Beware: Nursing Home Patients and Risk for MRSA
Hi. This is Dr. William Jarvis, President of Jason and Jarvis Associates and Medscape Infectious Diseases Expert Advisor. We know that one of the high-risk groups for carriage of methicillin-resistant Staphylococcus aureus (MRSA) are patients who come into our hospitals from long-term care facilities. Previous studies have shown a prevalence rate of anywhere from 5%-40% in this patient population. Recently, a study by Reynolds and colleagues, published in Infection Control and Hospital Epidemiology, looked at not just residents of 1 nursing home, but in all of the nursing homes in Orange County, California. This included 10 different nursing homes. Between October 2008 and November 2009, they sampled the nares of over 500 admissions and 1000 patients in a point-prevalence survey. MRSA on admission ranged from 8%-31%. The MRSA prevalence ranged from 7%-52%. When you subtracted from the point-prevalence survey those who had MRSA on admission, it ranged from 5%-22%.

Overall, point prevalence was 31% of patients having MRSA. These data show that at least these nursing homes in Orange County, California -- and there's no reason to believe that their nursing homes are any different than many other nursing homes -- have a very high prevalence of MRSA. We know that infection control practices at such nursing homes tend to be worse than at acute care facilities, and it facilitates the spread of MRSA from patient to patient. So it's not surprising then that these nursing home patients serve as a major reservoir for MRSA when they come into our acute care facilities. For that reason, nursing home patients should be at least one of the groups that is targeted if you're limiting your screening to high-risk patients.

Until next time, this is Dr. William Jarvis. Thank you very much.