Few strategies exist to prevent MRSA spread in nursing homes

Jan 24 2008

Methicillin-resistant Staphylococcus aureu (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.

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 Queen's 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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