Osteomyelitis is an infection of the bone, and sometimes occurs in nursing home residents who have bed sores.
How do bed sores lead to osteomyelitis?
One of the important functions that intact skin serves is to serve as a barrier to infecting organisms. When a nursing home resident develops a bed sore, especially a Stage IV pressure ulcer, the opening in the skin allows bacteria to penetrate the body. Bed sores commonly develop over bony prominences such as the sacrum, hips, or heels, where there is little soft tissue covering the bone. When the bone is exposed in a Stage IV pressure ulcer, infection causing bacteria can infect the bone relatively easily.
What are the symptoms of osteomyelitis?
Symptoms of osteomyelitis are similar to that of many other kinds of infection, and include:
- Severe pain in the affected area
- Lethargy, and warmth, swelling, and redness in the surrounding tissues
Nurses in nursing homes are not required to be able to diagnose osteomyelitis, but they are required to recognize signs and symptoms of an infection and must promptly notify the resident’s doctor.
How is osteomyelitis diagnosed?
The first test that is done is a blood draw which is used to check to see if there elevated level of white blood cells. White blood cells are released to fight an infection, and elevated white blood cell levels shows that the body is fighting an infection.
Radiographic testing is then done to image the infection. Plain film x-rays are not sensitive enough to show the presence of an infection until it is fairly advanced, so more advanced tests like a CT scan, MRI or bone scan will probably be needed to identify the presence and extent of the infection.
The gold standard for diagnosing osteomyelitis is a bone biopsy. This involves a surgeon taking a sample of the infected bone and sending it to a lab for analysis. The reason that this is useful is that it not only confirms the presence of the infection but allows doctors to determine exactly what kind of organism is causing the infection and what kind of antibiotics must be used to fight the infection.
How is osteomyelitis treated?
Osteomyelitis is a very serious condition, and left untreated, it results in osteonecrosis, or bone death. Unchecked osteomyelitis can result in systemic sepsis resulting in septic shock and wrongful death. Because it is such a serious medical problem, aggressive measures must be taken. At a minimum, osteomyelitis will require treatment with a powerful antibiotic like vancomycin administered through an IV, generally over a 6 weeks period.
Surgery is often required as well. The most common procedures include draining the infected area and debridement. Debridement is a surgical procedure where the doctor cuts away the infected bone and a small margin of healthy bone in order prevent the infection from spreading further. In extreme cases, amputation of the affected limb may be required.
Stage III and Stage IV bed sores can result in exposure of the deep soft tissues and bones to infecting organisms, resulting in a serious bone infection called osteomyelitis. Federal regulations provide that nursing home residents who are admitted to a facility without bed sores should not develop them unless they are clinically unavoidable and that nursing home residents who have bed sores should receive care and treatment necessary to promote healing and prevent infection.
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