22 Oct A Drug-Resistant, Deadly Fungus Is Plaguing Nursing Facilities
Called candida auris, this fungus is highly contagious, drug-resistant, and it’s plaguing nursing facilities. Half of the patients who contract this disease die within 90 days. It’s so difficult to eradicate that many facilities have stopped accepting patients infected with it. Public health officials struggle to contain the pathogen, while the government tells them that skilled nursing facilities are fueling its spread.
“They are the dark underbelly of drug-resistant infection,” said Dr. Tom Chiller, who heads the fungal division at the Centers for Disease Control and Prevention, speaking about skilled nursing facilities, particularly those with ventilated patients.
Nursing homes are playing a key role in the spread of this deadly fungus in New York
An estimated 396 people in New York are known to be infected, and another 496 are carrying the germ without showing symptoms, according to public health officials. In Chicago, half of patients living on dedicated ventilator floors in the city’s skilled nursing homes are infected with or are harboring C. auris, said Dr. Allison Arwady, the acting commissioner of the city’s Department of Public Health.
Much of the blame has focused on the overuse of antibiotics in humans and livestock
Nursing facilities and long-term hospitals are a weak link in the health-care system. Understaffed and ill-equipped to enforce rigorous infection control, they’re continuously cycling infected patients in and out of hospitals.
“They are constantly seeding and reseeding hospitals with increasingly dangerous bacteria,” said Betsy McCaughey, a former lieutenant governor of New York. “You’ll never protect hospital patients until the nursing homes are forced to clean up.”
Drug-resistant germs of all types thrive in settings where severely ill and ventilated patients are prone to infection and often take multiple antibiotics, which can spur drug resistance. Germs can move from bed to bed, from patient to family or staff, and then to hospitals and the public because of lax hygiene and poor staffing.
Those at highest risk: The elderly and those with weakened immune systems
The New York Department of Health has made controlling the spread of C. auris a high priority and has conducted extensive training and education.
- Elderly or severely ill people with weakened immune systems who carry the germ are at high risk of becoming infected.
- A Southern California study found that 65% of nursing-home residents harbored a drug-resistant germ, as did 80% of residents of long-term, acute-care hospitals, whose status is unknown to the facility.
- By comparison, only 10 to 15% of hospital patients carried such germs, the study found.
The deadly infection goes global
- Elderly residents of long-term care facilities in Britain were four times as likely to be infected with drug-resistant urinary tract infections as elderly residents living at home.
- Soaring levels of resistance were found in long-term care facilities in Italy, and a2019 study found that long-term care facilities in Israel are “a major reservoir” of a major family of drug-resistant germs.
- Brooklyn’s Palm Gardens, with a “respiratory pavilion” for patients on mechanical life support, is poorly ratedby the federal government.
Nursing homes and long-term care now play a bigger role in health care
Skilled nursing homes and long-term care facilities have been playing an increasingly important role in caring for seriously ill patients who once stayed longer in hospitals. Advances in medical technology have made it possible to prolong the lives of desperately ill patients. There are now about 400 long-term care hospitals across the country, up from about 40 in the early 1980s.
The socioeconomics of long-term care
The problem is pronounced in the United States due to changing economics that push high-risk patients out of hospitals and into skilled nursing homes. The facilities are reimbursed at a higher rate to care for these patients, providing an economic incentive for poorly staffed or ill-equipped facilities to care for vulnerable patients. Curbing drug-resistant infection may be an additional challenge that these facilities are unable to meet.
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The result is numerous conversations on a wide range of topics related to health, healthcare and end-of-life planning. For those who are caring for older family members who may be spending time in nursing facilities, candida auris is a growing concern.
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