MRSA and Nursing Home Admission Denials

Courtney Reynolds, PhD Medical Scientist Training Program University of California Irvine, School of Interview with:
Courtney Reynolds, PhD
Medical Scientist Training Program
University of California Irvine, School of Medicine What are the main findings of the study?

Dr. Reynolds: Our survey of factors influencing admission to 13 nursing homes in Orange County, California showed that MRSA carriers are denied admission more often than non-carriers, even after accounting for other important factors such as insurance status, required level of care and previous experience at the facility. In 80% of cases where MRSA carriage was responsible for denial of admission, nursing home administrators cited a lack of available single or cohort (MRSA only) rooms to accommodate these potential residents. Were any of the findings unexpected?

Dr. Reynolds: Yes, we were interested to find that there was substantial variation in admission rates across nursing homes for both MRSA carriers and non-carriers (from no rejections to about 2/3 of applicants rejected). This variation likely reflects that the most desirable nursing homes receive a higher volume of applicants and are able to be more selective in their admissions process.

Another surprising finding was that among accepted applicants, MRSA carriage did not lead to delays in placement. We had hypothesized that since most nursing homes attempt to place MRSA carriers in single or cohort rooms, there could be a delay associated with waiting for such a room or with moving current residents around to create one. It now seems that nursing homes may simply reject an MRSA carrier if such a room isn’t already available. It is also possible that any delays in finding a room occur when the facility is contacted but before the applicant is officially accepted; this type of delay was not captured in our study. What should clinicians and patients take away from your report?

Dr. Reynolds: Our finding that MRSA carriage negatively impacts the ability to find nursing home placement is highly concerning since many hospital patients require short or long term nursing home care after discharge. As nursing homes have limited space and thus ability to accommodate MRSA carriers in single or cohort rooms, consideration may need to be given to decolonizing known carriers before discharge in order to prevent difficulty in placement. What recommendations do you have for future research as a result of this study?

Dr. Reynolds:  An important question given our results is whether placing MRSA carriers in single or cohort rooms is actually effective in the nursing home setting, where residents are allowed and encouraged to interact socially. Transmission risk has been found in a few recent studies to be linked to this socialization rather than to having an MRSA positive roommate. Again, decolonization may be a more efficient strategy to prevent transmission and future infection in the nursing home setting.


Are nursing homes less likely to admit methicillin-resistant Staphylococcus aureus carriers?

Courtney Reynolds, Diane Kim, Sherrie H. Kaplan, Dana B. Mukamel, Eric Cui, Cameron Lee, Susan S. Huang

AJIC: American Journal of Infection Control – January 2014 (Vol. 42, Issue 1, Pages 63-65, DOI: 10.1016/j.ajic.2013.07.015)

Last Updated on January 11, 2014 by Marie Benz MD FAAD