What You Need to Know about MRSA and Senior Care

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious problem for anyone who gets an infection but especially so for residents of nursing homes.

Two in 100 people in the general public carry MRSA, according to the Centers for Disease Control and Prevention (CDC), but one out of four nursing home residents harbor the bacteria in some settings. People who harbor MRSA but who do not show signs of infection can spread the bacteria to workers, visitors and to other residents, potentially causing widespread infection.

MRSA is a type of bacteria that is resistant to many antibiotics. MRSA is a staph infection that can cause severe problems, including pneumonia, bloodstream infections, and surgical site infections. Bloodstream infections are common and fatal in the elderly, as is pneumonia.

Most cases of MRSA occur as skin infections, according to the U.S. National Library of Medicine (NLM). Red, swollen skin that is painful to the touch is a sign of a staph skin infection. MRSA typically spreads through direct contact with an infected wound. Contaminated hands, particularly those of healthcare providers, can also spread MRSA.

MRSA infections tend to be severe for patients in healthcare facilities, with staph infecting the bloodstream, heart, lungs, other organs, urine, or surgical site.

Symptoms of severe MRSA infections include:

• Chest pain
• Cough
• Shortness of breath
• Fatigue
• Fever, chills
• Malaise
• Headache
• Rash
• Chronic wound

MRSA Infection is Common and Has Serious Consequences for the Elderly

A study published in the Journal of Infection shows that patients over the age of 75 accounted for more than 40 percent of all MRSA cases. The researchers found that most cases were healthcare-related and mostly from geriatric centers. They also found that age is an independent risk factor for overall mortality and that infection was more frequently of an unknown origin in elderly patients.

The scientists conducted a prospective study at 21 Spanish hospitals. They included patients diagnosed with MRSA between June 2008 and December 2009. The focus of the study was to compare episode diagnosed in patients aged 75 or more with younger patients.

Out of 579 episodes of MRSA identified, 231 (39.9 percent) occurred in patients over the age of 75. Older patients suffered significantly higher comorbidity rates at 52.8 vs. 44 percent and considerably more severe underlying disease when compared with people under the age of 75. Early mortality and overall mortality were significantly more frequent in the 75+ age group, with early mortality rates of 12.1 vs. 6 percent and overall mortality of 42.9 vs. 23 percent.

Why are Older Adults at Risk?

Older adults are at greater risk for developing an antibiotic-resistant infection. An older person has likely taken antibiotics many times in the past, which causes the body to develop some level of resistance to these drugs. Older adults are also more likely to have a weakened immune system, which makes the elderly more vulnerable to infection.

Living in a nursing home also puts older adults at greater risk for contracting MRSA because it puts seniors in close quarters with those harboring the bacteria. The infection can enter a facility in a number of ways. New residents and residents returning from the hospital can carry bacteria in; visitors can also introduce MRSA into a facility. Residents and staff members can transport the bacteria from one area of the facility to another.

Nursing Home Infection Rates are on the Rise

Infections are already a leading cause of death in nursing homes and a study by Columbia University School of Nursing shows that infections rates in these extended care facilities are on the rise.

Researchers in this study examined infections in extended care facilities over five years and found that the infection rates for pneumonia, viral hepatitis, urinary tract infections (UTIs), wound infections, septicemia, and multiple drug-resistant organisms (MDROs) were up.

“Isolation is a common way to contain MRSA and other infections in hospitals, but in nursing homes this isn’t as common because these facilities are tailored to residential needs,” said lead study author Carolyn Herzig, MS. “If the nursing home does have rooms for isolation, it suggests a more robust approach to infection prevention and control.”

Reducing MRSA Infection in Extended Care Facilities

Aggressive action to prevent the spread of MRSA, such as regular hand washing by staff and patients, the use of gloves, and careful cleaning of resident rooms and equipment effectively reduce MRSA outbreaks.

Screening is an important tool for reducing the risk for MRSA. Some facilities test only residents that are at high risk or symptomatic, routine screening of new admissions would be more effective.

Contact precautions are helpful. Residents with MRSA can stay in a single room or share a room with another person with the infection. Staff and sometimes visitors should wear protective gowns and gloves when dealing with a resident with MRSA, taking care to remove the protective gear and wash their hands when they leave the room. Residents on contact precautions should remain in their room whenever possible to reduce the risk of spreading the infection throughout the facility.

Personal protective equipment (PPE) can protect the mucous membranes of the eyes, nose and mouth during nursing procedures and resident-care activities that are likely to generate splashes or sprays of blood, body fluids and secretions. The use of asks, goggles, face shields, and combinations of each add extra layers of protection.

Appropriate device handling of resident care equipment, instruments and devices further reduce the risk for MRSA infections in nursing homes. Staff should handle used resident care equipment soiled with blood, body fluids and excretions in a way that prevents skin and mucosa membrane exposure, contamination of clothing and the transfer of bacteria to other residents and areas within the facility. Staff must clean reusable equipment between uses and properly discard single-use items. Cleaning and disinfection of surfaces likely to be contaminated is essential, particularly those in the resident’s living space and frequently touches surfaces. Appropriate handling of laundry and used linen reduces contamination of air, surfaces and people.

While MRSA is still a problem in nursing homes and a major health threat to the public, MRSA infections in other healthcare settings are on the decline, dropping 54 percent between 2005 and 2011. Persistent attention to good hand washing, proper equipment care and screening, and careful disinfection of surfaces in resident areas can reduce the incidence and mortality of MRSA infections in nursing homes.