Methicillin Resistant Staphylococcus Aureus (MRSA) urinary tract infections (UTIs) are increasing throughout the United States, and transmissions acquired in hospitals and care facilities are of particular concern. A MRSA UTI cannot be treated with traditional antibiotics and the prevalence of antibiotic-resistant bacteria is a growing problem, especially for the elderly living in residential care facilities.
Moving into a skilled nursing facility is a great option for seniors that face compounding health issues and need the supervision of medical staff and possibly increased security due to dementia. There are many benefits to living in a nursing home, such as being under the care of a skilled nursing team provides. Residents of these facilities are also given access to specialized medical programs for the treatment of complex diseases and aging issues. However, the close proximity of living quarters and weakened immune systems of many nursing facility residents makes the spread of infection hard to control.
Living with a UTI later in life can cause more dangerous health implications to quickly pile up. When the kidneys are compromised, the body is unable to filter out toxins that can lead to sepsis. If septic blood toxicity occurs, seniors can be at risk of severe damage to their organs, as well as death. UTIs have many symptoms, some more obvious than others. One obvious sign of a urinary tract infection is experiencing pain in the groin area, or burning during urination. In the elderly, however, there may be less pain than that which a younger person with a UTI experiences, so this symptom may be missed. Other symptoms that may indicate a UTI include:
- Sudden changes in mood or behavior, especially if dementia is already present
- Loss of appetite
- Inability to hold one’s urine
- Fever and nausea- these are symptoms of sepsis and indicate an urgent need for healthcare if present with an infection like a UTI
MRSA UTI Risk Factors
Now that we know what to look for, let’s examine the specific factors contribute to the likelihood of contracting a MRSA UTI in a nursing home or other long-term care facility.
MRSA UTI Risk Factor #1: Exposure to MRSA Bacteria
The bacteria that causes MRSA is highly contagious and easily spread through direct contact as well as fluids in the air. Research of Veterans Affairs nursing homes shows that MRSA is easily spread throughout a community on the clothing and gloves of staff members. One recent study shows that it is more common for bacteria to thrive on the gloves of health care workers, indicating that proper handwashing techniques could protect communities against the spread of MRSA.
Studies have shown that residents in long-term care facilities are more likely to be carriers of MRSA in general. It is believed that patients often contract MRSA during a stay at a hospital or acute care facility, rather than in a nursing home or long-term care residence, however, facilities where many people are living in close proximity to one another can be prime areas of contagion. While infection control protocols are in place in most facilities, research has indicated that none are substantially effective in reducing the spread of infections. This may be due to both the highly infectious nature of MRSA as well as the social environment of long-term care facilities.
When considering what features to look for in a nursing home, think about the need for proper infection control. Some communities offer isolation rooms, which feature extra safety precautions and keep other residents out of the way of those waiting to heal from their infections.
MRSA UTI Risk Factor #2: Invasive Medical Devices
Urinary tract infections are common in nursing homes and long-term care facilities. Many elderly patients have poor bladder control and depend on a urinary catheter which can provide bacteria a direct route into the body, particularly if the catheter is left in place for long periods of time without being replaced. The Center for Disease Control estimates that 75% of urinary tract infections are the result of catheter insertion. When a catheter is inserted in a non-sterile environment, or by someone who is not wearing sterile clothes and gloves, there is a high likelihood of bacterium such as MRSA entering the urethra. This introduction of the bacteria directly into the urethra can cause it to take hold and spread rapidly into the kidneys and throughout the body.
People living with disabilities requiring them to use a catheter to maintain personal cleanliness are at a much greater risk of a urinary tract infection because of this threat of bacteria. Those in nursing homes are at an even greater risk of infection because catheter use is sometimes prescribed as a factor of convenience for caretakers, regardless of if the resident actually needs a catheter. In addition to this unnecessary catheter use, catheters in long-term care settings tend to stay in place much longer than in a typical healthcare setting, further increasing the risk of infection. Repeated catheter insertions are also common in nursing homes, and every re-insertion brings an independent set of risk factors.
When it is required to use a catheter to maintain health and hygiene, research shows that the best way to prevent an infection is to follow proper handwashing protocol on behalf of the caregiving staff, as well as those who the staff comes in contact with before and during the procedure. Since MRSA, like other staph organisms, can live on the skin, hygiene is the first line of defense in controlling the spread of infection. While healthy people can carry staph on their skin without being infected by it, elderly persons have a much harder time fighting off stubborn organisms like MRSA. It is critical for healthcare staff to ensure they use fresh gloves when performing any invasive procedure on long-term care facility residents and proper handwashing techniques before and after the procedure.
