Seniors and Superbugs
Saskia v. Popescu, PhD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in Biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control and has worked in both pediatric and adult acute care facilities.
An unexpected patient population may play a larger role in infection control struggles
Seniors and Superbugs
Healthcare-acquired infections (also known as nosocomial infections) are typically associated with poor practice by healthcare professionals. Breaks in sterile technique, poor hand hygiene, low personal protective equipment (PPE) compliance, and many other infection prevention strategies are often the cause of nosocomial infections. As Wisconsin and Michigan see a rise in a rare bloodstream infection, many wonder about the role of seniors in infection control and nosocomial infections.
Elizabethkingia is currently causing dozens of cases in Wisconsin and now a Michigan resident is suffering from the rare bloodstream infection. The bacteria, Elizabethkingia meningoseptica, that is causing the outbreak is commonly seen in soil but has been known to cause infections in hospitals. Typical infections have resulted in bacteremia and neonatal meningitis related to the gram-negative bacillus, although it is naturally found in soil, fresh water, and salt water.
Most of the 54 cases in Wisconsin have been in patients 65 years and older, of which 17 have died. While rarely seen in bloodstream infections, this organism is also concerning in that is frequently antibiotic resistant. A recent study from the University of Michigan Health System found that one in four seniors that are hospitalized, carry multidrug-resistant organisms (MDRO’s) on their hands.
Researchers studied 357 senior patients that were admitted to the hospital “for a medical or surgical issue and temporarily needed extra medical care in a PAC (post-acute care) facility before fully returning home. Older people often need extra time in a post-acute care facility for rehabilitation after common procedures such as hip and knee replacements.” A total of 24.1% of these patients were found to have at least one MDRO on their hands when they were admitted. Patients were tested again at two weeks and then monthly, for up to six months or until they were discharged. Follow-up visits found that the prevalence of MDRO’s on their hands actually increased to 34.2%. At baseline, of the hands that had MDRO’s on them, 13.7% had VRE (vancomycin-resistant Enterococci), 10.9% had MRSA (Methicillin-resistant Staphylococcus aureus), and 2.8% had RGNB (resistant gram-negative bacilli). A total of 10.1% of patients were found to have acquired a new MDRO at the time of their follow-up.
Researchers found that “patients commonly bring MDRO’s on their hands on discharge from an acute care hospital and acquire more during their stay at the PAC facility.” The global issue of antibiotic usage only compounds these findings. Future research could also benefit from studies on pediatric patients and patient visitors. Overall, this study reveals a serious gap within infection control efforts. Healthcare infrastructures can no longer solely focus on employees as a source of infection, but now must also include education and focus on the role of patient hand hygiene and infection prevention efforts.