Seniors Often Bring Drug-Resistant Germs to Rehab Centers

About one-quarter tested had so-called 'super-bugs' on their hands upon admission, study finds

Monday, March 14, 2016

MONDAY, March 14, 2016 (HealthDay News) -- Seniors transferred from a hospital to a rehabilitation facility often bring dangerous germs with them, a new study suggests.

The finding stems from an investigation that looked at resistant germ rates in the kind of post-hospital recovery centers that seniors often spend time in before returning home.

"Hand hygiene is considered to be the most important strategy to prevent infections and spread of drug-resistant organisms," explained study lead author Dr. Lona Mody. She is associate division chief of geriatric and palliative care medicine at the University of Michigan Medical School in Ann Arbor.

The problem is that most of the current focus is placed on ensuring caregiver hand hygiene, not patient hand hygiene, noted Mody, who is also a professor of internal medicine. A focus on patient hand hygiene is going to be increasingly important, because "we are now facing a tsunami of an aging population in our hospitals, post-acute care facilities and long-term care facilities," according to Mody.

The study is published in the March 14 online edition of JAMA Internal Medicine.

Every year, about 2 million Americans become infected with antibiotic-resistant bacteria, and about 23,000 die as a result, according to the U.S. Centers for Disease Control and Prevention.

To assess hand-related germ risk, the investigators tallied the presence of multidrug-resistant germs among more than 350 seniors, with an average age of 76. The study participants were being temporarily cared for in six different rehabilitation/assisted-living centers in Michigan, directly after being hospitalized for a short time.

Following germ testing on admission, the investigators continued to track three common resistant germs, including the potentially serious staph infection known as MRSA. Tracking continued on a monthly basis until discharge from the facility or for up to six months.

Almost one-quarter of the patients had at least one such germ on their hands at admission, including MRSA, the researchers reported.

In addition, about 10 percent then went on to newly acquire at least one type of resistant germ on their hands, and about two-thirds of carriers still had the germs at discharge, the study revealed.

What's more, the team suggested their findings may underestimate the gravity of the situation, given their focus on new incoming patients, rather than long-term residents.

The researchers said that they suspect the main culprit is a lack of routine hand washing.

Going forward, Mody said it will be important to combat the risk from these bacteria by developing new programs "that reinforce patient hand hygiene."

"Today, patient hands come in contact with environmental surfaces, rehabilitation equipment, health care worker hands, and other patients," she said, a risky fact of life that will require a concerted response on the part of both patient advocates and hospitals.

But Dr. Philip Tierno, a professor of microbiology and pathology with the NYU School of Medicine at NYU Langone Medical Center in New York City, suggested that it's important to place the findings in context.

"Germ transmission by hand is certainly a big problem," he said. "And clearly hand washing is very important. But it should be understood that this study did not prove, for example, that the patients picked up their germs in the hospitals they came from. In fact, it's very likely they brought germs with them into the hospital, and still had them when they came out."

Why? "Because it's the 'Wild West' out there," said Tierno. "Resistant germs are not just in hospitals. They're everywhere."

The two main reasons Tierno offered: inappropriate prescribing of antibiotics, and the widespread use of antibiotics in industrial animal feed.

"So, certainly hospitals and care facilities are a hotbed of resistant germs. And yes, what I call 'great hygiene' is very important -- meaning washing your hands prior to eating or drinking," he explained.

But if we're going to make any headway against resistant germs, everyone needs to heed that advice, not just patients, he said. "Because resistant germs come from the everyday handling of meat and raw vegetables. From simply picking up flora as you walk through life and interface with people. From touching doorknobs, elevator buttons, and stair rails. These germs come from the world in which we all live," Tierno said.

SOURCES: Lona Mody, M.D., M.Sc., professor of internal medicine, University of Michigan, and associate division chief, division of geriatric and palliative care medicine, and associate director, clinical and translational research, Geriatrics Center, University of Michigan Medical School, Ann Arbor, Mich.; Philip Tierno, M.D., Ph.D., professor, microbiology and pathology, NYU School of Medicine, NYU Langone Medical Center, New York City; March 14, 2016, JAMA Internal Medicine, online

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