SAN DIEGO (FRONTLINE MEDICAL NEWS) – Nearly half of nursing home residents harbored multi-drug resistant organisms on their skin, results from a large multi-center surveillance study showed.

“Residents in skilled nursing homes are the most vulnerable patients in the health care system,” lead study author James A. McKinnell, MD , said in an interview in advance of an annual scientific meeting on infectious diseases. “Many residents depend on help from health care workers for routine needs like eating or bathing. Skilled nursing facilities have an obligation to optimize the personal hygiene and environmental cleanliness in skilled nursing facilities.”

In an effort to measure the number of residents in skilled nursing facilities who carry bacteria that can cause infection, Dr. McKinnell, assistant professor of medicine at the University of California, Los Angeles, and his associates conducted a baseline point prevalence study of multidrug-resistant organism (MDRO) colonization in residents of 28 Southern California facilities that were participating in a decolonization trial. The residents were undergoing routine soap and water bathing, according their facilities’ bathing protocols.

The researchers obtained 2,797 body swabs from 1,400 residents in all. Swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended spectrum beta-lactamase producers (ESBLs), and carbapenem-resistant Enterobacteriaceae (CRE). “MRSA is a relatively well known bacteria, but CRE is the new pathogen that the CDC has defined as an urgent public health threat,” Dr. McKinnell said.

The researchers also conducted environmental surveillance of commonly touched items in skilled nursing facilities. The five surfaces tested in resident rooms were the bedside table, TV remote, door knobs, light switch, and bathrooms. The five surfaces tested in common areas were the nursing station counter, tables, chairs, hallway hand rails, and drinking fountains.

Overall, 49% of residents harbored MDROs. MRSA was found in 37% of residents, followed by ESBL in 16%, VRE in 7%, and CRE in 1%. Resident MDRO status was known for 11% of MRSA carriers, compared with 18% of ESBL, 4% of VRE, and none of the CRE carriers. Rates of colonization did not differ whether residents had long stays at the facility or postacute stays (49% vs. 48%, respectively), but bed-bound residents were more likely to be MDRO colonized, compared with ambulatory residents (59% vs. 46%; P less than .001). In the analysis of environmental swabs, 93% of common areas and 74% of resident rooms had an MDRO-positive object, with an average of 2.5 and 1.9 objects, respectively, found to be contaminated.

“The fact that about half of patients were carrying a bacteria that could cause infection on their skin was very high,” said Dr. McKinnell, who is a member of the Infectious Disease Clinical Outcome Research Unit at the Los Angeles Biomedical Research Institute at Harbor-UCLA. “Studies conducted in other care settings, we would typically see less than a quarter of patients carry these types of bacteria. I was also surprised to see that 1% of patients were carrying the CRE bacteria on their skin.”

He acknowledged certain limitations of the study, including the fact that the data were taken from a select group of nursing homes that are participating in an interventional study to improve personal hygiene for skilled nursing facility residents. “They may not be representative of all skilled nursing facilities,” he said.

The Agency for Healthcare Research and Quality funded the study. Dr. McKinnell disclosed that he is conducting studies in health care facilities with products supplied from 3M, Clorox, Sage, and Xttrium Laboratories. Many of his coauthors disclosed numerous financial ties to the pharmaceutical industry. The event was the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.


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