This spring when a patient with necrotizing fasciitis, also known as flesh-eating disease, was admitted to Nassau University Medical Center in East Meadow, N.Y., nurses and physicians treating him knew time was of the essence.
Although the young man had begun to feel ill just a few days earlier, he was in critical condition when he arrived and required immediate interventions to stop the aggressive bacteria from spreading beyond his arm to his entire body, said Amy Pakes, RN, MS, nurse manager for the burn center, hyperbaric medicine and wound care treatment center at NUMC, which sees a dozen cases of necrotizing fasciitis annually.
“We used all of our resources — our surgical team, hyperbaric team and skilled nursing in the burn center, who did the complicated wound dressings that accompanied the wound care,” Pakes said. “The patient was here for almost a month and we were able to save his arm, but it was a team effort.”
Pakes patient was fortunate that amputation wasnt required to eradicate the bacteria, which is sometimes fatal. Many patients with necrotizing fasciitis — which is caused by several strains of bacteria, including Group A streptococcus — are not so lucky.
Wendy Hess, RN, CIC, director of infection control at Hackensack (N.J.) University Medical Center, said the most severe case she treated involved a fisherman who had cut his finger while cleaning a fish that carried Vibrio vulnificus, a flesh-eating bacteria found in ocean-dwelling creatures.Eileen Abruzzo, RN
Just four days after cutting himself, the fishermans arm was amputated at the shoulder, said Hess, adding that the amputation followed numerous other surgical attempts to remove the bacterial spores from the patients limb. “Once you get the critical symptoms where you see the blood pressure dropping, the body taking on toxic-shock symptoms, the patient becoming unconscious, you can have multiorgan failure and it is touch-and-go as to whether the patient might survive,” Hess said.
According to the Centers for Disease Control and Prevention, about 20% of people with necrotizing fasciitis die from the disease. Each year in the U.S., between 650 and 800 people develop the disease, the CDC estimates.
“It is frightening because it is so malicious and spreads so fast,” said Eileen Abruzzo, RN, MSN, CIC, director of infection prevention at Winthrop University Hospital in Mineola, N.Y.
Within a matter of hours after introduction, the virulent bacteria reproduces, sending toxic spores throughout the affected tissue.
While there is no way to prevent contracting the bacteria that cause necrotizing fasciitis, which can enter the body through a small cut, scrape or bug bite, early detection is the key to survival, Abruzzo said.
The first hint a flesh-eating bacteria might be at work is intense pain at the injury site, said Abruzzo, who has treated several cases, including four that required intensive care classification, in her 15-year career. Next come flulike symptoms, such as diarrhea, nausea, fever and dizziness, which are followed by thirst because of dehydration.
“Many people dont go to the doctor for something like this, but you should go and bring it to their attention,” Abruzzo said. “And many times doctors dont diagnose it properly. They say, ‘Take some Tylenol and if you dont feel better come back in a few days. But I think you have to insist that it be ruled out.”
Because if it is a flesh-eating bacteria, a few days could mean the difference between life and death.
Nurses notice first
Frontline nurses are critical to recognizing the signs and symptoms of necrotizing fasciitis, said New Jersey resident Jacqueline Roemmele, who suffered a bout of necrotizing fasciitis in 1993.
Roemmele developed the disease in her abdomen after ventral incisional hernia surgery. She was in critical condition when a family friend — a nurse — insisted she go to the hospital following misdiagnosis by her operating surgeon.
After repeated hospitalizations where Roemmele received several rounds of IV antibiotics and multiple surgeries to remove infected and dead tissue, Roemmele beat the infection and now bears a scar she said looks like a huge shark bite.
“I would hope nurses pay attention to their ‘spidey sense when it comes to listening to the symptoms and their manifestations in clinical ways,” Roemmele said. “If a strapping young man is screaming in pain and it looks like a minor affliction, try to put two and two together and have necrotizing fasciitis ruled out.”
The sooner treatment begins, the more likely it is that patients will avoid life-threatening complications and recover, said Pakes, adding that the majority of the cases shes seen progress to the critical stage and result in one to several months of recuperation time.
Treatment after diagnosis
At Nassau, as soon as a diagnosis is made, the patient receives powerful intravenous antibiotics. Surgical debridement of the infected tissue immediately follows. In addition, hyperbaric oxygen therapy is given to prevent further tissue loss and promote healing.
“We usually take patients right from surgery to the hyperbaric chamber, but they might have to go back for several more surgeries to remove dead tissues and such,” Pakes said.
Abruzzo recalls one patient who needed numerous surgeries before his tissues were infection-free.
“This young man had been injecting himself with steroids, and when your immune system is compromised in any way [the bacteria] can take effect,” she said. “His whole buttocks were down to the bone. He kept going back and forth from surgery.”
The open-ended nature of the infection and lengthy recovery period require nurses to employ a psychosocial approach to treatment of patients.
“Nurses have to be very compassionate because this is a condition where the patient, as well as the family, need a lot of support,” Hess said. “Its a long-term battle. Theyre touch-and-go in the beginning, and even when they pass the danger point, theres going to be a lot of recuperation.”
Robin Huiras is a freelance writer.