly wound cares and oversight the daily wound care is often performed by the nursing and aide staff. Wound can progress rapidly and unless there is proper documentation of the all the characteristics of the wound (size, color, depth) and photographed serious changes in condition can go unreported. Avoiding wounds or catching them and having proper medical treatment in the early stages of the injury is critical. Once the skin is serious injured even when it heals it can still be scarred and compromised and more prone to future sores.
Often times the initial injury that causes an open sore is from an abrasion from the cast or brace after a fracture or surgery. Once started the sore can become infected and further aggravated until it is a deep wound. Wounds can also occur in due to unrelieved pressure from prolonged periods of sitting in a wheelchair or lying in bed. These wounds are called pressure sore injuries can usually be prevented with a regular turning and repositioning schedule and a pressure off-loading mattress and wheelchair cushion.