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Unsanitary Conditions and Poor Hygiene

As with all communal living settings, cleanliness and hygiene in nursing homes are essential to maintaining a safe and healthy living environment and preventing the spread of infectious diseases. The elderly are particularly vulnerable to infectious diseases due to their weakened immune systems that are less capable of fighting disease. While infectious diseases are unfortunately common in nursing homes, nursing home staff nonetheless have a duty to reasonably prevent residents from getting sick by maintaining appropriate cleanliness and hygiene standards. If a nursing home keeps its facility in an unsanitary and unhygienic state that results in harm to a resident,  it may be liable for nursing home neglect. Our California nursing home neglect attorney explains how unsanitary conditions and poor hygiene can lead to disease in nursing homes below. 

Standards for Cleanliness and Hygiene in California Nursing Homes

Proper sanitation and personal hygiene prevent the spread of germs and diseases. In medical facilities such as clinics, hospitals, and nursing homes, good sanitation and hygiene are particularly important because many patients have illnesses or injuries that not only increase their risk of getting sick but also increase their risk of developing serious complications or even dying from their illnesses. Nursing homes are subject to strict sanitation and hygiene regulations from both the federal government and state governments. While the scope of regulations is vast, some examples from California’s Code of Regulations are listed below.


  • Each facility must routinely clean articles and surfaces such as furniture, floors, walls, ceilings, supply and exhaust grills, and lighting fixtures.
  • Schedules and procedures must be posted that indicate the areas of the facility that shall be cleaned daily, weekly, or monthly.

Nursing Services 

  • Each facility must adopt a written manual on cleaning, disinfecting, and sterilization procedures. 
  • The manual must include procedures to be used in the care of utensils, instruments, solutions, dressings, articles, and surfaces. 
  • Bedside equipment must be sanitized in one of the following methods: (1) submersion in boiling water for a minimum of 30 minutes; autoclaving at 15 pounds pressure and 121 degrees C (250) for 20 minutes; (3) gas sterilization.


  • All perishable foods and beverages must be maintained at temperatures of 7 degrees C (45 degrees F) or below, or 60 degrees C (140 degrees F) or above
  • Frozen foods must be stored at minus 18 degrees C (0 degrees F) or below at all times
  • Utensils not washed by mechanical means must be placed in hot water with a minimum temperature of 43 degrees C (110 degrees F), washed using soap or detergent, rinsed in hot water to remove soap or detergent and disinfected by (1) immersion for at least two minutes in clean water at 77 degrees C (170 degrees F; (2) immersion for at least 30 seconds in clean water at 83 degrees C (180 degrees F); (3) immersion in water containing a bactericidal chemical.


  • Clean linen must be stored, handled, and transported in a way that precludes cross-contamination.
  • Soiled linen must be sorted in a separate room by methods that offer protection from contamination.
  • Soiled linen must be stored and transported in closed containers that prevent airborne contamination of corridors and areas occupied by patients and that prevent cross-contamination of clean linen

If you suspect that a breach of sanitation regulations has resulted in injury, please contact a California nursing home neglect attorney

Common Infectious Diseases Caused by Unsanitary Conditions in San Francisco and California Nursing Homes

Unsanitary conditions and poor hygiene create a breeding ground for infectious diseases. Nursing home residents are uniquely vulnerable to contagious illnesses for several reasons. First, airborne pathogens spread easily among nursing home residents due to tight living quarters and frequent contact between residents. Second, the elderly often suffer weakened immune systems that cannot fight off infections as well as younger individuals. And third, residents share sources of food, water, air, and medical care, catalyzing the spread of even non-airborne pathogens.

