Bedsore Infections

How Bedsores Become Infected

Healthy, intact skin serves as the body's primary defense against bacterial invasion. When a pressure ulcer breaks the skin, this protective barrier is compromised, creating a direct pathway for pathogens to enter the body. Several factors contribute to wound infections in bedsore patients:

Compromised Skin Barrier

Any open wound is vulnerable to infection, but bedsores present unique risks. The pressure damage that caused the wound also impairs blood flow to surrounding tissues, weakening the local immune response. Dead and dying tissue in the wound bed (necrotic tissue) provides an ideal environment for bacterial growth.

Proximity to Contamination Sources

Many pressure ulcers develop near the sacrum, buttocks, and perineal area—regions in close proximity to fecal matter and urine. Patients with incontinence are at particularly high risk, as prolonged exposure to moisture and waste can introduce harmful bacteria directly into open wounds.

Healthcare Environment Exposures

Nursing homes and hospitals harbor a variety of bacteria, including antibiotic-resistant strains. Cross-contamination from caregivers, equipment, and other patients can introduce dangerous pathogens to vulnerable wounds. Poor hand hygiene and inadequate wound care protocols significantly increase infection risk.

Patient Risk Factors

Elderly and debilitated patients—those most likely to develop bedsores—often have weakened immune systems that cannot effectively fight infections. Other conditions such as diabetes, malnutrition, and vascular disease further impair the body's ability to resist and recover from wound infections.

Types of Bedsore Infections

Several types of infections can develop in pressure ulcers, ranging from localized wound infections to life-threatening systemic conditions:

Bacterial Wound Infection

The most common type of bedsore infection involves bacterial colonization of the wound bed. Common bacteria found in infected pressure ulcers include:

• Staphylococcus aureus – One of the most common wound pathogens, capable of causing serious tissue damage
• Streptococcus species – Can cause rapidly spreading cellulitis and systemic infection
• Pseudomonas aeruginosa – Often identified by green drainage and a distinctive sweet or grape-like odor
• Escherichia coli (E. coli) – Common in wounds contaminated with fecal matter
• Enterococcus species – Increasingly antibiotic-resistant bacteria from the intestinal tract

MRSA Infections

Methicillin-resistant Staphylococcus aureus (MRSA) represents a particularly dangerous threat to bedsore patients. This antibiotic-resistant strain of staph bacteria is common in healthcare settings and extremely difficult to treat. MRSA infections can:

• Resist most common antibiotics, limiting treatment options
• Spread rapidly through wound tissue and to the bloodstream
• Cause severe tissue destruction requiring surgical intervention
• Lead to prolonged hospitalization and repeated treatment courses
• Progress to life-threatening sepsis

Healthcare facilities have a responsibility to implement MRSA prevention protocols, including proper screening, isolation precautions, and hand hygiene compliance. Failure to follow these protocols can contribute to MRSA transmission to vulnerable patients.

Cellulitis

Cellulitis is a spreading bacterial infection of the skin and subcutaneous tissue surrounding a wound. Signs include expanding redness, warmth, swelling, and pain that extends beyond the wound edges. Without prompt treatment, cellulitis can spread rapidly and lead to systemic infection.

Abscess Formation

Pockets of pus can develop within or beneath bedsores, forming abscesses. These collections of infected material often require surgical drainage and can serve as reservoirs for continued bacterial growth even when systemic antibiotics are administered.

Necrotizing Fasciitis

In severe cases, infection can spread along the fascial planes—the connective tissue layers between muscles. This condition, sometimes called "flesh-eating bacteria," is a surgical emergency that destroys tissue rapidly and carries a high mortality rate even with aggressive treatment.

Warning Signs of Infection

Early recognition of wound infection is critical for effective treatment. Warning signs that a bedsore may be infected include:

Local Wound Signs

• Increased redness – Expanding or intensifying redness around the wound edges
• Warmth – The wound and surrounding tissue feel warmer than nearby healthy skin
• Swelling – Increased edema or puffiness around the wound
• Purulent drainage – Thick, yellow, green, or gray pus draining from the wound
• Foul odor – A strong, unpleasant smell from the wound
• Increased pain – New or worsening pain at the wound site
• Delayed healing – Wound that fails to improve or actively worsens despite treatment
• Wound breakdown – Wound edges separating or wound size increasing

Systemic Signs

When infection spreads beyond the local wound, patients may exhibit systemic symptoms requiring urgent medical attention:

• Fever (temperature above 100.4°F/38°C) or abnormally low temperature
• Chills or rigors
• Rapid heart rate
• Confusion or altered mental status
• Rapid breathing
• Low blood pressure
• General malaise or feeling of illness

Systemic symptoms may indicate the infection has progressed to sepsis, a life-threatening condition requiring immediate emergency treatment.

