MRSA in the Elderly 101: The Essential Guide
MRSA is a name that many of us will have seen in headlines online or in news reports. It is usually accompanied by stories about outbreaks, health warnings in local facilities or fatalities. As a result, many in the senior care industry – and their relatives – are understandably worried by it.
The trouble is that many seniors and their relatives don’t fully understand what MRSA is. They don’t know about the causes and means of contamination – nor about the many complications and risks involved. This lack of knowledge and understanding just put those involved at greater risk.
The aim of this guide is to explain MRSA in more detail for carers, relatives, and people at risk of
infection. The more that you know, the better able you will be to minimize risks in the future. We will look at the risk of contamination with these bacteria and ways that patients can contract it. From there, we will look at some of the ways that the infection presents itself – from the early signs to some of the major complications. We will then look at ways of treating the infection and preventing further spread. Unfortunately, this also means talking about potential mortality. Before that, let’s look at what MRSA actually is.
What is MRSA?
MRSA may sound like a disease in its own right. Those that have not dealt with it before can understandably assume that it is because of its impact on the sick and elderly. The reality is that this is actually a form of bacteria – much like E-Coli. Its full name is Methicillin-resistant Staphylococcus Aureus. As this is far too long to use in general conversation, most shorten this to MRSA. You will also find that while some pronounce this like an acronym – M.R.S.A – others use the term “mersa”.
Despite its prevalence, many people are ignorant about the impact and dangers of this bacteria. That is why October 2 is now World MRSA Day, where we are encouraged to raise awareness of the bacteria and learn how to prevent it from spreading.
One of the first things that we all need to know about MRSA is that it is actually very common. This isn’t some rare form of bacteria that we only find in hospitals or in bad cases of poor hygiene. Instead, it is said that as many as 1 in 30 people in the general population are carriers of the bacteria. This doesn’t mean that they are dealing with a dangerous infection. It simply means that the bacteria in question lives somewhere on their skin. It could be on their hands or around their nose or mouth. It could remain there undetected unless it then infects a wound on that carrier. Otherwise, carriers can spread it around in day-to-day life without realizing.
MRSA and Seniors
MRSA may be common and of little risk in much of the general population, but it is a different story with the elderly. It is said that an average of one in four nursing home residents will harbor the bacteria. This is a massive increase. In fact, a study in the Journal of Infection showed that over 40% of all cases of MRSA were in patients aged over 75. There are some simple reasons for this. A weakened immune system can increase the change of contraction, and of the infection worsening. There is also the fact that many seniors have an intolerance of antibiotics – due to their previous medical history. This means that many basic, front-line treatments for MRSA won’t be effective.
How is MRSA contracted?
There are two main ways that seniors can pick up these bacteria and become infected. They are
- through their environment
- through contact with other infected people
Contamination through the local environment is surprisingly common. Even those that are careful to disinfect surfaces and wash their hands can pick up the bacteria. That is because MRSA is tough. It can survive on many surfaces for a long time – whether within a home or a public space.
There is also the fact that many people harboring the bacteria have no idea that they have it. They may unknowingly contaminate a countertop, door handle or handrail as they go about their daily business. MRSA is often found on public transportation, in playgrounds and in communal areas of swimming pools and gyms.
Then there is contamination directly from other people. Physical contact with an infected person can transfer the bacteria. This is highly likely in medical situations or in nursing homes where relatives and nurses come into contact with the infection area.
Understanding the Signs of an MRSA Infection
It is important that all seniors, their relatives and those in a healthcare role understand the symptoms of an infection. This means an awareness of both the major complications and the smaller warning signs. There are some major knock-on effects that can occur that carers need to be aware of. Still, early detection and intervention could prove to be invaluable in fighting the bacteria.
It is important to remember that an infection can occur around any small break in the skin. A small cut or bite may prove to be the ideal breeding ground for the MRSA bacteria. Therefore, it is important to watch out for warning signs in these areas. Is the wound area warm, swollen or red in color? Are seniors experiencing pain here, or noticing any pus or other sign of infection?
Skin Infections and the Development of MSRA Infections
Skin infections are one of the most common, early signs of an MRSA infection. This occurs when the bacteria enter the skin via an entry point and breeds. This can create a more complicated infection that, in turn, may lead to a further medical issue. These infections are also known as staph infections. This may be a term that some people are more familiar with.
Many younger patients may deal with staph infections due to ill health or a weakened immune system. Some may not realize that this is actually related to MRSA at all. As you saw above, it doesn’t take much for this infection to develop. There are some people that will experience contamination in a simple cut or bite. There is also the risk of infection in surgical sites.