Any infectious disease can spread quickly in nursing homes, but some of the most common include: 

  • Flu: The flu is a community-based airborne infection that spreads via droplets released when an infected persons sneezes, coughs, or speaks, although it can also be spread by coming into physical contact with contaminated surfaces
  • Pneumonia: Pneumonia is a respiratory infection that spreads via airborne droplets released into the air or through sharing cups or utensils with infected individuals 
  • Urinary tract infections (UTIs): UTIs are often the result of weakened immune systems, dehydration, or the widespread use of catheters in nursing homes 
  • Methicillin-resistant Staphylococcus aureus (MRSA): MRSA is a type of staph infection that spreads through direct skin-to-skin contact or shared equipment. In some cases, it can lead to sepsis. 
  • Carbapenem-resistant Enterobacteriaceae (CRE): CRE is an antibiotic-resistant bacteria that spreads by way of improperly cleaned or incorrectly sterilized medical tools 
  • Norovirus: Norovirus is a virus that causes severe vomiting and diarrhea. It is typically spread by physical contact between infected individuals, touching contaminated surfaces, or eating or drinking contaminated liquids.

For information about the Coronavirus in California nursing homes, click here

Scabies: A Serious Problem in Nursing Homes

Scabies is an itching skin condition caused by a microscopic, eight-legged burrowing mite called Sarcoptes scabiei. It is extremely contagious and can be spread quickly through close physical contact between skin-to-skin contact or through the sharing of infested clothing or bedding. As such, it is commonly seen in communal living spaces like nursing homes. Symptoms include itching of varying severity and the presence of thin, irregular burrow tracks made up of blisters or bumps on the skin. The tracks typically appear in folds of the skin, such as between the fingers, in the armpits, on the inner elbows, around the breasts, and around the male genital area. Scratching a scabies infection can break the skin and lead to secondary infections caused by staph bacteria. 

The elderly are at a particularly high risk of infection from a severe form of scabies called crusted scabies (or Norwegian scabies). This type of scabies tends to affect certain groups of people, including: 

  • Those with chronic health conditions that weaken the immune system
  • Individuals who are very ill
  • Older individuals living in nursing homes 

Crusted scabies affects large portions of the body and causes the skin to become crusty and scaly. Whereas an individual with regular scabies may have about 10-15 mites, an individual with crusted scabies can be infested with millions of mites. Crusted scabies is also more contagious and difficult to treat. The risk of scabies infections in nursing homes highlights the importance of rigorous cleanliness and hygiene measures, particularly with regard to clothing, bedding, and other linens. 

Nursing Home Liability for Unsanitary Conditions in California

Nursing homes have a duty to minimize the spread of infectious diseases by following specific sanitation guidelines established by state and federal authorities. As mentioned above, the guidelines vary but generally require proper sanitation of medical instruments, clothing and bed linens, adequate ventilation, mask-wearing, frequent hand-washing, and isolating contagious patients from others. An essential component of preventing the spread of disease is adequate staffing and proper staff training, which are both common deficiencies in many nursing homes. If understaffing or inadequate staff training contribute to injuries and deaths from infectious diseases, a nursing home may be held liable under a negligence standard. A California nursing home neglect attorney can help you determine whether negligence was at play in a nursing home injury.  

Proving That a Nursing Home Was Liable for an Infectious Disease Outbreak Is Difficult, but Not Impossible  

Proving that a nursing home was liable for an infectious disease outbreak that caused harm to a particular resident can be difficult. For example, the defendant nursing home could argue that the actions of nursing home staff were not the “but for” cause of the plaintiff’s injury (i.e., the resident could reasonably have contracted the disease outside of the facility or as a result of a contagious visitor infecting the plaintiff). In that scenario, a plaintiff could try to show causation by demonstrating that the nursing home consistently failed to follow a particular regulation. To demonstrate: Assume that a resident is infected with scabies and sues for personal injuries. During discovery, it is revealed that the facility instructed staff to launder residents’ bedding at a temperature far below the statutory minimum temperature required to kill the scabies mite. It also comes out in discovery that the facility has been cited in the past for failing to comply with the regulation in question. The plaintiff there would have a much stronger argument that the nursing home was the “but for” cause of the plaintiff’s injury because he or she could point to a specific, well-documented failing.  

Contact a California Nursing Home Neglect Attorney

For more information about holding nursing homes liable for infectious diseases due to neglect or professional negligence, please contact a California nursing home neglect attorney at the Evans Law Firm by using our online form or calling us at 415-441-8669.


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