A new study of Maryland nursing homes has found that facilities with a higher prevalence of pressure ulcers among high-risk long-stay residents were more likely to experience transmission of Candidozyma auris, a drug-resistant fungus that spreads in healthcare settings and is difficult to eradicate. The finding links wound burden and general care quality to a facility’s infection risk — and suggests that what families observe about a nursing home tracks with measurable outcomes.
C. auris is a fungus that colonizes skin, persists on surfaces and equipment, resists many antifungal drugs, and spreads readily between residents in facilities that care for medically complex patients. It has become a growing concern in long-term care, particularly in facilities serving residents with ventilators, catheters, and open wounds.
The association with pressure ulcers is not difficult to understand. An open pressure injury is a breach in the body’s primary barrier against infection. It requires repeated dressing changes, hands-on contact, and shared equipment — every one of which is an opportunity for transmission when hand hygiene, glove changes, and isolation precautions are not followed consistently. A facility with many residents carrying open wounds has both more portals of entry and more contact events.
The more consequential point is what the clustering suggests. Pressure ulcer prevalence, infection transmission, and family dissatisfaction appearing together at the same facilities is consistent with a single underlying cause rather than three separate problems. The work of preventing pressure injuries — turning residents, inspecting skin, changing incontinence briefs promptly — and the work of preventing infection — hand hygiene, careful wound care, honoring isolation precautions — draw on the same staff, the same time, and the same supervisory attention. When there is not enough of any of those, both sets of outcomes deteriorate together.
The finding on family ratings deserves emphasis for a different reason. Families are often told that their impressions are anecdotal, that they see only a narrow window, or that they do not understand clinical realities. This study found that aggregate family judgment about whether they would recommend a facility corresponded with a hard clinical outcome the families had no way of measuring directly. What relatives notice on visits appears to carry real information about how a facility functions.
The researchers also found higher transmission at facilities with a higher percentage of minority residents, consistent with a substantial body of research documenting that residents of color are more likely to be concentrated in lower-resourced nursing homes.
In our work representing families in pressure injury cases, wounds and infections are rarely isolated events. A resident who develops a pressure ulcer in an understaffed facility is frequently the same resident who later develops a wound infection, and the facility’s records often show the same gaps behind both: skin assessments not performed, repositioning not documented, dressing changes missed, and staffing levels that made consistent care unrealistic.
This study also offers families a practical takeaway. If your impression of a facility is that residents are not being attended to, that impression is worth taking seriously and worth writing down. Ask how many residents on the unit have open wounds and what infection control precautions are in place. Ask what the staffing ratio is on nights and weekends. Do your own research into a facility’s history and public records before and during a placement, and keep dated notes of what you observe.
If your loved one developed a pressure injury, a serious infection, or sepsis while in a nursing home, the facility’s records can show whether prevention and infection control were actually carried out. Call 844-407-6737 or contact us at bedsore.law/contact for a confidential review.
McKnight’s Long-Term Care News — Ventilator use, poor nursing home care quality linked to C. auris fungus transmission, study finds
