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Methicillin-resistant Staphylococcus aureus colonization in a new nursing home
K Feingold1, E L Siegler, B Wu
1School of Arts and Sciences, University of Pennsylvania, Philadelphia.
Abstract:
Methicillin-resistant Staphylococcus aureus (MRSA) has been detected in nursing homes and long-term care facilities. Studies disagree about the risk of infection with MRSA in colonized patients. MRSA colonization and infection were tracked for one year in all admissions to a 60-bed ward at the Philadelphia VA Nursing Home Care Unit (NHCU) from the time of its opening in June, 1990. Patients and staff were blinded to culture results, and the NHCU followed universal precautions for all patients. Of the first 72 patients, 7 were found to be colonized with MRSA; only one of them was known to have had MRSA prior to NHCU transfer. Three patients died (2 had negative cultures prior to death), and 1 was discharged home. Three patients spontaneously cleared MRSA colonization and lived to the end of the study. Three patients appeared to be colonized by MRSA after admission; subsequent cultures were negative. No patients were infected by MRSA in the NHCU. At the close of the study, one year after the nursing home opened, no patient in the nursing home had a culture positive for MRSA. In conclusion, colonization with MRSA at the time of admission to the nursing home is not uncommon, but patients can spontaneously clear it. Besides, nursing homes that pre-screen only those patients with classic risk factors may be admitting many MRSA-colonized patients. Nonetheless, universal precautions appear to be effective in limiting transmission of MRSA in the nursing home; in this study, MRSA acquisition was sporadic and brief.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) colonization is common in nursing homes, but patients can clear it. Universal precautions effectively prevent MRSA transmission in these facilities.
Area of Science:
- Infectious Diseases
- Healthcare Epidemiology
- Geriatric Medicine
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) is a significant concern in long-term care facilities.
- Existing research presents conflicting data on the infection risk for MRSA-colonized patients.
Purpose of the Study:
- To investigate the incidence and outcomes of MRSA colonization and infection in a new nursing home.
- To evaluate the effectiveness of universal precautions in preventing MRSA transmission.
Main Methods:
- Prospective study tracking MRSA colonization and infection in all admissions to a 60-bed nursing home ward over one year.
- Blinded culture results for patients and staff, adherence to universal precautions for all patients.
Main Results:
- Seven of the first 72 admitted patients (9.7%) were colonized with MRSA upon admission.
- No patients acquired MRSA infection within the facility; sporadic and brief acquisition occurred.
- Three patients spontaneously cleared MRSA colonization during the study period.
Conclusions:
- MRSA colonization at nursing home admission is frequent, but spontaneous clearance is possible.
- Universal precautions appear effective in controlling MRSA transmission in this setting.
- Targeted pre-screening based on risk factors may miss many colonized patients.