According to a new study, Methicillin-resistant Staphylococcus aureus (MRSA), a strain of staph infection, is becoming a major source of illness acquired in nursing homes. Little is known about how to prevent its spread among nursing home residents because most studies have been done in hospital settings.
MRSA spreads easily and antibiotics like penicillin are ineffective against it. Elders in nursing home settings are vulnerable because MRSA infection is acquired more easily by elderly people and it is carried and spread quickly by skin contact.
According to the study, living in close quarters, taking multiple medications, and issues such as pressure sores and catheters all make nursing homes key breeding places for MRSA. However, nursing homes haven't been an area of concentrated education on the subject.
"Many different ways of preventing the spread of MRSA have been studied, particularly in hospitals; however, we found no studies that looked at ways of preventing the spread of MRSA in nursing homes for older people," the reviewers say.
The study suggests that effective control in hospitals might be easier because hospitals have "isolation facilities and greater access to infection control expertise." It also suggests that infection control training is not "routinely available in nursing homes."
This information highlights one of the dilemmas nursing homes face. A good nursing home shouldn't be like a hospital. It should be as much like a home as possible. People should have soft, comforting surroundings. They should touch. They should have choices. Yes, good hygiene and preventive measures need to be taken to keep infection at a minimum and keep them from spreading, but in good nursing homes, people often hug. They are like family.
The idea that hospital-like procedures, such as washing hands between "patients" be taken to heart in nursing homes is going to fly in the face of forward thinking projects where nursing homes are purposely less hospital-like and more home-like.
The home my elders lived in routinely practiced infection control in that hand sanitizers and hand washing were a high priority when someone was ill, or a medical procedure was being administered. When there was a flu outbreak, a few years back, they had to shut out visitors and wouldn't even allow people go between floors. That was a kind of "lockdown" that was necessary to prevent a huge flu outbreak that would have caused widespread misery and likely many deaths. Their response to this emergency reflected concern, professionalism and common sense. After ten days, the crisis passed, and things got back to normal.
Hospitals are for sick people who hope to go home better, not sicker than when they were admitted. Nursing homes are homes. Yes, they are group homes, but they are the residents' homes.
As nursing homes evolve, they will face choices on all levels that concern safety and infection. There will have to be choices and compromises made when it comes to staph infections, just as there are choices that could lead to prevention of falls. People in nursing homes are not patients. They are people living their lives. They deserve to have as much protection against infection as possible, without having their home turned into a hospital.
The line is a very fine one, and it likely will zigzag as nursing homes re-define their identity. Are they hospitals or homes? Finding a common sense middle ground isn't going to be easy.
Published On: January 22, 2008