Treatment Failures That Allow Infections

Wound infections in healthcare settings often result from preventable failures in patient care. Common deficiencies that lead to infected bedsores include:

Inadequate Wound Assessment

Regular, thorough wound assessment is essential for early infection detection. Failures include:

• Infrequent wound evaluations
• Incomplete documentation of wound characteristics
• Failure to recognize early infection signs
• Lack of wound measurement and photography protocols

Poor Wound Care Technique

Proper wound care requires trained staff following evidence-based protocols:

• Inadequate wound cleansing
• Failure to debride necrotic tissue
• Inappropriate dressing selection
• Infrequent dressing changes
• Use of contaminated supplies or equipment

Infection Control Failures

Healthcare facilities must maintain rigorous infection control standards:

• Poor hand hygiene compliance
• Failure to use appropriate personal protective equipment
• Inadequate isolation precautions for infected patients
• Cross-contamination between patients
• Environmental contamination from inadequate cleaning

Delayed Response to Infection

Once infection is identified, prompt treatment is essential:

• Delays in obtaining wound cultures
• Delays in initiating antibiotic therapy
• Failure to adjust treatment based on culture results
• Failure to escalate care when infection worsens
• Delayed notification of physicians about deteriorating conditions

Incontinence Management Failures

For wounds near the perineal area, proper incontinence care is critical:

• Infrequent checking and changing of incontinence products
• Failure to use barrier creams to protect wound areas
• Inadequate cleansing after incontinence episodes
• Failure to use fecal containment devices when appropriate

Legal Accountability for Bedsore Infections

When bedsore infections result from substandard care, healthcare facilities and providers may be held legally accountable. Elements that establish negligence include:

Duty of Care

Healthcare facilities owe patients a duty to provide care that meets accepted standards. This includes preventing bedsores from developing, treating existing wounds appropriately, and preventing and treating infections promptly.

Breach of Standard of Care

A facility breaches its duty when it fails to meet the standard of care that reasonably prudent healthcare providers would follow. Evidence of breach may include:

• Inadequate staffing that prevents proper wound care
• Lack of proper wound care protocols
• Documentation showing missed wound assessments
• Delayed treatment of obvious infection signs
• Failure to follow infection control guidelines
• Inadequate staff training on wound management

Causation and Harm

To recover damages, plaintiffs must show that the breach of duty caused harm. With infected bedsores, this may include:

• Progression of infection that required hospitalization
• Development of sepsis or other systemic complications
• Need for surgical intervention
• Prolonged illness and suffering
• Permanent injury or disfigurement
• Death from infection-related complications (giving rise to wrongful death claims)

Regulatory Violations

Nursing homes must comply with federal regulations requiring facilities to ensure residents receive appropriate treatment for skin conditions and infections. Violations of these regulations can support negligence claims and may result in additional penalties.

How Infections Should Be Prevented

Healthcare facilities should implement comprehensive infection prevention programs for patients with pressure ulcers:

Wound Prevention

The best way to prevent wound infections is to prevent wounds from developing:

• Regular skin assessments
• Appropriate repositioning schedules
• Use of pressure-redistributing surfaces
• Adequate nutrition and hydration
• Proper incontinence management

Proper Wound Management

When wounds develop, proper care minimizes infection risk:

• Regular wound cleansing with appropriate solutions
• Timely debridement of necrotic tissue
• Selection of appropriate dressings that maintain a moist wound environment
• Dressing changes per protocol and when soiled or dislodged
• Protection from contamination

Infection Control Measures

• Strict hand hygiene before and after wound care
• Use of clean or sterile technique as appropriate
• Proper disposal of wound care supplies
• Isolation precautions for patients with resistant organisms
• Environmental cleaning and disinfection

When to Seek Legal Help

If your loved one has developed an infected bedsore in a nursing home, hospital, or other care facility, you should consult a bedsore attorney if:

• The wound became infected while under facility care
• Signs of infection were ignored or treatment was delayed
• Your loved one developed sepsis or other serious complications
• A MRSA or other hospital-acquired infection was identified
• The infection required hospitalization or surgical treatment
• Your loved one died from infection-related complications
• You have concerns about the facility's wound care practices

At Traction Law Group, we understand that infected bedsores represent serious failures in patient care. We help families investigate how infections developed, hold negligent facilities accountable, and recover compensation for the harm caused. Contact us for a free, confidential consultation. There is no fee unless we win your case.

Documenting Bedsore Infections

If your loved one has developed an infected pressure ulcer, thorough documentation is crucial for any potential legal action:

1. Request medical records including wound care logs, lab results showing infection, antibiotic orders, and nursing notes
2. Note the timeline of when infection was first suspected versus when treatment was initiated
3. Document observations during visits about wound appearance, odor, and drainage
4. Record any complications such as hospitalization, surgery, or sepsis treatment
5. Keep records of communications with staff about the infection and treatment plan
6. Note any concerns about staffing levels, wound care practices, or incontinence management