Related Experiment Videos
Transmission and control of methicillin-resistant Staphylococcus aureus in a skilled nursing facility
J C Thomas1, J Bridge, S Waterman
1Department of Health Services, Los Angeles County, California.
Abstract:
Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly frequent in both acute care facilities (ACFs) and skilled nursing facilities (SNFs). Admissions to SNFs from ACFs with endemic MRSA are one likely source of infection in SNFs. The occurrence of MRSA in SNFs and the relative roles of ACFs and SNFs in MRSA transmission have not been well characterized. We conducted an epidemiologic investigation in an SNF reporting a high incidence of MRSA cases and found that the prevalence of MRSA exceeded that reported in acute care settings. Fifteen (9.1%) of the 164 residents were colonized or infected with MRSA. Risk factors for MRSA identified through a prevalence case-control study were nasogastric intubation (odds ratio = 5.5; 95% confidence interval = 1.2, 26.4), antibiotic therapy (OR = 3.9; CI = 1.2, 13.0), and hospitalization in an acute care facility within the previous six months (OR = 2.9; CI = 0.9, 9.7). During a three-month period, 6 of 100 new admissions were MRSA-positive; all positive patients were from ACFs. Five new cases also emerged from previously MRSA-negative residents. SNF residents are often discharged to ACFs. Transmission of MRSA within the SNF and the transfer of patients to ACFs increases the reservoir of potentially infective patients and the potential for MRSA infections in ACFs. Modest control measures, including targeted surveillance culturing and cohorting of colonized residents, may minimize MRSA transmission in the SNF and decrease the reservoir of MRSA in the community.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) is prevalent in skilled nursing facilities (SNFs), with risk factors including nasogastric intubation and recent acute care hospitalization. Targeted control measures can reduce MRSA transmission in SNFs.
Area of Science:
- Infectious Diseases
- Epidemiology
- Healthcare-Associated Infections
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) is a growing concern in acute care facilities (ACFs) and skilled nursing facilities (SNFs).
- The transmission dynamics of MRSA between ACFs and SNFs are not well understood.
- SNFs may harbor a significant MRSA reservoir, impacting community spread.
Purpose of the Study:
- To investigate the prevalence and risk factors of MRSA in a high-incidence SNF.
- To characterize the role of ACFs in MRSA introduction into SNFs.
- To assess MRSA transmission within SNFs and its potential contribution to ACFs.
Main Methods:
- Conducted a prevalence case-control study in an SNF with high MRSA incidence.
- Identified MRSA colonization or infection in 15.1% of 164 residents.
- Monitored new admissions and resident-acquired infections over three months.
Main Results:
- MRSA prevalence in the SNF (9.1%) exceeded that in typical ACFs.
- Identified risk factors: nasogastric intubation (OR=5.5), antibiotic therapy (OR=3.9), and recent ACF hospitalization (OR=2.9).
- 6% of new admissions were MRSA-positive, all from ACFs; 5 new resident-acquired cases occurred.
Conclusions:
- SNFs represent a significant reservoir for MRSA, with substantial introduction from ACFs.
- Patient transfers between SNFs and ACFs amplify MRSA transmission and community burden.
- Targeted surveillance and cohorting can mitigate MRSA spread within SNFs.