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Staphylococcus aureus carriage in care homes: identification of risk factors, including the role of dementia

  • G. LASSETER (a1), A. CHARLETT (a2), D. LEWIS (a3), I. DONALD (a4), R. HOWELL-JONES (a5) and C. A. M. McNULTY (a1)...

Summary

The aim of this study was to investigate the prevalence and associated risk factors of methicillin-susceptible and methicillin-resistant Staphylocccus aureus (MSSA and MRSA) carriage in care homes, with particular focus on dementia. A point-prevalence survey of 748 residents in 51 care homes in Gloucestershire and Greater Bristol was undertaken. Dementia was assessed by the clock test or abbreviated mini-mental test. Nasal swabs were cultured for S. aureus on selective agar media. Multivariable analysis indicated that dementia was not a significant risk factor for MSSA (16·2%) or MRSA (7·8%); and that residents able to move around the home unassisted were at a lower risk of MRSA (P=0·04). MSSA carriage increased with increasing age (P=0·03) but MRSA carriage decreased with increasing age (P=0·05). Hospitalization in the last 6 months increased the risk of MSSA (P=0·04) and MRSA (P=0·10). We concluded that cross-infection through staff caring for more dependent residents may spread MRSA within care homes and from the recently hospitalized. Control of MSSA and MRSA in care homes requires focused infection control interventions.

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Copyright

Corresponding author

*Author for correspondence: Mrs G. Lasseter, Primary Care Unit, Gloucester Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK. (Email: Gemma.Lasseter@hpa.org.uk)

