Sepsis in Nursing Homes: Know the Facts

Introduction to Sepsis

What is sepsis? Sepsis (also called septicemia) is a serious (and sometimes fatal) condition caused by the body’s response to an infection. If sepsis leads to septic shock, a patient’s blood pressure can plummet, leading to death.

Colloquially known as blood poisoning, sepsis is sometimes called “the hidden killer.” The Sepsis Alliance found that only 44% of Americans have even heard of sepsis. But every two minutes, someone in the U.S. is affected by sepsis and more than 250,000 Americans die of sepsis every year. The Centers for Disease Control and Prevention (CDC) reported 621,000 cases of sepsis in the U.S. in 2000; by 2008, that number had ballooned to 1,141,000. One in five deaths worldwide occurs as a result of sepsis. Furthermore, sepsis is the most expensive health condition to treat, costing $20 billion per year. Sepsis is often mistakenly called a “rare” condition, but that is far from the truth; it is more common than most people think, and so it’s important to be educated about sepsis.


Risk Factors

What are the risk factors for sepsis? Sepsis is most common in the following groups of people:

  • pregnant women
  • babies
  • people with chronic illness (such as diabetes, kidney disease, lung disease, or cancer)
  • people with cirrhosis
  • people with wounds or injuries (like bedsores or burns)
  • people with invasive medical devices (like intravenous catheters or breathing tubes)
  • people who have previously received antibiotics or corticosteroids
  • people who are immunosuppressed or immunocompromised
  • older adults

Given that the elderly are at an increased risk for sepsis, residents of nursing homes and their loved ones should take particular care to learn about sepsis.

How People Get Sepsis

How do people get sepsis? Sepsis most commonly occurs in people who are hospitalized or have recently been hospitalized, especially if they’ve spent time in the ICU. Patients who are already dealing with several different illnesses may find themselves fighting sepsis as a result. Due to these factors, sepsis in nursing homes can be devastating.

People are more likely to get sepsis if they are already dealing with pneumonia, a digestive system infection (like an infection in their stomach or colon), a kidney infection, bladder infection, or an infection in other parts of the urinary system, or a bloodstream infection (bacteremia). When elderly people get sepsis, they are likely to get it from pneumonia, a urinary tract infection, infected teeth, or bedsores.

People 65 years old or older comprise 65% of sepsis cases. Nursing home residents are particularly vulnerable. Why are nursing home residents more susceptible to sepsis? Nursing homes are already an environment where ill patients live together in close quarters, and many facilities do not have a robust system in place to control the spread of infection. An investigation conducted by the Chicago Tribune and Kaiser Health News found that 72% of nursing homes have been cited for poor infection controls.  This is problematic because sepsis can be prevented by regular vaccinations, proper handwashing, taking every infection seriously, and caring for all wounds (even the most minor cut). Furthermore, low staffing levels in nursing homes can lead to resident neglect. Bedsores are a telltale sign of nursing home abuse and neglect; when bedsores are left untreated, they can become infected, leading to sepsis. If a nursing home resident gets sepsis, nursing home neglect may be to blame. Neglectful nursing staff may overlook the signs of symptoms.

Symptoms of Sepsis

Once sepsis occurs, it is important to get help right away, which is why it’s crucial to know the signs of sepsis. What are the signs and symptoms of sepsis?

Remembering the acronym SEPSIS can help you learn the signs of sepsis. S is for serious complication of an infection.

S is for serious complication of an infection.

E is for extreme shivering or muscle pain.

P is for passing no urine (in a day).

S is for severe breathlessness.

I is for it feels like you are going to die.

S is for skin mottled or discolored.

The Sepsis Alliance simplifies the symptoms of sepsis even further, encouraging people to remember the acronym TIME.

T is for temperature. If it’s higher or lower than normal, that could be a sign of sepsis.

I is for infection. A patient may have signs and symptoms of an infection.

M is for mental decline. Someone suffering from sepsis may be fatigued, confused, or lethargic.

E is for extremely ill. A patient may be suffering from severe pain or discomfort.

Other major symptoms of sepsis include:

  • a change in mental state (such as confusion, disorientation, anxiety, agitation, or apprehension)
  • a systolic blood pressure reading of less than 100
  • a respiratory rate higher than 22 breaths per minute

Time is of the essence when dealing with sepsis. As sepsis progresses, blood flow to the organs becomes impaired. This can lead to blood clots, organ failure, and tissue death (known as gangrene). As sepsis becomes more serious, it may lead to septic shock. The patient may need medication to maintain blood pressure greater than 65 mm Hg. If there are high levels of lactic acid in the blood, this means that cells aren’t using oxygen properly, which can lead to death. Unfortunately, septic shock carries a 40% mortality rate.

Treatments for Sepsis

How is sepsis treated? Once sepsis sets in, it can be fatal if not treated within a few hours, so rapid treatment is essential to ensure the survival of patients. Once sepsis is suspected, patients should be given an antibiotic drip within one hour. Antibiotics are administered, as are large amounts of fluid delivered intravenously. Vasopressor medications, designed to constrict blood vessels and thus increase blood pressure, may also be administered to sepsis patients.


Aftereffects of Sepsis: Post-Sepsis Syndrome

Once someone has had sepsis, they might experience aftereffects. These lingering effects could include:

  • Difficulty getting to sleep or staying asleep
  • Nightmares
  • Hallucinations
  • Panic attacks
  • Depression
  • Decrease in cognitive functioning
  • Muscle or joint pain
  • Lower self-esteem
  • PTSD
  • Amputations

Unfortunately, 25% of sepsis survivors will be re-hospitalized within 30 days (most commonly because of another infection). Furthermore, elderly sepsis survivors are three times as likely to see a decline in cognitive abilities; that can make it difficult or even impossible for them to return to independent living arrangements, leading many to end up in nursing homes.

Next Steps

Sepsis may also put patients at higher risk for infections later, so patients with a history of sepsis should take particular care to avoid infections. It can be hard to avoid infections in a nursing home, especially if a nursing home has been cited for poor infection controls that have led to a high number of infections in the facility. If you have questions about sepsis or if your loved one has had sepsis, don’t hesitate to contact a nursing home abuse attorney to learn more about nursing home abuse and neglect. Call (877) 238-4175 or email for your free consultation with an attorney.