Abstract
BackgroundSince many hospitals report high MRSA colonization rates among elderly patients, and because it has been shown that S. aureus colonization increases with advancing age, there are concerns about the introduction of MRSA into nursing homes by MRSA positive patients discharged from hospital. So far, admission screening and subsequent longitudinal screening in residence homes or screening at time of hospital discharge is not established on a regular base. On the other hand, MRSA is acquired frequently during hospital stay. Therefore, the MRSA status of residents remains unclear at the time of re-admission to the residence home. This study was conducted to evaluate the rate of nasal MRSA carriage among residents and nursing staffs of 2 nursing homes for the elderly, the potential acquisition of MRSA during a hospital stay and the feasibility to perform direct screening tests in nursing homes for elderly.MethodsIn a study period of 5 months, possibility of active PCR-based screening for MRSA has been tested within 2 residence homes for the elderly, with the obligation to avoid inconvenience to the daily working time and working schedule. Residents and staff members were included in the study and positive test results were confirmed with MRSA culture.ResultsFeasibility of active on site screening in a residence home for the elderly using a rapid PCR method has been confirmed. 154 of 156 residents participated on baseline testing for all current and new admitted residents. In 9 participating residents with former unknown status, nasal carriage with MRSA was confirmed (5.8%). Among 32 documented and eligible movements between the nursing home and the hospital, MRSA could be confirmed after return to the residence home in 2 cases (6.3%). MRSA could also be detected in 1 of 14 participating nursing staff (7.1%).ConclusionPrevalence of MRSA was in a range that has been observed for nursing homes in Germany in previous studies. Residents can acquire MRSA during a hospital stay so that further spread after re-admission into the nursing home cannot be excluded. This study shows that easy to perform direct screening tests in outpatient facilities for nursing of the elderly are promising tools as part of potential new strategies for transmission and infection control in such facilities. Additional studies are needed to investigate if screening followed by interventional hygiene measures can reduce MRSA transmission and infection in such facilities.
Highlights
Since many hospitals report high Methicillinresistant Staphylococcus aureus (MRSA) colonization rates among elderly patients, and because it has been shown that S. aureus colonization increases with advancing age, there are concerns about the introduction of MRSA into nursing homes by MRSA positive patients discharged from hospital
It is likely that the prevalence of MRSA within nursing homes is increasing as a result of the increased prevalence of MRSA within hospitals, which may have been compounded by the considerable movement of patients from long-stay hospitals to community-based nursing homes [2]
There was no significant difference between the age of residents colonized with MRSA and residents not colonized with MRSA (p = 0.47)
Summary
Since many hospitals report high MRSA colonization rates among elderly patients, and because it has been shown that S. aureus colonization increases with advancing age, there are concerns about the introduction of MRSA into nursing homes by MRSA positive patients discharged from hospital. It is likely that the prevalence of MRSA within nursing homes is increasing as a result of the increased prevalence of MRSA within hospitals, which may have been compounded by the considerable movement of patients from long-stay hospitals to community-based nursing homes [2]. The subsequent spread of MRSA between patients would create a reservoir of MRSA within a nursing home [3], providing the potential for an outbreak and further hospital outbreaks when affected nursing home residents require hospital treatment [2]. Nursing homes provide an ideal environment for the acquisition and spread of MRSA, since residents have an increased risk of colonization due to known risk factors [4,5,6,7,8,9]. MRSA colonization is a marker of mortality risk amongst nursing home residents [10, 11]
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