There are many things that people can do to help take care of their catheters. One of the most prevalent issues that face catheter users, which could increase the risk of a bacterial infection, is the catheter line becoming blocked somehow, twisted, or simply pulling out. Research into ways to improve self-care techniques for catheter use shows that simply educating people about what the signs of a blocked catheter are and how to try to prevent blockages is the best way a person can protect themselves against harmful blockages.
MRSA UTI Risk Factor #3: Impaired Cognitive Function
Having an invasive urinary catheter inserted in your body requires ongoing maintenance, which might be difficult for those with cognitive impairments. One of the symptoms of Alzheimer’s disease and related dementias is the inability to remember daily tasks, as well as the inability to feel the same physical sensations that one once did, such as the pressure of a full bladder. It might be difficult to accurately care for your catheter if you can’t feel that there is an issue, so those with impaired cognition are at a heightened risk of UTIs.
Increasing the amount of fluids in one’s diet will help to flush out bacteria from the bladder and urinary tract, but elderly residents may not remember to drink enough without close monitoring. In addition to being incontinent, long-term care residents may be mobility-impaired and confused, which contributes to the possibility of a UTI. Patients who do not have a catheter but still have issues with incontinence may refrain from drinking larger amounts of fluids in an attempt to avoid accidents, and this provides an opportunity for bacteria in the bladder and urinary tract to thrive. It is important to find the best way to maintain self-care habits such as water intake, as well as have a good system for reporting discomfort and having access to observant and well-trained caregivers so they can check for catheter issues.
MRSA UTI Risk Factor #4: Impaired Immune Function
Residents of nursing homes may have chronic medical conditions that decrease the strength of their immune system, and this makes MRSA more dangerous and potentially even life-threatening. The inability of some elderly patients to communicate adequately with staff, combined with a high frequency of asymptomatic MRSA UTIs, may create a nearly impossible situation. The use of high-power antibiotics that are effective on resistant bacteria like MRSA can be very hard on the patient and may affect kidney function as well.
Elderly people are at a greater risk of having a compromised immune system due to the high likelihood of prior antibiotic use. According to the CDC, 20% of infections in a nursing home are UTI-related, but often times any of the symptoms associated with a UTI will be treated with an antibiotic, before verification of any infection. This may result in a quicker solution for overworked caregivers and nursing staff, but overuse of antibiotics leads to biological agents such as MRSA becoming resistant to the community’s most commonly used antibiotics. A lowered immune system can make it fairly easy for other bacteria such as E. coli to take hold in the body, another common cause of UTIs. This bacteria, like any other, builds up a tolerance to antibiotics when they are taken repeatedly over a lifetime.
There are many natural ways to protect your immune system and keep your body running at its best. If you want to give a natural method a shot, try some of these easy daily lifestyle changes to increase your health:
- Your body works best when well hydrated, so make sure to drink at least 8 glasses daily.
- Take a daily multivitamin to ensure you have all the nutrients you need to feel your best, but check with your healthcare team if you have health issues that might require you to be avoidant of certain combinations of vitamins or minerals.
- Manage your stress! Studies show that high levels of stress have many negative impacts on your immune system. Try taking a walk in nature if meditating isn’t your thing, or write down your difficult thoughts to help soothe yourself.
MRSA UTI Risk Factor #5: High Potential for Contagion
MRSA may begin as a nasal or respiratory infection and can easily spread to other parts of the body. It is a highly contagious infection that can be transmitted by direct contact with:
- Touching an infected persons
- Handling towels, washcloths, bedding, drinking glasses or any other items handled by infected persons
- Being exposed to fluids in the air caused by a sick person coughing and sneezing
If cognitive changes are present that prevent patients from being fully aware of things like proper and frequent handwashing, the spread of the infection can become especially difficult to manage. Nursing homes can provide isolation rooms to sick residents to protect their communities from the bacteria spreading. Family members can visit sick residents, but extra caution is taken care in these rooms to prevent the spread of infection. Keeping contagious residents away from each other is one of the best ways to prevent MRSA infections from spreading throughout a community.
Caring for a UTI
If you find yourself suffering from a urinary tract infection, there are some things you can do for yourself that could help alleviate the symptoms, as well as prevent an infection in the first place. Healthy self-care techniques like drinking plenty of water and taking your vitamins are easy ways to help keep your body in fighting shape. Here are a few more approaches you can take:
- Certain compounds such as those found in cranberries have been shown to reduce the prevalence of the E. Coli bacteria that is the cause of some UTIs, but this treatment is not known to be effective against MRSA.
- Vitamins A and C have been shown to improve UTI outcomes, as well as probiotics.
Traditional medicines from across the globe have shown some promise as a natural measure to battle MRSA infections.