MRSA in Care Homes and Nursing Homes

Methicillin-resistant Staphylococcus aureus (MRSA) is not only a dangerous, sometimes fatal and difficult to treat disease for hospital patients but also a significant concern in care home settings where residents often have nursing needs. Despite this surprisingly few studies have examined how to prevent MRSA spread among elderly residents in Care Homes according to Carmel Hughes, lead author of a recent review of the subject.

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MRSA Risk Factors
The usual antibiotics, like penicillin do not work with the organism MRSA and the problems it causes are compounded by the fact that it spreads very easily, often on the hands of health care workers. Elderly Care Home (Nursing Home) residents can be particularly vulnerable not only because the risk of infection increases with advancing age but also because a proportion of residents will have periods in an out of hospital where they may either pick up or pass on the bug.

In addition to these factors residents in nursing homes also live in close proximity to each other, are often on multiple medications, are susceptible to pressure sores and often have catheters. All of these are factors which facilitate MRSA infection.

The reviewers searched for randomized and controlled clinical trials that focused on infection control interventions in nursing homes. "We found no studies that looked at ways of preventing the spread of MRSA in nursing homes for older people," they report.

Hospitals have isolation facilities and greater access to infection control expertise compared to Care Homes and infection control training is not routinely available in nursing homes.

MRSA control measures in Care Homes
Care Homes (nursing homes) can and must still learn lessons from the existing research; which has been mostly hospital focussed.

MRSA intervention in Care Homes / Nursing Homes should include screening of recently admitted residents to the nursing homes possibly with the assistance of attending GP's. A thorough approach might also need to take account of residents who have periods of hospital admission and the possibility that they may aquire MRSA during these periods.

Staff training in the importance of hand washing and high standards of cleaning and decontamination is very important as are mechanisms to ensure the staff follow such routines. Identifying specific members of staff to take responsibility for promoting and monitoring infection control measures may also help.

Carmel Hughes is a professor of primary care pharmacy at Queen's University Belfast in Northern Ireland. The Cochrane Library is an international organization that evaluates medical research.
Reference: Hughes CM, Smith MBH, Tunney MM. Infection control strategies for preventing the transmission of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people (Review). The Cochrane Database of Systematic Reviews 2008, Issue 1.