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Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older peopleHughes CM, Smith MBH, Tunney MM
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SummaryNo evidence for effective ways of preventing the spread of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people due to a lack of appropriate trialsMRSA is a bacterium that can cause infection in patients, particularly those who are in hospital. MRSA is now becoming a problem for older people (residents) who live in nursing homes. Nursing homes are ideal places for MRSA to spread: the residents live close to each other, many have a number of medical conditions and may receive several prescriptions for antibiotics, and some may have pressure sores and medical devices such as catheters. All of these factors increase the risk of residents getting MRSA, and so increase their risk of dying. 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. Although there is some evidence for techniques that work well to prevent the spread of MRSA in hospital, it is not clear if these approaches will work in nursing homes for older people. Research is needed to establish what will work in nursing homes.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 2, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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January 23. 2008 AbstractBackgroundNursing homes for older people provide an environment likely to promote the acquisition and spread of meticillin-resistant Staphylococcus aureus (MRSA), putting residents at increased risk of colonisation and infection. It is recognised that infection control strategies are important in preventing and controlling MRSA transmission. ObjectivesThe objective of this review was to determine the effects of infection control strategies for preventing the transmission of MRSA in nursing homes for older people. Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2007, Issue 1), the Cochrane Wounds Group Specialised Register (searched April 2007); the Infectious Diseases Group and EPOC also searched their Specialised Registers for this review (both May 2006). We also searched MEDLINE (from 1966 to March Week 3 2007), EMBASE (1980 to 2007 Week 13), CINAHL (1982 to March Week 3 2007), British Nursing Index (1985 to March 2007), DARE (1992 to March 2007), Web of Science (1981 to March 2007), and the Health Technology Assessment (HTA) database (1988 to March 2007). Research in progress was identified through the National Research Register, Current Clinical Trials (www.controlled-trials.com), Medical Research Council Register, Current Research in Britain (CRIB), and HSRPRoj (current USA projects). SIGLE was also searched in order to identify atypical material which was not accessible through more conventional sources. Selection criteriaAll randomised and controlled clinical trials, controlled before and after studies and interrupted time series studies of infection control interventions in nursing homes for older people were eligible for inclusion. Data collection and analysisTwo authors independently reviewed the results of the searches. Main resultsSince no studies met the selection criteria, neither a meta-analysis nor a narrative description of studies was possible. Authors' conclusionsThe lack of studies in this field is surprising. Nursing homes for older people provide an environment likely to promote the acquisition and spread of infection, with observational studies repeatedly reporting that being a resident of a nursing home increases the risk of MRSA colonisation. Much of the evidence for recently-issued United Kingdom guidelines for the control and prevention of MRSA in health care facilities was generated in the acute care setting. It may not be possible to transfer such strategies directly to the nursing home environment, which serves as both a healthcare setting and a resident's home. Rigorous studies should be conducted in nursing homes, to test interventions that have been specifically designed for this unique environment. |
