MRSA in Nursing Homes | Symptoms of MRSA in Elderly Residents, Complications & Proper MRSA Precautions in Nursing Homes

Has a loved one in a long-term care facility suffered serious consequences or even lost their life from a MRSA infection? Sadly, MRSA in nursing homes is a common problem, but infection is preventable. Thousands of older adults lose their lives to MRSA infection and complications every year, in many cases due to poor infection control and cleaning protocols, understaffing, and neglect.

At Berman & Riedel, LLP, we are committed to helping you hold the responsible parties accountable. We can help you seek fair compensation to move your loved one to a safe facility, provide the medical care they need, and support their quality of life.

Here is what you need to know about MRSA, proper MRSA protocol in nursing homes, and what facilities should do to protect your loved one.

What Is MRSA?

MRSA or methicillin-resistant Staphylococcus aureus is a potentially dangerous staph infection that is difficult to treat because it is resistant to many antibiotics. MRSA still responds to some antibiotics but treating serious infections can be challenging. It was first detected in 1961 about 20 years after methicillin treatment of Staph infections began.

MRSA is classified into two types:

  • Community-associated MRSA (CA-MRSA), and
  • Healthcare-associated MRSA (HA-MRSA)

HA-MRSA includes resistant strains of Staph acquired in a hospital or long-term care facility. These infections are usually more serious because they tend to be invasive or serious infections after a surgical or invasive procedure. HA-MRSA is also more likely to be resistant to other types of antibiotics like vancomycin.

Antibiotic Resistance and Seniors

Older adults face a higher risk of antibiotic-resistant infections for many reasons:

  • Weakened immune systems and chronic health conditions which make it easier to develop an infection
  • A lifetime of antibiotic use combined with decades of over-prescription or inappropriate use of antibiotics by physicians
  • More time spent in long-term care facilities and hospitals which increases the risk of exposure
  • Antibiotic resistance is a growing problem that makes it hard to fight diseases and even avoid complications from treatment like joint replacement surgery.

According to a study published in 2021, about 40% of fatalities due to the most common antibiotic-resistant infections occur in seniors. Over 11,000 adults 65 and older died from hospital- and community-inset infections in 2017 alone due to one of six resistant bacterial infections. The most common antibiotic resistant pathogens are:

  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Extended-spectrum beta-lactamase (ESBL)-producing Enterobacetriaceae
  • Multidrug-resistant Pseudomonas aeruginosa
  • Carbapenem-resistant Acinetobacter baumannii (CR Acinetobacter)
  • Carbapenem-resistant Enterobacteriaceae (CRE)
  • Vancomycin-resistant Enterococcus

CR Acinetobacter is the hardest to treat and most dangerous, but MRSA and ESBL-producing Enterobacteriaceae are more common.

How Common Is MRSA in Nursing Homes?

MRSA and staph infections in nursing homes are incredibly common. About one-third of all Americans carry Staphylococcus auereus or staph in their nasal passages or on their skin. Around 1% of these people carry MRSA which is introduced and spread in nursing homes by staff, visiting healthcare providers, visitors, and residents.

In some settings, about 1 out of every 4 nursing home residents carries MRSA. Many do not realize they are carriers and may not have an active infection – but may spread it to other residents, often through healthcare workers.

A study published in the American Journal of Infection Control revealed the shocking prevalence of MRSA in nursing homes. After testing 37 surfaces in each of seven nursing homes, researchers found S. aureus on almost 29% of the surfaces and MRSA on 20% of surfaces.

A study in Minnesota found the average age of people with MRSA in health care facilities and hospitals was 68 years old.

