Last Updated: April 4, 2013
At the Queen Anne Healthcare long-term facility in Seattle, it
is not uncommon to have one or two of the 125 residents in
isolation, recovering from a drug-resistant infection.
The afflicted persons may be permanent residents of the
facility, or they may be visiting specifically to recover from the
infection, according to Kristi Lott, a nurse at the facility. In
the latter case, they may come from an assisted living center, a
hospital, or at-home care.
"They come to get antibiotics for six weeks, in the more serious
cases," Lott says. "To clear someone, they have to get at least
three negative cultures."
Hospitals and other healthcare facilities are seeing a rising
rate of drug-resistant infections, according to officials at the
Centers for Disease Control and Prevention. These infections,
called methicillin-resistant Staphylococcus aureus (MRSA)
infections, are unable to be treated by traditional antibiotics
such as penicillin, amoxicillin, and methicillin.
The proportion of bacteria that are resistant to antibiotics has
risen steeply during the last thirty years, as the bacteria adapt
to the antibiotics intended to kill them, according to CDC
research. Today, 63% of bacteria don't respond to traditional
antibiotics, and MRSA in the elderly is becoming a growing problem,
especially among seniors who are treated in healthcare
MRSA in the elderly is a serious problem, especially in
institutional settings, where they have a higher risk of death from
the disease as a result of its resistance to typical antibiotics.
While the spread of MRSA infections are most common in hospitals,
people with poor functional status are more susceptible to carrying
MRSA, and therefore any institutional setting, including nursing
homes, must take precautions.
The elderly are "a population of people who have a history of
taking antibiotics in the past, so they have developed some
resistance to these drugs," said Jennifer Morcone, a CDC health
The combination of frequent use of antibiotics and a weakened
immune system make the elderly particularly susceptible to MRSA.
Many contract the disease when they are admitted to hospitals or
long-term care facilities to be treated for underlying health
problems. MRSA in the elderly is also a concern in assisted living
communities or at home, although this is less common.
MRSA is most common as a skin infection, as "staph" are common
bacteria that live on the skin. They cause infection whenever they
enter the skin through a cut or sore. A person can also become
infected with MRSA when the bacteria move inside of the body
through a catheter, breathing tube, or other entry point.
MRSA infections can be minor, such as a mild scratch or a
pimple, but can become problematic if left untreated. The disease
is much more serious if related to a surgical wound or
urinary tract infection, as these provide an entry point to
bloodstream infections and
pneumonia. Bloodstream infections and pneumonia can potentially
A typical staph infection normally causes a red, swollen, and
painful area on the skin, according to information provided by the
National Institutes of Health. Other symptoms may include:
- A skin abscess
- Drainage of pus or other fluids from the site
- Warmth around the infected area
Symptoms of a more serious staph infection may include:
- Shortness of breath
- Chest pain
- Muscle aches
Diagnosis and Treatment
Depending on the extent and severity of the symptoms, a doctor
may recommend a skin biopsy and culture from the affected area,
culture of drainage from the infection, a blood culture, sputum
culture through coughing if pneumonia is suspected, or a urine
culture if a urinary tract infection is a possibility.
Treating the infection depends on the level of severity.
Draining the abscess at the doctor's office is usually the only
treatment needed for a local skin MRSA infection.
More serious MRSA infections are treated with a few antibiotics
that include vancomycin (Vancocin®, Vancoled®),
trimethoprim-sulfamethoxazole (Bactrim®, Bactrim® DC, Septra®,
Septra® DS), and linezolid (Zyvox®).
The most serious MRSA infections are treated in the hospital or
a long term care facility. In these cases, supplemental oxygen and
intravenous medication may be part of the treatment. In cases of
kidney failure, dialysis may be needed.
Persons come to the Queen Anne long-term care facility for
various levels of treatment, says Lott.
While those with a serious infection make get intravenous
antibiotics for six weeks, others come for a month-long treatment
and take their medicine orally.
"People take the pill for thirty days," Lott says. "Their stay
can be shorter, but we still have to rule out infection before we
can send them home."
Prevention and Containment
Because of the nature of the disease, prevention and containment
of MRSA in the elderly is an ongoing process that encompasses
everything from paying close attention to a skin abrasion, to
placing an infected patient in seclusion.
