METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS COLONIZATION IN A NEW NURSING-HOME

Methicillin-resistant Staphylococcus aureus (MRSA) has been detected i n nursing homes and long-term care facilities. Studies disagree about the risk of infection with MRSA in colonized patients. MRSA colonizati on and infection were tracked for one year in all admissions to a 60-b ed ward at the Philadelphia VA Nursing Home Care Unit (NHCU) from the time of its opening in June, 1990. Patients and staff were blinded to culture results, and the NHCU followed universal precautions for all p atients. Of the first 72 patients, 7 were found to be colonized with M RSA; only one of them was known to have had MRSA prior to NHCU transfe r. Three patients died (2 had negative cultures prior to death), and 1 was discharged home. Three patients spontaneously cleared MRSA coloni zation and lived to the end of the study. Three patients appeared to b e colonized by MRSA after admission; subsequent cultures were negative . No patients were infected by MRSA in the NHCU. At the close of the s tudy, one year after the nursing home opened, no patient in the nursin g home had a culture positive for MRSA. In conclusion, colonization wi th MRSA at the time of admission to the nursing home is not uncommon, but patients can spontaneously clear it. Besides, nursing homes that p re-screen only those patients with classic risk factors may be admitti ng many MRSA-colonized patients. Nonetheless, universal precautions ap pear to be effective in limiting transmission of MRSA in the nursing h ome; in this study, MRSA acquisition was sporadic and brief.