Maggots infest wound of nursing home patient

OTTAWA – Staff at an Ottawa nursing home recently discovered that maggots had infested a resident’s leg wound, landing the woman in hospital – horrifying her family and triggering a police investigation.

The National Post newspaper reports that Ontario’s health ministry inspected Ottawa’s West End Villa last month and issued an order for voluntary changes to the home’s practices.

It takes days for fly larvae to reach a full-grown stage, something that should not happen in a properly treated patient, said Jeff Tomberlin, a Texas A&M University professor and chairman of the American board of forensic entomology.

“Maggots in a wound are not good,” he said. “I can’t think of a case where you could actually say it’s not negligent … If they found fully developed larvae in it, you have to wonder how frequently they’re cleaning the wound, and really paying attention to what they’re doing.”

The incident comes two years after the same woman, 89-year-old Luba Ignatieva, was “viciously” attacked by another resident at West End, sending her to hospital with a broken hip, her daughter, Lara Gerol said.

In the most recent incident, Ignatieva failed to get one of the twice-weekly dressing changes required for a chronic “venous stasis ulcer” on her leg.

When staff finally removed Ignatieva’s bandage on Oct. 10 after six days, they found the sore crawling with maggots and sent her to hospital.

“I was in shock,” said the daughter, who believes either hospital employees or paramedics called the police. “It means the wound was not cleaned properly … It means they’re not even looking.”

In a letter to the home, she wrote: “I don’t have enough words in my vocabulary to describe the horror (we felt) when we learned my mother went to hospital with maggots in her leg.”

Extendicare Inc., West End Villa’s owner, said in a statement that it can’t comment on specific residents, but that Ignatieva is being looked after by a team that includes a doctor, while the facility is in an “open dialogue” with the family.

“We can assure you that the quality of care of our residents is of utmost importance to us,” the statement said.

In a letter to Gerol obtained by the National Post, West End administrator Kelly Keeler said the ulcer, caused by poor circulation, won’t heal partly because Ignatieva refuses to have her leg elevated. Keeler said the woman also declined twice on Oct. 7 to have the dressing changed.

But the daughter says Ignatieva told her no one even tried to replace the bandage, and that it would have been completely out of character for her to refuse.

Gerol alleged the letter also seemed to play down the incident and almost blame her mother. Keeler argued “maggots are not the result of a dirty environment or unprofessional care,” and said Ignatieva liked to spend time outside in the garden, where she said flies are plentiful.

A 2003 article in the Nursing Times, a British publication, may serve to put the incidence of maggot infestations into perspective:

“Infections of wounds and other tissues by micro-organisms are considered an undesirable but inevitable risk in patient management, but infestation by maggots has largely been regarded with horror by carers.

“In some instances such invasions have been seen as examples of a breakdown in standards of care. One reason for this may be that the low level of reported natural maggot infestations has bred a reluctance to report infestations for fear of reproof.”

As the article noted, “The majority of flies that are likely to cause myiasis in humans belong either to the blowfly group, family Calliphoridae, or the housefly group, family Muscidae. Most species causing facultative myiasis in humans are not pathogenic.”