The most basic level of prevention simply involves good hygiene,
especially if attending a healthcare center for treatment, or
visiting someone in a long-term care facility. People should wash
hands frequently, and use alcohol-based hand sanitizers. They
should avoid sharing personal items such as towels or razors, as
MRSA can be transmitted through contaminated items. All wounds
should be covered with a clean bandage, and contact avoided with
other people's soiled bandages.
Extremely important is the close monitoring of skin wounds of
any type, whether a minor abrasion or a surgical wound.
"Let's say you have a scratch and then two days later it's angry
red; anything that gets darker in color, or if the skin gets into a
hole, or peels away, should be immediately dealt with," Lott
Elderly residents living alone or at assisted living
facilities, where they are not necessarily in constant
interaction with a caregiver, tend to overlook a MRSA infection in
its initial stages. "They don't think to tell anyone, it gets worse
and worse, and by the time they tell someone it's really infected,"
Lott says. "A lot of the elderly think it will be okay, and don't
want to be a bother."
But, she says, that is exactly the wrong thing to do, as this
gives the infection time to grow. She said this is also a concern
for the elderly living with a caregiver, although in this case an
obvious skin infection may be noticed by the caregiver.
Once a MRSA infection has been identified, there are several
steps that must be taken to prevent a worsening infection in the
patient, and transmittal to others.
Good hygiene is again important, as the patient may infect
themselves in other areas. For example, urinary tract infections
are caused by MRSA patients using the bathroom without washing
their hands beforehand. A urinary tract infection can lead to the
potentially life-threatening bloodstream infection.
Wounds that are draining or have pus should be covered with
clean, dry bandages, and patients should be careful to follow their
healthcare provider's instructions on care of the wound. Pus from
infected wounds can contain staph and MRSA. Keeping the infection
covered prevents the spread to others. Bandages and tape can be
discarded in the regular trash. Hands should be washed after
touching the wound or bandages.
At-home caregivers for the elderly are less likely to see the
infection spread to other members of the household. This is
because, outside of healthcare settings, there is little risk of
transmitting organisms to persons at risk of disease from MRSA.
Healthy people who do not frequent healthcare facilities are
therefore at low risk of getting infected. Nevertheless, the
following precautions should be followed in the home, according to
- Caregivers should wash their hands with soap and water after
physical contact with the infected or colonized person and before
leaving the home.
- Towels used for drying hands after contact should be used only
- Disposable gloves should be worn if contact with body fluids is
expected and hands should be washed after removing the gloves.
- Linens should be changed and washed if they are soiled and on a
- The patient's environment should be cleaned routinely and when
soiled with body fluids.
- Notify doctors and other healthcare personnel who provide care
for the patient that the patient is colonized/infected with a
As the possibility of spreading a MRSA infection rises
dramatically for elderly persons residing in hospitals, long-term
care facilities, or nursing homes,
extra precautions must be taken in these cases.
"It's a major problem," Morcone says. "Preventing MRSA
infections is a priority across healthcare, including long term
care facilities. Patients who have MRSA can easily spread the
infection to others through their own activities or their
To help prevent the spread of the infection, most institutions
isolate the affected patient. The extent of this isolation depends
on the severity of the infection.
"If the wound is closed, small, and wrapped in dressing and with
drainage, the only precaution you have to take is standard
isolation," Lott said. In standard isolation, caretakers wear
gloves, but the infected person does not need to remain quarantined
in her room; she can take a trip to the commons areas, or visit
fellow residents, as long as those residents are not themselves
carrying a disease or a skin infection, which would put them at
On the other hand, a more serious skin infection-or worse, a
blood infection-requires the patient to be placed in contact
isolation, meaning he is required to stay in his room.
Although MRSA in the elderly is a growing problem, health
officials stress that these kinds of preventive measures-taken by
healthcare providers, caregivers, and the patients themselves-make
a significant difference in warding off infections or lessening
their severity. Patients can easily perform the most basic of
these, such as keeping an eye on skin wounds. And as institutions
like the CDC continue to educate long-term care providers about the
standardized protocols for prevention and containment of the
infections, MRSA in the elderly is finally receiving the serious
attention it deserves.