Methicillin-resistant Staphylococcus aureus (MRSA) management in palliative care units and hospices in Germany: A nationwide survey on patient isolation policies and quality of life

Abstract

Background: For palliative care settings, little is known about the benefits of specific methicillin-resistant Staphylococcus aureus containment regimens and the burdens patient isolation imposes on affected patients, their families, and professional caregivers. Aim: To explore the current practice of MRSA management and its impact on inpatients' quality of life as perceived by professional caregivers. Design: Survey of inpatient palliative care institutions using 23-item questionnaires (infrastructural data: six items, management process: 14, clinical significance: three). Setting/participants: All palliative care units (179) and hospices (181) listed in Germany's directory of palliative care services. The c 2 test was used to test for differences; significance level: p ≤ 0.05. Results: 229 of 360 questionnaires were returned. More than 90% of the responding institutions employed specific MRSA protocols. Lack of resources was a more important issue for palliative care units than for hospices regarding availability of single rooms (p = 0.002) and staffing (p = 0.004). Compared to hospices, palliative care units more frequently isolated MRSA patients (p = 0.000), actively treated colonization (p = 0.026), assessed the efficacy of eradication (p = 0.000), provided information on MRSA management to patients (p = 0.014) and relatives (p = 0.001), more often restricted patients' activities (p = 0.000), and reported a negative impact on quality of life (p = 0.000). Conclusions: Rigorously applied MRSA protocols impose significant burdens at the end of life. Research on clinical outcomes including quality of life may identify interventions of questionable benefit. The issue of handling MRSA should be studied as a model for the management of other highly complex conditions and special needs such as patient isolation.

Employment Status and Work-Related Difficulties among Family Members of Terminally Ill Patients Compared with the General Population

“…Our results were similar to the findings of previous studies of caregivers of cancer patients; that is, previous studies showed that 20% of caregivers provided fulltime or constant care (Bukki et al, 2011), 5-20% of caregivers had quit their jobs or declined advancement as a result of caregiving (Dybicz et al, 2011;Fairfield et al, 2012;Pantilat et al, 2012). Fatigability was also a major reason for not working among cancer survivors in previous studies (Phipps et al, 2011;Flannelly et al, 2012).…”

“…For example, several studies have documented typically high levels of dailyliving assistance, including help with transportation, shopping, homemaking, emotional support, nutritional care, nursing care, and personal care (Shahmoradi et al, 2009;O'Connor and Kumar, 2012;Stiel et al, 2012). As a result of daily-living assistance, many studies focused on family caregiver burdens such as high levels of stress, poor physical condition, emotional health, and family savings losses (Bukki et al, 2011;Duclos et al, 2012;Gomes et al, 2012;von Gunten, 2012).…”

Prevalence of Methicillin-Resistant Staphylococcus aureus Colonization and Infection in Hospitalized Palliative Care Patients With Cancer

“…In addition, hospital-based PC units were more likely to report that MRSA control protocols have a negative impact on patients' quality of life (P < .001). 3 Conclusions A significant proportion of hospitalized PC patients with advanced cancer in our institution is MRSA positive. Further research is warranted to study the impact of MRSA control protocols on the quality of PC delivered to terminally ill patients.…”

“…2 In hospital-based palliative care (PC) units, the MRSA-positive patients receive what may be perceived as an aggressive care near the end of life like isolation and restriction of activities. 3 While an important issue, little is known about the prevalence of MRSA colonization and infection in hospitalized PC patients.…”

Changes in Economic Status of Households Associated with Catastrophic Health Expenditures for Cancer in South Korea

“…In addition, previous studies showed that 20% of caregivers provided fulltime or constant care (Bukki et al, 2013); 5-20% of caregivers had quit their jobs or declined advancement as a result of caregiving (Dybicz et al, 2011;Fairfield et al, 2012;Pantilat et al, 2012). Fatigability was another major reason for unemployment among cancer survivors in previous studies (Phipps et al, 2011;Flannelly et al, 2012).…”