Wounds, Sepsis & Infections in Nevada Nursing Homes

A wound that will not heal is rarely just a wound. Broken skin is an open door, and in a frail resident the infection that follows can move from the tissue into the bloodstream faster than families are led to expect. Our overview of nursing home neglect claims in Nevada covers the wider pattern of care failures; this page is about non-healing wounds and the infections that grow out of them — cellulitis, bone infection, sepsis and septic shock.

In these cases the wound itself is often not the whole story. A decisive question is usually what the facility did in the hours and days after the resident began to look different — the low-grade fever, the new confusion, the falling blood pressure — and whether anyone made the decision to send them to a hospital.

O'Reilly Law Group has represented families in Las Vegas since 1972. Our office is at 325 South Maryland Parkway, Las Vegas, Nevada 89101. If you want the chart, the medication records and the hospital admission reviewed by someone independent, call 702-382-2500. Nothing here is legal advice about your particular situation, and no result can be promised.

How a wound becomes an infection

Most wounds in long-term care begin as pressure injuries, and they are staged by depth. Under the NPIAP staging system, a Stage 3 pressure injury is full-thickness skin loss in which adipose tissue is visible, and undermining and tunneling may occur at this stage. A Stage 4 pressure injury is full-thickness skin and tissue loss in which fascia, muscle, tendon, ligament, cartilage or bone is exposed or directly palpable. An unstageable injury is one whose true depth is obscured by slough or eschar. A deep tissue pressure injury shows as persistent non-blanchable deep red, maroon or purple discoloration and can conceal serious damage underneath intact-looking skin.

Once tissue is open, bacteria that live harmlessly on skin have a route inward. Infection can spread outward into the deeper skin and fat as cellulitis, downward to bone as osteomyelitis where a deep wound sits over the tailbone, hip or heel, or into the bloodstream, where the body's own response to the infection begins to injure its organs. That last stage is sepsis.

Healing is also easily undermined. Poor nutrition, dehydration, low protein intake, unmanaged incontinence, anemia and unrelieved pressure all slow closure — and each of them is something a facility is supposed to be tracking.

Sepsis moves quickly, and the signs are subtle in older people

Sepsis is defined clinically as life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is the more severe subset, in which a patient needs medication to hold blood pressure up and shows a raised blood lactate despite adequate fluid. Clinical reviews of sepsis report that sources of infection, in order of prevalence, are pneumonia, intra-abdominal infection and urinary tract infection, and that age over 65 has been shown to be an independent predictor of mortality in sepsis.

Separate from that definition is an older screening construct that nursing staff are commonly taught: the systemic inflammatory response syndrome, or SIRS, criteria — temperature above 38°C or below 36°C, a heart rate over 90, and breathing faster than 20 breaths a minute. SIRS criteria are a screening tool, not the definition of sepsis; they can be met without sepsis and can be absent in a resident who has it. Low blood pressure, reduced urine output and altered mental status are not SIRS criteria — they are signs of the organ dysfunction that does define sepsis. All of them are changes a nursing team is expected to recognize and escalate.

The trap is that older residents frequently do not run a fever. Sometimes the only early sign is that someone is suddenly confused, unusually sleepy, off their food, or has an unexplained fall. Those changes are not vague — they are recognized warning signs, and they can mark the point at which the outcome is still changeable.

Why the failure to transfer is often the decisive failure

A skilled nursing facility is not a hospital. Blood cultures, serial lactate measurement, aggressive intravenous fluid resuscitation, imaging, surgical debridement and intensive monitoring generally require an acute-care setting. When a resident is showing signs of a systemic infection, one of the most consequential decisions available to the facility is whether to send them out — and how quickly.

This is why many of these cases turn on timing rather than on the wound. A wound that was managed imperfectly but recognized and escalated looks very different from one where abnormal vital signs were recorded across three shifts and no physician was called.

Federal rules reinforce the point. A facility must immediately inform the resident, consult the resident's physician, and notify the resident's representative when there is an accident involving the resident which results in injury and has the potential for requiring physician intervention; a significant change in the resident's physical, mental or psychosocial status; a need to alter treatment significantly; or a decision to transfer or discharge the resident from the facility (42 CFR 483.10(g)(14)). Facilities are also required to maintain an infection prevention and control program, including a surveillance system designed to identify possible infections (42 CFR 483.80).

What the facility's own records should show

Infection cases often turn on what the chart shows. Where care was adequate, the record tends to show a clear sequence: a change noticed, vital signs taken, a physician contacted, an order given, treatment delivered, a response reassessed. Where care failed, the sequence tends to have holes in it.

The documents that generally carry the most weight are the nursing notes, the wound care flow sheets with dated measurements and photographs, the vital sign records, the weight and intake-and-output logs, the physician orders and progress notes, laboratory and culture results, the care plan and its revisions, and the medication administration record. The last of these can be the most informative. An antibiotic that was ordered but not given, or given hours late, or stopped without explanation, may appear there and nowhere else.