References

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1.Cosgrove, SE, et al. The impact of methicillin resistance in bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infection Control and Hospital Epidemiology 2005; 26: 166174.
2.Cosgrove, SE, et al. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clinical Infectious Diseases 2003; 36: 5359.
3.Delaney, JA, et al. Mortality after infection with methicillin-resistant Staphylococcus aureus (MRSA) diagnosed in the community. BMC Medicine 2008; 6: 2.
4.Davis, KA, et al. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent infection. Clinical Infectious Diseases 2004; 39: 776782.
5.National Statistics. Ageing – fastest increase in the ‘oldest old’. National Statistics Online 2009 (http://www.statistics.gov.uk/cci/nugget.asp?ID=949). Accessed 26 November 2009.
6.West Midlands Public Health Observatory. Indications of Public Health in the English Regions 9: Older People. Association of Public Health Observatories, 2008.
7.Drinka, P, et al. Adverse events associated with methicillin-resistant Staphylococcus aureus in a nursing home. Archives of Internal Medicine 2001; 161: 23712377.
8.Lucet, J-C, et al. High prevalence of carriage of methicillin-resistant Staphylococcus aureus at hospital admission in elderly patients: implications for infection control strategies. Infection Control and Hospital Epidemiology 2005; 26: 121126.
9.Jernigan, JA, et al. Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission. Infection Control and Hospital Epidemiology 2003; 24: 409414.
10.Cox, RA, Bowie, PE. Methicillin-resistant Staphylococcus aureus colonization in nursing home residents: a prevalence study in Northamptonshire. Journal of Hospital Infection 1999; 43: 115122.
11.Fraise, AP, et al. Methicillin-resistant Staphylcoccus aureus (MRSA) in nursing homes in a major UK city: an anonymized point prevalence survey. Epidemiology and Infection 1997; 118: 15.
12.Namnyak, S, et al. Methicillin-resistant Staphylcoccus aureus: a questionnaire and microbiological survey of nursing and residential homes in Barking, Havering and Brentwood. Journal of Infection 1998; 36: 6772.
13.Barr, B, et al. Prevalence of methicillin-resistant Staphylococcus aureus colonization among older residents of care homes in the United Kingdom. Infection Control and Hospital Epidemiology 2007; 28: 853859.
14.O'Sullivan, NPO, Keane, CT. Risk factors for colonization with methicillin-resistant Staphylococcus aureus among nursing home residents. Journal of Hospital Infection 2000; 45: 206210.
15.Alzheimer's Society. Dementia UK: a report into the prevalence and cost of dementia. Alzheimer's Society, 2007 (http://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=1). Accessed 10 August 2009.
16.Suetens, C, et al. Methicillin-resistant Staphylococcus aureus colonization is associated with higher mortality in nursing home residents with impaired cognitive status. Journal of the American Geriatric Society 2006; 54: 18541860.
17.Office of National Statistics. Correction: current estimates – population estimates by ethnic group mid-2007 (experimental) (http://www.statistics.gov.uk/downloads/theme_population/Tables_EE1-EE6_2007.xls). Accessed 9 October 2009.
18.Indices of Deprivation 2007. Communities and Local Government 2009 (http://www.communities.gov.uk/communities/neighbourhoodrenewal/deprivation/deprivation07/). Accessed 26 November 2009.
19.McNulty, CAM, et al. Is there an opportunity to reduce urinary catheter-related infections? Exploring variation in catheterisation rates in care homes. British Journal of Infection Control 2006; 7: 2228.
20.Shulman, KI. Clock-drawing: is it the ideal cognitive screening test? International Journal of Geriatric Psychiatry 2000; 15: 548561.
21.Shulman, KI, et al. Clock-drawing and dementia in the community: a longitudinal study. International Journal of Geriatric Psychiatry 1993; 8: 487496.
22.Brodaty, H, Moore, CM. The clock drawing test for dementia of the Alzheimer's type: a comparison of three scoring methods in a memory disorder clinic. International Journal of Geriatric Psychiatry 1997; 12: 619–27.
23.Scanlan, JM, et al. Comparing clock tests for dementia screening: naive judgements vs formal systems – what is optimal? International Journal of Geriatric Psychiatry 2002; 17: 1421.
24.van der Burg, M, et al. Scoring clock tests for dementia screening: a comparison of two scoring methods. International Journal of Geriatric Psychiatry 2004; 19: 685689.
25.Antonelli Incalzi, R, et al. Construct validity of the Abbreviated Mental Test in older medical inpatients. Dementia and Geriatric Cognitive Disorders 2003; 15: 199206.
26.Brown, DFJ, et al. Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). Journal of Antimicrobial Chemotherapy 2005; 56: 10001018.
27.Health Protection Agency. Specimens for screening for MRSA. Standard Operating Procedure 2008, 29(5.1) (http://www.hpa-standardmethods.org.uk/documents/bsop/pdf/bsop29.pdf). Accessed 26 October 2009.
28.Health Protection Agency. Identification of Staphylococcus species, Micrococcus species and Rothia species. Standard Operating Procedure 2007, 7(2·1) (http://www.hpa-standardmethods.org.uk/documents/bsopid/pdf/bsopid7.pdf). Accessed 26 October 2009.
29.Coia, JE, et al. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. Journal of Hospital Infection 2006; 63S: S1S44.
30.von Baum, H, et al. Risk factors for methicillin-resistant Staphylococcus aureus carriage in residents of German nursing homes. Infection Control and Hospital Epidemiology 2002; 23: 511515.
31.Dall'Antonia, M, et al. Competition between methicillin-sensitive and -resistant Staphylococcus aureus in the anterior nares. Journal of Hospital Infection 2005; 61: 6267.
32.Mental Capacity Act 2005. Department of Constitutional Affairs, Office of Public Sector Information (2007) (http://www.opsi.gov.uk/ACTS/acts2005/ukpga_20050009_en_1). Accessed 7 January 2010.
33.Peters, C, Redding, P, Allardice, G.MRSA Screening: is one nose swab enough? Federation of Infection Societies 2009; Poster Presentation (P169). ICC Birmingham.
34.Nahimana, I, Francioli, P, Blanc, DS. Evaluation of three chromogenic media (MRSA-ID, MRSA-Select and CHROMagar MRSA) and ORSAB for surveillance cultures of methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2006; 12: 11681174.
35.Nonhoff, C, et al. Comparison of three chromogenic media and enrichment broth media for the detection of methicillin-resistant Staphylococcus aureus from mucocutaneous screening specimens: comparison of MRSA chromogenic media. European Journal of Clinical Microbiology and Infectious Diseases 2009; 28: 363369.
36.National Patient Safety Agency. Ready, steady, go! The full guide to implementing the cleanyourhands campaign in your Trust, 2004 (http://www.npsa.nhs.uk/cleanyourhands/). Accessed 26 October 2009.
37.Health Protection Agency. Introduction to infection control in care homes. DVD 2009 (http://194.74.226.162/HPA/Publications/InfectiousDiseases/InfectionControl/1229594195568/). Accessed 26 October 2009.

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