Pressure Ulcer Osteomyelitis

Pressure ulcer osteomyelitis is a serious and painful condition of the bone, causing the affected person great discomfort and long-term health complications. In this article, we will define this condition, its causes, consequences, prevention, and legal implications. 

What is Osteomyelitis?

Osteomyelitis is a serious bone infection typically caused by bacteria, although fungi or other microorganisms can also be involved. 

Causes of Osteomyelitis

Bed sores osteomyelitis occurs when bacteria enter the bone, often through an open wound or spread from another part of the body through the bloodstream. Once bacteria reach the bone, they can cause inflammation, pain, and tissue damage.

Symptoms of Osteomyelitis

While the symptoms vary depending on location and severity, they usually include:

• Pain: Pain is usually localized, constant, and throbbing. It becomes worse with pressure or movement. 
• Swelling: The surrounding area may be swollen and warm to the touch. 
• Redness: Discoloration may be present on the skin over the infected bone. 
• Fever: It may be accompanied by chills, fatigue, and general discomfort.
• Nausea and vomiting: This is especially common if the infection worsens or spreads.
• Drainage: If the infection leads to an open wound or starts with a pressure sore, pus or other fluids may drain from the wound, causing a bad odor.

It may be difficult to distinguish a pressure ulcer with a soft tissue infection from one with underlying osteomyelitis. Because the symptoms may not always be clear, diagnosing osteomyelitis may require a bone biopsy, magnetic resonance imaging, or bone scans.

Untreated osteomyelitis can lead to more severe complications, including chronic osteomyelitis, bone necrosis, infectious diseases, sepsis, and death.

Treatment Options

The primary treatment for osteomyelitis is antibiotic therapy, which can be oral or intravenous (IV), depending on the severity of the infection. Antibiotic treatment can last several weeks or months.

In more severe cases, antibiotic therapy can be combined with surgery. Bone infection surgery typically involves removing necrotic bone tissue, surgical debridement of surrounding soft tissue, drainage, and, in some cases, bone grafts. 

These treatment options are combined with wound care, which includes cleaning and dressing the wound, as well as more advanced methods, such as negative pressure wound therapy.

The Link Between Pressure Ulcers and Osteomyelitis

Pressure ulcers occur when prolonged pressure on the skin and underlying tissues reduces blood flow, damaging the tissue. Once they become deep enough, pressure ulcers can expose the underlying bone to bacteria and increase the risk of infection. 

Stage IV pressure ulcers are especially susceptible to osteomyelitis, as they can penetrate tendons, muscles, and bones. The exposed bone is no longer protected by soft tissue and skin, which allows the bacteria to enter directly. A stage IV pressure ulcer will spread to osteomyelitis in one in three cases. [1]

Risk Factors for Osteomyelitis

A pressure ulcer patient is more likely to suffer a bone infection if they have the following issues:

• Diabetes: Diabetes slows wound healing, increasing the risk of infection that could spread to the bone. Diabetes foot ulcers are another risk factor. 
• Fractures and injuries: This is especially true for injuries that limit the patient’s mobility (spinal cord injury, hip fracture, femur fracture).
• Poor circulation: Refers to conditions that limit blood supply to affected areas, such as sickle cell disease and peripheral artery disease.
• A cerebrovascular accident: If a person is confined to a bed or wheelchair because of a stroke, they are more likely to suffer pressure sores. 
• Weakened immune system: This can be due to another infection, HIV, or chemotherapy.  

Sacral pressure ulcers and pelvic pressure ulcers pose an especially high risk for bone infections.

How to Prove Liability of Nursing Homes

Proving nursing home liability requires you to understand the elements of negligence. They include duty of care, breach of duty, causation, and damages.

Duty of Care

Nursing homes have a legal duty of care, meaning they must protect their residents from pressure ulcers and complications such as bone infections. They must follow procedures and regulations set by federal and state agencies, which include:

• Creating and implementing care plans
• Conducting regular skin inspections
• Monitoring patients with existing pressure ulcers
• Providing adequate wound care
• Notifying the physician of any changes, such as infected pressure ulcers
• Documenting the care

If a bone infection is suspected, nursing homes must coordinate with healthcare providers who can diagnose osteomyelitis through proper diagnostic procedures, including bone biopsies.

Breach of Duty

If the nursing home fails to provide appropriate services or clinical evaluation and does not fulfill its duty of care, it has breached its duty. Examples of this breach include failing to monitor patients, failing to reposition them according to the care plan, or making medication errors.