Gaps can matter as much as entries. Vital signs that stop being recorded once they turn abnormal, a wound measurement that has not been updated in weeks, or a care plan that was never revised after the wound worsened are all things a reviewer will look at.

The Nevada law that applies

Pressure injuries and the "unavoidable" exception. Federal regulation states that a resident receives care consistent with professional standards of practice to prevent pressure ulcers and does not develop them unless the individual's clinical condition demonstrates they were unavoidable (42 CFR 483.25(b)(1)). "Unavoidable" is a narrow exception the facility ordinarily has to support with its own records, not a general explanation.

Enhanced damages. Under NRS 41.1395, when an older person — defined as a person who is 60 years of age or older — or a vulnerable person suffers a personal injury or death caused by abuse or neglect, the person who caused the injury or death is liable to that older or vulnerable person for two times the actual damages incurred by that person. If it is established by a preponderance of the evidence that a person liable under the section acted with recklessness, oppression, fraud or malice, the court shall order that person to pay the attorney's fees and costs of the person who initiated the lawsuit. The section does not apply to a person who did not know and had no reason to know that the harmed person was a vulnerable person.

If the resident died. NRS 41.085 allows the heirs and the personal representative to bring a wrongful death action. Heirs may recover for grief or sorrow, loss of probable support, companionship, society, comfort and consortium, and for the decedent's pain, suffering or disfigurement. The personal representative may recover special damages such as medical and funeral expenses.

Deadlines. NRS 11.190(4)(e) generally allows two years for injury or death caused by the wrongful act or neglect of another. A claim framed as professional negligence falls under NRS Chapter 41A instead. NRS 41A.097 as it stands today contains several different periods, and which one applies depends on when the injury occurred rather than on which version of the statute is in force. Under NRS 41A.097(3), an injury occurring on or after October 1, 2023 must be sued on within 3 years after the date of injury or 2 years after the plaintiff discovers, or through the use of reasonable diligence should have discovered, the injury, whichever occurs first. Subsection 2 covers an injury occurring on or after October 1, 2002 and before October 1, 2023, with 3 years from the date of injury or 1 year from discovery. Subsection 1 covers an injury before October 1, 2002, with 4 years from the date of injury or 2 years from discovery. Subsection 4 tolls the limitation for any period during which a provider of health care has concealed an act, error or omission on which the action is based. NRS 41A.071 separately requires a supporting affidavit from a qualified medical expert at filing.

What a family should do now

1. Request the complete chart in writing. Ask specifically for wound care flow sheets and measurements, the medication and treatment administration records, vital sign records, weights, physician orders and progress notes, and every care plan revision.
2. Get the hospital records too. The admission workup often documents wound stage, laboratory values and clinical findings that bear on how long the infection had been developing before transfer.
3. Report the concern. Suspected neglect of an older or vulnerable person can be reported to the Aging and Disability Services Division, to a police department or sheriff's office, or to a county office for protective services; under NRS 200.5093 listed professionals must report as soon as reasonably practicable and no later than 24 hours. A family member may report as well.
4. If a resident has died, act before records are archived. A personal representative may need to be appointed before an estate claim can proceed, and that takes time.

You do not need to know whether you have a case to ask. Call 702-382-2500 and we can go over what the records show.

O'Reilly Law Group, 325 South Maryland Parkway, Las Vegas, Nevada 89101; 702-382-2500. Nothing on this page is legal advice about your particular situation, and no result can be promised.

Terms you may hear

Cellulitis

A bacterial infection of the deeper layers of skin and the fat beneath. It appears as spreading redness, warmth, swelling and tenderness with a poorly defined border, and can extend well beyond the original wound.

Osteomyelitis

Infection of bone. Where a deep pressure injury sits over the tailbone, hip or heel, bacteria can reach exposed bone. It usually requires prolonged intravenous antibiotics and sometimes surgery, and it is one recognized reason a wound will not close.

Sepsis

Life-threatening organ dysfunction caused by a dysregulated host response to infection. It is not simply "an infection in the blood" — it is the body's reaction to infection beginning to damage its own organs. This is the Sepsis-3 definition; the older SIRS criteria are a screening tool, not a definition of sepsis.

Septic shock

The severe subset of sepsis in which circulatory and metabolic abnormalities are profound enough that medication is needed to keep mean arterial pressure at or above 65 mmHg, with blood lactate above 2 mmol/L despite adequate fluid resuscitation.

Medication administration record (MAR)

The running log of every medication ordered for a resident and every dose actually given, initialed and timed. In an infection case it shows whether antibiotics were delivered as ordered, and it is one of the first documents to request.