Symptoms of a more serious staph infection may start with the swelling, redness, and pain mentioned above. From there, some people with a more severe case could experience a rash or muscle pain in the area. There could also be fever-like symptoms, such as chills, headaches, and fatigue. Others may deal with chest pain, shortness of breath and malaise. It is important that all those in the care industry recognize that these issues could be symptomatic of MRSA. It is too easy to see them as the result of something else, which may lead to an infection going unnoticed.
The Risk of Urinary Tract Infections
This is something that isn’t always covered in guides to MRSA. Other complications and illnesses are more common when it comes to MRSA and the general population. However, seniors are at risk of developing urinary tract infections if the bacteria spreads throughout the body. These UTIs can be very dangerous in the elderly. Some people that exhibit signs of dementia – such as increase disorientation and cognitive problems – are actually suffering from urinary tract infections. It is important that all seniors with MRSA infections maintain a high standard of hygiene when going to the bathroom.
The Risk of Pneumonia
Pneumonia is a common problem and a big cause of death in the elderly population. This is where an infection inflames the lungs and makes it difficult for patients to breathe unaided. The best cause of treatment is a strong course of antibiotics. As we mentioned above, this can be a big problem for seniors with MRSA. Not only is MRSA highly antibiotic resistant, but many seniors have also built up their own resistance after years of repeated use. MRSA is one of the many types of bacteria, viruses and other issues that can cause pneumonia. MRSA is very difficult to treat
The Risk of Bloodstream Infections
Sadly, seniors are a great risk of developing bloodstream infections as a consequence of contracting MRSA. Severe infections can spread deeper into the blood if untreated. One of the main concerns here is sepsis. Sepsis is potentially fatal at any age. However, fatality rates from this form of blood poisoning are even higher in the elderly population.
The Risk of Osteomyelitis
This is another factor that may not come up in a more general guide to the symptoms and causes of MRSA infections. Osteomyelitis is a debilitating condition where infections get deep inside a bone and into the marrow. This infection can deform or destroy the bone, which may lead to the need to amputate the limb. Many of these osteomyelitis infections are the result of developing staph infections. Some doctors may, therefore, be able to diagnose specific cases of MRSA osteomyelitis. The frailty of many seniors’ bones means that the risk of deformity is high in this age group.
Diagnosing an MRSA Infection
There are different ways to diagnose an MRSA infection. The approach taken by the doctor will depend on the symptoms presented. For example, those with skin infections may end up having a culture or biopsy taken. This could also involve some form of drainage of the wound to better identify the bacteria at work. Blood culture could help if the illness has progressed into the bloodstream. Similarly, a sputum culture could prove helpful where a patient may have pneumonia and a urine sample is essential if there is a urinary tract infection.
Medical Intervention for Treating MRSA Infections
If the infection is isolated within the skin, and in its infancy, it may be enough just to drain the wound. If a patient presents more serious MRSA symptoms, they may benefit from a course of antibiotics. If successful, there should be no more need for treatment at this point.
However, these antibiotics may not help. At this point, or if blood or lung infections are suspected, it is time to admit a patient to a hospital. Here they can receive more specialist help, supplemental oxygen, and intravenous medication
There are also many precautionary measures that carers, medical staff, and patients can use to control the development of MRSA.
One of the best courses of preventative action is a vigilant approach to cleaning and general cleanliness in a facility. This works in two ways. Firstly, all involved need to combat the issue of contamination and contraction through the local environment. This means regular efforts to clean any surfaces and equipment that may carry the bacteria. This includes food preparation areas, communal eating areas, bathrooms and any equipment that may be shared. Secondly, there is that risk of contamination between people. Patients and carers need to make sure that wash their hands and follow good hygienic practices.
Hospitals and residential homes can also work to reduce the risk of infection between residents and/or patients through improved screening measures. At the moment, some facilities don’t take the time to screen all patients. They will only do so for those that are considered to be at high risk or symptomatic. This is understandable as a time-saving measure. However, it means that facilities run the risk of a carrier with low-level symptoms entering a facility unchecked. They might pass on the bacteria to everyone they meet.
Then there are preventative measures known as contact precautions. These measures can be helpful for those that have already been diagnosed with an infection. Once a staff or MRSA infection is diagnosed, carers and relatives can take further precautionary measure to reduce the risk. This could involve the use of protective gowns or gloves to minimize contact with the infected area. Increased hygienic precautions, such as hand-washing, also help here. Everyone should do so when entering or leaving the room.
