College of American Pathologists
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  The long-term care challenge


CAP Today




November 2009
Feature Story

Many of MRSA’s challenges vary by location of care in the health care system. In the long-term care setting, such as in a nursing home, the risk of MRSA infection is lower than in an acute-care setting, but the prevalence of MRSA colonization is much higher. “You can, if you culture noses and wounds, find MRSA in up to 50 percent of people in a long-term care facility,” says Mary-Claire Roghmann, MD, associate professor of epidemiology and preventive medicine at the University of Maryland School of Medicine, Baltimore, and hospital epidemiologist for the VA Maryland Health Care System. Dr. Roghmann spoke on MRSA in the long-term care setting as part of the ASM session in which Loren Miller, MD, and Michael B. Edmond, MD, participated.

What to do with MRSA-colonized residents in the long-term care setting is still unclear. Because imposing isolation precautions on long-term care residents is difficult, active surveillance is not used. As Dr. Roghmann points out, there are few single rooms in most residential facilities, and residents are encouraged to eat in common areas and participate in group activities. “It’s their home. You can’t have them isolated. That’s not a solution they can live with.”

While “it’s attractive to try to decolonize,” Dr. Roghmann says now, “it’s never been shown that you reduce the risk of MRSA infection in the long-term care setting. You may be making everybody feel good about it, but I don’t think you’re really improving the health of your residents.”

For one thing, she says, “if I decolonize somebody in my facility, I know there are many MRSA-colonized residents who will just give MRSA back to them. Could I decolonize everyone in the nursing home to prevent this? That’s not easy. Although it’s relatively easy to get rid of S. aureus from the nose, it’s extremely difficult to get rid of it from skin breakdown, and there’s a lot of skin breakdown in residents in long-term care facilities.” In addition, “S. aureus is a normal part of our body’s bacterial communities,” she says. “It’s a tricky issue to decolonize people with MRSA because you have to ask: If you remove a part of normal flora for them, what’s going to take its place? Something’s going to take its place. Nature abhors a vacuum.”

Anne Ford

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