When such breaches directly cause resident harm through action or inaction, the nursing home can be considered negligent. 

Signs of Neglect

Most pressure sores can be prevented — so it’s important to assess whether they were caused by neglect. Families and legal professionals should pay attention to signs such as:

• Unsanitary conditions: Unwashed bedding and soiled clothing can contribute to pressure sores and infections.  
• Inadequate staffing: Pressure relief and other prevention methods require adequate staffing. If a pressure injury develops, it may point to a lack of staff or proper training. 
• Lack of proper wound care: Inadequate dressing and cleaning of the wound may make it worse and contribute to stage 4 pressure ulcers, osteomyelitis, and necrosis. 

Preventing Pressure Sores and Osteomyelitis

Healthcare providers can prevent osteomyelitis associated with pressure sores by focusing on proactive care, regular monitoring, repositioning, skin care, and proper nutrition. These measures are also crucial in treating existing pressure injuries.  

Repositioning

Regular repositioning helps relieve pressure on the affected area. This simple but effective practice prevents new decubitus ulcer development and reduces discomfort.

Also, by promoting blood circulation and wound healing, repositioning helps repair tissue damage in existing sores. Repositioning is often combined with special dressings, mattresses, and foam cushions. 

Skin Care

Proper skin care can prevent pressure injuries from developing or getting worse. It includes keeping the skin clean and dry by using mild soap and moisturizers and managing incontinence to avoid irritation and infection.

Dry, fragile, and irritated skin is more prone to pressure injuries, especially in sensitive areas that suffer more friction. 

Wound Care

Pressure injury and osteomyelitis patients benefit from consistent, gentle, and timely wound treatment. This part is essential in preventing and treating infection, as it keeps the wound clean and prevents further complications. It can include:

• Regular cleaning
• Sterile dressing changes
• A surgical procedure to remove dead tissue
• Appropriate moisture management based on wound type
• Monitoring for signs of infection 

Nutrition and Hydration

Adequate nutrition and hydration are often neglected in nursing homes, although they’re crucial for wound prevention and treatment. A balanced diet strengthens the skin’s resilience and supports faster healing. 

A diet for adult patients at risk for skin ulcers must include protein-rich foods, vitamins and minerals, proper hydration, and adequate caloric intake.

Seeking Legal Help

Having osteomyelitis beneath pressure sores is extremely uncomfortable and painful, and due to the commonly present odor, it can also be socially isolating. Sadly, inadequate treatment can sometimes lead to systemic infections, sepsis, septic shock, and death. 

If someone you love has gone through this ordeal due to a nursing home’s negligence, you are not powerless. You can hold the facility accountable with the help of a legal professional. 

A nursing home injury lawyer can help by:

• Evaluating your case: Your lawyer will assess your case and advise on your legal options without any upfront cost.
• Investigating the case: They’ll gather evidence like medical records, witness statements, and facility inspection reports to build a strong case.
• Working with medical experts: They can consult medical experts who will show how the nursing home’s behavior led to pressure sore osteomyelitis.
• Filing a personal injury claim: A lawyer can file a formal claim and seek compensation for pain, suffering, and costs tied to the neglect.
• Negotiating a settlement: They can also negotiate with the insurance company to ensure you get a fair settlement. 
• Representing you in court: If the settlement is not satisfactory, they can take your case to court and represent you in trial.

Compensation

A typical nursing home neglect case takes an emotional, physical, and financial toll on the resident and their family. Your lawyer will help you document and prove all the harm, increasing your chances for compensation.

Victims and surviving families may be eligible for the following damages:

• Medical costs: This includes the cost of surgical treatment, rehabilitation, medication, medical devices, and other current and future medical expenses related to the neglect. 
• Pain and suffering: Osteomyelitis causes immense suffering and pain, which may be included in the compensation. 
• Emotional distress: The compensation may also include the fear, anxiety, depression, and isolation caused by the neglect.

Secure Expert Legal Counsel! 

If you suspect that a loved one is or has suffered from nursing home neglect, it’s important to take action quickly. Nursing home injury cases have a statute of limitations on how long you have to file a claim. 

Contact Nursing Home Law Center for a free consultation, and one of the attorneys will tell you whether your case is viable and what to do to protect your rights. We work on a contingency basis, so you don’t pay anything unless we win your case.

Call (800) 926-7565 or fill out our contact form.

References: [1] National Library of Medicine