Hospital Acquired Infections and Nursing Home UTI’s
Healthcare Associated Infections and Death: Catheter Use and Urinary Tract Infections
A Massachusetts settlement of $2 million resulted after a seventy-seven year-old woman died from septic shock. The nursing home resident was transferred to the defendant’s facility for rehabilitation following injuries sustained in a motor vehicle collision. She arrived with a Foley catheter and orders for the nursing staff to monitor her intake and output.
The plaintiff alleged the defendant nursing home was negligent in failing to properly supervise and train its staff , causing the decedent to go unmonitored despite specific instructions for close monitoring.
The plaintiff further alleged the staff negligently failed to monitor her, leading to an untreated urinary tract infection which ultimately led to septic shock and her death 17 days after admission to the nursing home. The defendant denied the allegations and disputed any deviation from acceptable standards of care. The parties reached a $2 million settlement in this anonymous case reported in the February 2019 edition of Medical Malpractice Verdicts, Settlements & Experts.
Urinary Tract Infections and Catheters
The Foley catheter is associated with one of the most common healthcare-acquired infections. A biofilm develops on the catheter, inviting bacteria to collect and multi ply. The most important way to prevent urinary catheter-associated infections is to limit the use of this device, and to stop using it as soon as clinically possible.
It is unclear from the write up of this case why the nursing home resident
still had the catheter in place at the time of her transfer from the hospital to
the nursing home. Once the nursing home staff assumed her care, the
emphasis should have switched to getting the catheter out, and if that was
not possible, using precautions to prevent and diagnose infection.
Avoidance of Catheter Use
The single most important intervention to prevent catheter-associated
urinary tract infections is to avoid use of an indwelling urinary catheter.
There are only a limited number of accepted indications for catheter use:
- Monitoring of hourly urine output in acutely ill patients
- Perioperative use for selected surgical procedures
- Urologic surgery
- Surgery on contiguous structures of the genitourinary tract
- Large volume infusions or diuretics during surgery
- Requirement for intraoperative monitoring of urine output
- Management of acute urinary retention and urinary obstruction
- To facilitate healing of open pressure ulcers or skin grafts in selected patients with urinary incontinence
- Neurogenic bladder
- In exceptional circumstances (e.g. end-of-life care), at patient request to improve comfort
Urinary tract infections are among the most common causes of sepsis in
hospitals and nursing homes. Urinary tract infections cause over 50% of the
episodes of blood steam infections in long term care facilities.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114799/. While some are
simple and easily treated with antibiotics, others can cause sepsis and
The risk of developing a urinary tract infection from a Foley catheter
increases with each day it is in place. A patient may have bacteria in the
urine without having any symptoms. However, a symptomatic urinary tract
infection is the big risk, especially with so many antibiotic-resistant
organisms proliferating. Commonly the infected patient has a fever, and less
commonly, has acute blood in the urine, pain over the suprapubic area, or
pus in the urine. This is seen as a cloudy sediment. In older adults,
symptoms are often very different – they often become lethargic, anorexic,
confused, or fall.
Given the high risk of sepsis from the Foley catheter, the nursing home staff
should have been reviewing why the catheter was still in place, getting it
removed, and monitoring the patient for signs of an infection to ensure
OnPoint LNC provides nursing home and hospital experts qualified to opine on liability, causation and damages associated with healthcare-acquired infections.
Contact us for help with your nursing home cases!
Ingrid Sidorov, MSN, RN
Program Coordinator Geriatrics
Kimm Ebersole, MHA, RN