Transmission and Control of Methicillin-Resistant Staphylococcus aureus in a Skilled Nursing Facility

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.

Nosocomial Infection and Antibiotic Utilization in Geriatric Patients: A Pilot Prospective Surveillance Program in Skilled Nursing Facilities

“…We recognize that our pilot survey was also subject to additional limitations in the precise definition of infections; for exam ple, it was not possible to incorporate direct Gram stains of sputum smears to aid evalua tion of suspect pneumonia or bronchitis, and no systematic baseline screening of urine cul tures was done to distinguish pre-existing asymptomatic bacteria from newly acquired UTI. Nevertheless, the distribution of infec tions by site was similar to previous reports with the urinary tract, respiratory tract and skin and soft tissue being the most common [7,21,25], Relative to the question of quality of care, we examined the charts to determine record ing of clinical evidence of an infectious pro cess, such as fever, other specific symptoms or physical signs. In over half of the cases, chart documentation for the presence of a sign or symptom suggestive of infection was lacking.…”

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

“…The recognized risk factors then identified for MRSA infection and colonization included recent hospitalization; other exposures to the health care system; residence in a longterm care facility (91,95,245,246,524,637,638,649,864,867,897) or an acute-rehabilitation unit (578); the presence of an indwelling line or catheter; surgical wounds; chronic liver, lung, or vascular disease; malignancy; recent exposure to antibiotics; intravenous drug use (130); ICU admission; and exposure to a patient with any of these risk factors for MRSA (148,383,559,914).…”

Epidemiology of Methicillin-Resistant <i>Staphylococcus aureus</i>

“…Once colonized the half-life of MRSA persistence in readmitted carriers was estimated to be about 40 months. Patients colonized with MRSA will bring the organism into long-term facilities, where it will spread and infect the debilitated patients [31,35]. On the other hand, long-term facilities may serve as a reservoir of MRSA.…”