MRSA comes home with more patients, primarily with multiple hospitalizations
HHAs look for ways to prevent transmission
Methicillin-resistant Staphylococcus aureus (MRSA) is common in most hospitals, but a recent study shows that almost 13% of patients discharged from the hospital to home health care are infected with MRSA.1
"There has been an increase in the number of patients coming to home health with MRSA," says Marcia R. Patrick, RN, MSN, CIC, director of infection control for Multicare Health Systems in Tacoma, WA. "In 2000, we typically saw about 7% of patients admitted from hospitals to home health colonized with MRSA; now we see 12%," she says. The most common patients to have MRSA are patients with multiple hospital visits, she points out. "Patients with a lot of hospital admissions are more likely to be exposed to MRSA and are more likely to have medical conditions that put them at risk for infection," she explains.
In general, home health agencies are not screening new admissions for MRSA or other MDROs, says Patrick. "At our hospital system, patients discharged from the intensive care unit are screened, as are other high-risk patients, so we do know if they have MRSA when admitted," she says. "Other patients who don't receive screening in the hospital are not screened unless we have a problem, such as a wound that does not heal," she explains. The difficulty in selecting which patients might require screening at admission is that about half of patients who are colonized with MRSA do not have any symptoms or risk factors, she says.
Although some hospitals do have MRSA screening programs, they don't address all patients, just patients in high-risk areas such as intensive care, says Irena L. Kenneley, PhD, APRN-BC, CIC, professor at Case Western University in Cleveland.
The Association for Professionals in Infection Control (APIC) Scientific Research Council funded a study to find out the national prevalence of MRSA at U.S. health care facilities in the form of a survey sent to infection control professionals across the country.2 "The APIC MRSA inpatient survey found that the MRSA colonization and infection prevalence in U.S. health care facilities is 46.3 per 1,000 inpatients, which is 8-12 times higher than previous estimates," points out Kenneley. "What has important implications for home health care is that it was also found that 67% of MRSA identified were on medical services, suggesting that MRSA is not focused just in ICU or surgical patients. As for active surveillance cultures, only 28% of the respondents performed them," she adds.
"We really can't do a thorough risk assessment for MRSA unless we screen, but implementing a screening program in home health presents some challenges," admits Patrick. Not only is reimbursement for the cost of the test an issue, but also additional training would be required to ensure that the screening test is conducted properly, she says. "The most commonly used method, swabbing the nose, still requires proper technique to obtain accurate results," she explains.
Although her home health agency does not conduct routine screenings for MRSA or other MDROs upon admission, Judie Truelsen, RN, BSN, interim co-director of Northwest Community Home Care in Arlington Heights, IL, will contact physicians for orders to culture wounds that are not healing to check for MRSA and other organisms, she says.
In the absence of thorough MRSA screening programs for both hospitals and home health agencies, the best way to protect patients, family members, and staff members from transmission of MRSA is to assume that everyone is potentially infected, suggests Truelsen. "We teach our staff members to use standard precautions in all patients' homes to prevent the spread of MRSA and any other infection," she says. Rather than single out MRSA in infection control practices, it works best to expect standard precautions to be followed all of the time, she says. "This is the best way to develop good habits and practices and makes it much easier to remember what should be done to prevent the spread of any infection," she adds.
Although MRSA patients can be decolonized after initial exposure, they are at risk for contracting MRSA again, Patrick points out. "Once MRSA, always MRSA" is the rule followed by Patrick's staff. "A patient with MRSA contaminates his or her home, so some areas can't be disinfected," she says. "A kitchen and bathroom are easy to disinfect, but sofas, chairs and rugs can't be disinfected to remove all traces of MRSA," she says. This is another reason that Patrick stresses the use of standard precautions in all homes, she adds.
"We will not fix the problem of increasing rates of infection and colonization caused by MDROs overnight," points out Kenneley. The solutions are not simple given the complex health care delivery system, she says. "Solutions will require increased support for ownership of infection control and prevention not only in home health, but also throughout the entire health care delivery system."
Reference
1. Lucet JC, Paoletti X, Demontpion C, et al. Carriage of methicillin-resistant Staphylococcus aureus in home care settings. Arch Intern Med. 2009; 169:1372-8.
2. Jarvis WR, Schlosser J, Chinn RY, et al. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006. Am J Infect Control. 2007; 35(10): 631-7.
Sources
For more information about Methicillin-resistant Staphylococcus aureus (MRSA) in home care, contact:
Irena L. Kenneley, PhD, APRN-BC, CIC, Assistant Professor, Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Avenue, Cleveland, OH 44106-4904. Telephone: (216) 368-4841. E-mail: [email protected].
Marcia R. Patrick, RN, MSN, CIC, Director of Infection Control, Multicare Health Systems, 315 Martin Luther King Jr. Way, Tacoma, WA 98405. Phone: (253) 403-1622. E-mail: [email protected].
Judie Truelsen, Northwest Community Home Care, 3060 Salt Creek Lane, #110, Arlington Heights, IL 60005. Phone: (847) 618-7860. E-mail: [email protected].
Methicillin-resistant Staphylococcus aureus (MRSA) is common in most hospitals, but a recent study shows that almost 13% of patients discharged from the hospital to home health care are infected with MRSA.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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