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Superbugs and Nursing Home Residents

October 13, 2014 0 Comments

According to Monash University, studies reveal that nursing home residents seem to be potential carriers of superbug infections in hospitals. These findings are part of studies when Monash University investigated the management of infection in Melbourne’s Aged Care Facilities and over-prescription of antibiotics.

These findings prompted a call to re-evaluate how nursing homes in Melbourne manage hygiene. Questions as to whether aged care facilities need to me more structured like hospitals was also raised.

Monash University researchers performed swab tests on 115 residents from four high care facilities in Melbourne. Results showed that more than a third of them were infected with antibiotic superbugs.

Associate Professor Anton Peleg, lead researcher from Monash School of Biomedical Sciences said that about 50% of the residents received antibiotics three months before the swab tests were done – 22% of them had been admitted to hospital for two days within 3 months before swabbing.

“This highlights the level of antibiotic exposure to these residents, as well as the high frequency of them being transported to and from acute care, therefore posing potential risk,” said Dr Peleg.

He noted that the greatest concern was the emergence of a wider range of drug-resistant bacteria in the care facilities. Bugs such as MRSA (Methicillin-resistant Staphylococcus aureus) and VRE (Vancomycin-resistant Enterococcus) are usually the most common, but this wider range of drug-resistant bacterial infection appears more prevalent than MRSA and VRE.

“This means the scope of the problem is broader and the risk of transmission is greater,” he added.

The study also delved into the risk factors of nursing home residents to be infected. Dr Ching jou Lim, principal author, found that wounds from medical devices such as catheters and pressure sores increase the risk of having resistant bacteria.

Professor Lindsay Grayson of the Infectious Diseases at Austin Health and the University of Melbourne noted that the issue of nursing homes being a susceptible reservoir for infection had been an emerging concern since the turn of the century. He conducted an earlier study on the presence of VRE in eight Maroondah nursing homes and found a high rate of “faecal carriage” – an infection spread by bowel incontinence.

“[The Monash University] study looked at a wider number of superbugs and found a consistent result that the colonisation rate is pretty high, and this is consistent with overseas studies and what we know,” Grayson said.

Professor Grayson pointed out that the issue of nursing home residents as carriers of superbug infection was a real dilemma for hospitals. For instance, in Austin Hospital, patients who are admitted from nursing homes often carry superbugs. In order to manage this, he thinks it is ideal to isolate all incoming residents in a single room and make sure they are free from infection. However, he also said that “the system is not designed to cope with that.”

“For a start, hand hygiene has to be upgraded to alcohol-based wash,” he said. “They need more sinks and basins. Often nursing homes aren’t staffed by fully qualified nurses, but aged care workers, training courses must include hand hygiene.”

“Nursing homes are usually lined with carpet. When dealing with incontinence on carpet, steam cleaning is cosmetic. It’s not anti-bacterial. So there’s the question of changing carpet for lino – but how do you balance that need with the fact that these facilities are meant to be homes for people” he added.

He mentioned that for the last three years, Austin Hospital had been routinely cleaned with bleach and the staff use alcohol-based hand wash.

“Our standard precautions are strictly applied and the risk of infection spreading to other patients is minimised. This is critical for big centres such as the Austin and Alfred with transplant and chemotherapy patients.” Professor Grayson said.

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