Hostname: page-component-857557d7f7-9f75d Total loading time: 0 Render date: 2025-11-25T03:31:27.327Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  21 June 2016

J. Conley Thomas ,
Janis Bridge ,
Stephen Waterman ,
Jacqueline Vogt ,
Liga Kilman  and
Gary Hancock
J. Conley Thomas*
Affiliation:
Acute Communicable Disease Control Unit, Department of Health Services, Los Angeles County, California
Janis Bridge
Affiliation:
Acute Communicable Disease Control Unit, Department of Health Services, Los Angeles County, California
Stephen Waterman
Affiliation:
Acute Communicable Disease Control Unit, Department of Health Services, Los Angeles County, California
Jacqueline Vogt
Affiliation:
Acute Communicable Disease Control Unit, Department of Health Services, Los Angeles County, California
Liga Kilman
Affiliation:
Acute Communicable Disease Control Unit, Department of Health Services, Los Angeles County, California
Gary Hancock
Affiliation:
Acute Communicable Disease Control Unit, Department of Health Services, Los Angeles County, California
*
Acute Communicable Disease Control, Department of Health Services, 313 North Figueroa Street, Room 231, Los Angeles, CA 90012
Get access Rights & Permissions [Opens in a new window]

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.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 10 , Issue 3 , March 1989 , pp. 106 - 110
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1989 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1. Haley, RW, Hightower, AW, Khabbaz, RE, et al: The emergence of methicillin-resistant Staphylococcus aureus infections in the United States hospitals. Ann Intern Med. 1982;97:297–308.Google Scholar
2. Peacock, JE Jr: Methicillin-susceptible “methicillin-resistant Staphylococcus aureus”: A sheep in wolves clothing. Infect Control. 1986;7:161–163.Google Scholar
3. Fekety, R: The management of the carrier of methicillin-resistant Staphylococcus aureus , in Remington, JS and Swartz, MN (eds): Current Clinical Topics in Infectious Diseases, vol 8. New York, McGraw Hill, Inc, 1987, pp 169–180.Google Scholar
4. Keane, GT, Cafferkey, MT: Re-emergence of methicillin-resistant Staphylococcus aurens causing severe infection. J Infect 1984;9:6–16.Google Scholar
5. Casewell, MW, Hill, RLR: The carrier state: Methicillin-resistant Staphylococcus aureas . J Antimicrob Chemolher 1986:18 (suppl A):1–12.Google Scholar
6. Hsu, CCS, Macaluso, CP, Special, L, et al: High rate of methicillin resistance of Staphylococcus aureus isolated from hospitalized nursing home patients. Arch Intern Med. 1988;148:569–570.Google Scholar
7. O'Toole, RD, Drew, WL, Dahlgren, BJ, et al: An outbreak of methicillin-resistant Staphylococcus aureus infection. Observations in hospital and nursing home. JAMA 1970;213:257–263.Google Scholar
8. Storch, GA, Radcliff, JL, Meyer, PL. et al: Methicillin-resistant Staphylococcus aureus in a nursing home. Infect Control. 1987;8:24–29.Google Scholar
9. Garner, JS, Jarvis, WR, Emori, TG, et al: CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
10. Thornsberry, C, McDougal, LK: Successful use of broth microdilution in susceptibility tests for methicillin-resistant (heteroresistant) staphylococci. J clin Microbiol 1983;18:1084–1491.Google Scholar
11. Ayliffe, GAJ, Lilly, H.A. Lowbury, EJL: Decline of the hospital Stophytoroccus? Incidence of multiresistant Staph. aureus in three Birmingham hospitals. Lancet. 1979;1:538–541.Google Scholar
12. Thompson, RI, Cabezudo, I, Wenzel, RP: Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med. 1982;97:309–316.Google Scholar
13. Saravolatz, LD, Pohlad, DJ, Arking, LM: Community-acquired methicillin-resistant Staphylococcus aureus infections: A new source for nosocomial outbreaks. Ann Intern Med 1982;97:325–329.Google Scholar
14. Walsh, TJ, Vlahov, D. Hansen, SL. et al: Prospective microbiologic surveillance in control of nosocomial methicillin-resistant Stophylococus aureus . Infect Control 1987;8:7–14.Google Scholar
15. Roccaforte, JS. Bittner, MI, Stumpf, CA. et al: Attempts to eradicate methicillin-resistant Staphylococcus aureus colonization with the use of trimethoprim-sulfamethoxazole. rifampin, and bacitracin. Am J Infect Control. 1988;16:141–146.Google Scholar
16. Ward, TT, Winn, RE, Hartstein, Al, et al: Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: Role of antimicrobial therapy in infection control. Infect Control. 1981;2:453–159.Google Scholar