RACFs at greater risk of E.coli

Residential aged care facilities are likely to have a higher prevalence of mutiresistant Escherichia coli (E.coli) than hospitals because residents share dining rooms and recreation areas and hand hygiene is poor, according to recently released Australian research.

The authors of a new study, published in the Medical Journal of Australia yesterday, have reported that E.coli colonisation was present in 12 per cent of the 119 residents screened in three Australian facilities, last year.

Half of the infected residents were found to be living in the same wing of one facility and eight of 13 residents had persistent colonisation on repeat testing three months later.

The study’s authors said that in hospital settings, patients with multiresistant gram-negative bacteria are placed in contact isolation to limit spread of the organisms. However this was difficult to achieve in residential facilities because residents usually share dining rooms and recreation areas.

Environmental contamination and poor hand hygiene were also likely to contribute to the spread of the bacteria, the authors said, while increased use of antibiotics is associated with the development of resistance.

Lead author and medical director of Infection Control and Epidemiology at Monash Medical Centre, Dr Rhonda Stuart, believes that antimicrobial resistance in residential aged care facilities “is of growing concern”.
 
“Residential aged care facilities should have programs emphasising processes that will limit spread of these organisms, namely good hand hygiene compliance, enhanced environmental cleaning, and dedicated antimicrobial stewardship programs,” Dr Stuart said.

In an accompanying MJA editorial, medical microbiologist, Timothy Inglis, and geriatrician, Christopher Beer, said a control method for multiresistant bacteria that relies on surveillance and targeted infection control measures may seem appealing but in reality is likely to be “costly, impractical and ineffective”.

“An alternative strategy is to use multiple measures targeting improvements in the skilled nursing care of those at identifiably higher risk of multiresistant bacterial infection, without prior surveillance culture,” they said.

“We recognise that this proposal will not sit comfortably with those who have long advocated a post-hoc, species-specific, search-and-destroy approach to organisms of interest.

“But with an estimated multimillion dollar annual cost of multiresistant bacteria control measures, and a residential aged care sector facing many challenges, we will be forced to explore all options.

“This should include considering a more public health-based approach, as long-term care facilities lie outside the remit of conventional hospital infection control.”

The Medical Journal of Australia is a publication of the Australian Medical Association.