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Elder Care News
Few Strategies Exist to Prevent MRSA Infection
Spread in Nursing Homes
Residents vulnerable because infection with the bug
tends to increase with advancing age
By Christe Bruderlin-Nelson, Contributing Writer
Health Behavior News Service
 Jan.
23, 2008 - Methicillin-resistant Staphylococcus aureus (MRSA)
is making news as a dangerous, sometimes fatal disease for hospital
patients, and in recent cases, students. MRSA is also a major source of
illness acquired in nursing homes, yet few studies have looked at how to
prevent its spread among elderly residents, according to a new review.
Much of the research effort around MRSA to date
has focused primarily on hospitals, said Carmel Hughes, lead review
author.
MRSA spreads easily - most commonly via the hands
of health care workers - and first-line antibiotics, like penicillin,
are ineffective against the organism. Nursing home residents are
particularly vulnerable because infection with the bug tends to increase
with advancing age.
Close living proximity, multiple medications,
pressure sores and catheters all make nursing homes ideal for breeding
and spreading MRSA. However, nursing homes appear to have been
short-changed in the medical literature on prevention, despite studies
repeatedly reporting that residents are at higher risk.
Many different ways of preventing the spread of
MRSA have been studied, particularly in hospitals; however, we found no
studies that looked at ways of preventing the spread of MRSA in nursing
homes for older people, the reviewers say.
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Rates of hospitalization with MRSA infection per
100,000 population, by age group, 2004
Source: AHRQ, Center for Delivery, Organization, and
Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient
Sample, 2004
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The review appears in the latest issue of The
Cochrane Library, a publication of The Cochrane Collaboration, an
international organization that evaluates medical research. Systematic
reviews draw evidence-based conclusions about medical practice after
considering both the content and quality of existing medical trials on a
topic.
Hughes, a professor of primary care pharmacy at
Queens University Belfast in Northern Ireland, and colleagues searched
for randomized and controlled clinical trials that focused on infection
control interventions in nursing homes. They found none.
The medical community has not prioritized MRSA and
its transmission because of many competing patient safety issues. MRSA
is just one of the many problematic and epidemiologically significant
organisms we are dealing with in the health care setting, said Trish
Perl, M.D., professor of medicine, pathology and epidemiology at Johns
Hopkins Medical Institutions.
Perl was not involved with the review.
Hughes said introducing effective interventions in
hospitals might be easier because hospitals have isolation facilities
and greater access to infection control expertise. Infection control
training is not routinely available in nursing homes, she added.
If we can use studies [like the current Cochrane
review] to show the poor state of the science we can hopefully generate
interest in epidemiologic studies performed by healthcare
epidemiologists who understand the hospital environment, Perl said.
In the meantime, nursing homes can take advantage
of lessons learned from hospital research.
It is likely that an intervention for MRSA in
nursing homes will consist of screening recently admitted residents to
the nursing homes, hand washing and high standards of cleaning and
decontamination, Hughes said.
It will be important for some staff
members to make infection control a priority and that this is
communicated to all other staff. Rigorous testing in the nursing home
environment and detailed notes about such interventions will help ensure
that they are effective, she added.
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