Personal Protective Equipment
Then there is the potential for the use of Personal Protective Equipment (PPE). The benefit here is that these masks, goggles and other forms of shields help to protect the wearer – especially in more vulnerable areas there is always the chance that nurses or carers may accidentally come into contact with infectious substances during routine care.
Survival and Mortality for People that Get MRSA Infections
It is important to talk about survival and mortality rates with this bacterial infection. It is far too simplistic to say that people that contract the MRSA bacteria can die from it. The reality is that an untreated infection can develop into something that is harder to cure.
Eventually, this could worsen into a life-threatening illness. It all depends on the stage and complications of the infection. People with low-level infections in the skin can undergo a successful treatment and cure themselves before the infection develops into a deadly disease. Despite this, they may still find that they have traces of the bacteria within them, and remain carriers. Those that have contracted and survived staph infections in the past could well develop another one in the future.
Mortality rates increase when the infection heads deeper into the body. The skin and wound infections aren’t likely to life-threatening on their own. The risks develop when the MRSA gets into the bones, lungs bloodstream and patients develop other illnesses. Patients can die from the pneumonia or the sepsis caused by that initial MRSA infection. The sad reality is that as many as a third of people that develop sepsis will die. Death rates from pneumonia can depend on the severity of the condition and the treatment offered. For example, around half of those with MRSA pneumonia on vancomycin could die.
Dealing with MRSA and Infection Rates in Hospitals
There is a greater risk of infection and complications with MRSA when seniors are patients within healthcare facilities. The large number of sick and injured people means a greater chance of contamination. Staff and relatives walking the wards can accidentally spread bacteria if they aren’t careful. The issue mentioned above about cuts and surgical sites is another big issue. The downside here is that there are many ways that MRSA could enter the systems and bloodstream of a senior in hospital. The plus side is that doctors should be trained to recognize the signs and have appropriate treatment options on hand.
Dealing with MRSA in Care Homes
It may be a slightly different story in care homes. There is a high chance of contamination here too because of the focus on communal living and undetermined illnesses of new residents. It is possible that residents may pass the bacteria between each other in shared facilities. The staff that is poorly trained, or under-resourced, may struggle to offer the right prevention or treatment measures.
Relatives can bring in the bacteria or spread it themselves. The plus side here is that there may not be as many severe cases and contraction rates can be lower. The downside is that staff may not spot a problem quite as quickly.
Care homes and nursing homes also lead to the issue of isolation as a preventative measure. There are many healthcare providers that will advocate isolation measures to stop the spread of illness. Patients with an infection are kept away from others to minimize the risk of the MRSA spreading. This is easy enough in hospitals with separate rooms and more sterile areas. It isn’t the case in care homes that promote the social, inclusive side of senior life. Many won’t have the room or the means to offer this option.
Dealing with MRSA at Home
Then there are the carers that are relatives of seniors and care for them within their own home. It is vital that everyone in this situation understands the risks and preventative measures too. It is much easier to keep a relative in comfortable isolation here. Doctors can come out to check on the infection and refer patients to a hospital if other problems occur. In the early stages, it may be possible to use the right course of drugs to handle the infection.
Carers at home need to carry out many of the same practices as professional healthcare providers to ensure that patients receive the best care. This means minimizing that risk of environmental and human contamination at all times. Carers should wear disposable gloves when handling an infected area. They also need to wash their hands often. Environmental concerns include the surfaces in the patient’s bedroom, the surfaces in the bathroom and the linen from their beds. This means regular, thorough cleaning. It is also the responsibility of the carer to inform any other relatives, healthcare providers and other visitors about the situation.
What Have We Learned About MRSA and Seniors?
Unfortunately, there is a much higher likelihood of seniors contracting the MRSA bacteria and developing infections. A combination of healthcare and environmental factors increase the chance of contamination – and of the infection worsening.
It important that we understand the basic symptoms of MRSA and staph infections to halt the progress of the bacteria. If we don’t, we could find that it develops deeper into the bloodstream, bones, lungs and urinary system. This could then result in complications and major, life-threatening illnesses.
Treatment options are available if caught early enough. But, there is a high mortality rate for those that develop sepsis and pneumonia as a result of MRSA. Preventative measures and better community care policies can help patients improve their chances of recovery.
This is why it is so important that relatives and carers take the time to better understand this issue. MRSA can be a scary topic when it relates to major outbreaks and fatal forms of MRSA sepsis. But, we need to understand just how many of us can be carriers.
Furthermore, we need to know that we can help to protect vulnerable seniors with the right practices in hospitals, care homes and in their own home. MRSA doesn’t have to be a death sentence if we spot the signs, prevent further spread and screen care home residents more thoroughly. MRSA doesn’t have to be misunderstood any longer.