MRSA Causes in Nursing Homes – How Elderly People Catch MRSA

MRSA is normally spread by direct skin-to-skin contact with someone who is infected or contact with items or surfaces contaminated with MRSA. If items are not sterilized or washed, MRSA can live on surfaces for days or up to 6 months. MRSA can live on towels, bedding, hard surfaces, and even dust and pets!
Nursing home residents catch MRSA in many ways:

  • Open wounds
  • Contaminated devices like implanted feeding tubes and catheters
  • Skin-to-skin contact with visitors’ or care providers’ hands contaminated by other patients with a MRSA infection
  • Contact with contaminated surfaces or objects

Open wounds, including cuts, scrapes, incisions, or abrasions, are often the site of MRSA infections. However, you can catch MRSA without an open wound. Infection may occur in mucus membranes the nose or even on unbroken skin. Because the elderly are at increased risk of infection, MRSA infection is more likely to happen on intact skin.

MRSA Signs and Symptoms

MRSA symptoms depend greatly on the site of infection. A staph infection in elderly people may involve the skin, lungs, heart, bloodstream, urinary tract, surgical site, or other organs.

The typical MRSA skin infection may cause a range of symptoms:

  • Swollen, red, and painful area on the skin known as a “MRSA rash”
  • A small abscess or boil that resembles a pimple known as a “MRSA bump”
  • Area that is warm to the touch
  • Drainage of fluids or pus from a bump or rash
  • Fever

A staph skin infection is often mistaken for a spider bite or even a pimple.

More serious MRSA symptoms include:

  • Fatigue
  • Shortness of breath
  • Chills
  • Chest pain
  • Muscle ache
  • Headaches

MRSA UTI Symptoms

MRSA can also result in a bladder infection or urinary tract infection (UTI). UTIs are one of the most common infections in nursing homes, often underdiagnosed, and may even lead to sepsis in elderly residents. While Staph is not a common organism associated with UTIs, the prevalence is rising – especially in long-term care facilities where patients who use catheters or have limited mobility are at an increased risk. A 2014 study found more than 5% of urine samples collected over six years showed MRSA infection. About 25% of sepsis cases begin as UTI. A MRSA UTI can lead to a MRSA bloodstream infection with far more serious symptoms and a higher mortality rate.

Many patients have no MRSA UTI symptoms. In the elderly, a unique and common symptom of UTI is confusion. A UTI may also cause pain during urination, a frequent and intense urge to urinate, cloudy or foul-smelling urine, sudden incontinence, reduced mobility, and agitation.

MRSA Pneumonia Symptoms

MRSA infection can lead to pneumonia, empyema, and lung abscesses. Common pneumonia symptoms may include:

  • Unproductive cough
  • Rapid breathing
  • Stabbing or sharp chest pain
  • Shortness of breath
  • Fever
  • Chills
  • Vomiting or nausea
  • Confusion

MRSA Blood Infection Symptoms (Bacteremia)

If MRSA enters the blood, it can lead to a systemic bloodstream infection known as bacteremia. This can trigger sepsis, a seriously life-threatening condition that can cause acute organ damage, acute respiratory distress syndrome (ARDS), low blood pressure, decreased urination, and altered mental status.

What are the first signs of MRSA?

The first signs of MRSA are usually small, red bumps that become painful and deep abscesses of the skin. They may resemble a spider bite. The skin may be warm to the touch, tender, or swollen.

MRSA Treatment & Complications

MRSA infection is notoriously challenging to treat, especially in elderly patients with weakened immune systems. While MRSA is resistant to all ß-lactam drugs, it can still be treated with some antibiotics. It may be susceptible to a new class of MRSA-active cephalosporin.

Most MRSA infections respond to vancomycin, but strains with reduced susceptibility or full resistance to vancomycin have been reported since the 1990s. Treatment failure can happen even when strains are susceptible to vancomycin with a failure rate of 44% to 90% depending on the strain.

Many strains of healthcare-associated MRSA (unlike community-associated infections) are also resistant to other common antimicrobials and antibiotics like clindamycin, fluoroquinolones, and erythromycin.

If treatment with vancomycin fails for a serious infection, there are few other options aside from linezolid and trimethoprim-sulfamethoxazole.

Is MRSA deadly?

MRSA infection is described as a silent killer, particularly among seniors. The MRSA mortality rate ranges from just 5% to 60% depending on the patient’s age and overall health and the infection site. The MRSA in bloodstream survival rate is much lower than the survival rate for a MRSA skin infection, for example. In 2017, MRSA resulted in about 20,000 deaths.

The 2021 study on antibiotic resistance among older adults found invasive treatment-resistant infections are incredibly deadly. The 30-day MRSA death rate for seniors was 14.8% compared to 26.9% for invasive CR Acinetobacter infection.

Another study to predict the risk of death from MRSA found the following factors increase the risk of MRSA death:

  • Older age
  • Living in a nursing home
  • Severe bacteremia
  • Organ impairment (liver cirrhosis, renal insufficiency, and diabetes in particular)
  • Vasopressor use

Having lived in a nursing home, renal insufficiency, and cirrhosis are all independently associated with a 7% to 15% higher risk of death from MRSA within 90 days.

Complications of MRSA

In addition to its high mortality rate, MRSA infection can come with many complications for older adults, especially when it leads to an internal infection.
Potential MRSA complications include:

  • Endocarditis or inflammation of the inner lining of the heart
  • Sepsis, a life-threatening reaction to infection that can cause organ damage and death
  • Empyema which causes pus to develop between the chest wall and lungs
  • Osteomyelitis or infection of the bone marrow and bone
  • Cellulitis, a skin infection that can be life-threatening
  • Necrosis or death of tissue around the infection

MRSA Precautions in Nursing Homes – How Facilities Can Prevent MRSA in Elderly Residents

In conjunction with the 2021 study, Pew Charitable Trusts released a policy brief highlighting steps it says the government and policymakers can take to reduce the risk of antibiotic-resistant infections in seniors. The brief recommended that the CMS push policies that incentivize hospitals to develop quality measures, track, and report the use of antibiotics and data on drug resistance, particularly in nursing homes.

MRSA poses a significant risk to vulnerable nursing home residents, but infection is preventable.

The use of gloves that are regularly changed, regular hand washing by residents and staff, and careful cleaning of all equipment and resident rooms are critical MRSA nursing precautions that should be taken.

The facility should have an infection control policy in place that addresses Staph infections. Nursing home residents with MRSA should remain in a single-occupancy room or with another resident with MRSA. Visitors and staff should always wear personal protective equipment (PPE) when visiting or caring for the resident and remove the equipment then wash their hands after leaving the resident’s room.

Sadly, MRSA infections in nursing homes are often related to understaffing and cost-cutting measures. If the nursing home fails to take adequate steps to prevent and treat MRSA, they can be held liable.

Schedule a Free Consultation with a California Nursing Home Negligence Attorney

Have you lost a loved one to a nursing home-acquired MRSA infection or has a family member suffered serious complications from MRSA? If the nursing home failed to take proper precautions to prevent MRSA or give your loved one the care they needed, they can be held accountable.

Berman & Riedel, LLP specializes in nursing home litigation in California. We represent families in seeking justice and holding negligent nursing homes accountable for abuse, understaffing, and neglect that harms the residents for whom they are entrusted to care. Our main office is in San Diego, but we handle nursing home neglect, abuse, and wrongful death cases throughout California.

Contact our law office today to schedule a free case review with a San Diego nursing home neglect lawyer to discuss your case.


About Berman & Riedel, LLP firm managing partner attorney William M. Berman:

Attorney William M. Berman focuses his practice in the areas of catastrophic personal injury, wrongful death and elder abuse and neglect. Strictly a plaintiffs’ dedicated firm, he never represents insurance companies in the defense of claims. Mr. Berman’s firm remains staunchly committed to helping those who have suffered serious injury or loss due the negligence, intentional misconduct or wrongful acts of others.

Mr. Berman has grown his firm to what is considered one of the largest and most successful elder abuse/neglect practices within California. Through his continued successes in handling claims involving nursing home and elder abuse and neglect, Mr. Berman remains a prominent figure in advocating on behalf of this vulnerable class of citizens.

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Attorney Bill Berman

William M. Berman, Esquire
Berman & Riedel, LLP
12264 El Camino Real, Suite 300
San Diego, California 92130
ph: (858) 350-8855
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web: www.bermanlawyers.com