Antimicrobial Resistance Measures at Facilities for the Elderly: A Fact-finding Survey on Infection Control Measures at Private Nursing Homes and Long-term Care Insurance Facilities

Abstract

The objective of this study was to examine the nature of antimicrobial resistance (AMR) measures by clarifying the actual state of such measures at private nursing homes and long-term care insurance facilities. Infection control staff at a total of 2,800 randomly sampled facilities for the elderly (private nursing homes, designated facilities covered by public aid providing long-term care to the elderly, long-term care health facilities, and medical long-term care sanatoriums) were surveyed using a self-administered questionnaire. The responses of 254 (9.1%) facilities were tabulated. The conditions for hindering the spread of antimicrobial-resistant bacteria were being met at private nursing homes, but outbreaks of methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum beta-Lactamase-producing bacteria, carbapenem-resistant Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa, multidrug-resistant Acinetobacter, and vancomycin-resistant enterococci infections had occurred like at other types of facilities. AMR measures at facilities for the elderly, such as availability of manuals, training, and measures upon admission, were insufficient. Screening upon admission was only implemented at 22% ― 33% of the facilities, and the target bacterium in screening was almost always limited to MRSA. There were also issues with care that facilitates the spread of antimicrobial-resistant bacteria (such as urethral indwelling catheter management and diaper care). Accordingly, this demonstrated the risk of the spread of antimicrobial-resistant bacteria from overlooked carriers. These findings suggest that because AMR measures at facilities for the elderly do not require screening upon admission, it may be effective to strengthen contact precautions in addition to standard precautions during provision of care that facilitates the spread of antimicrobial-resistant bacteria to all residents. Medical care and long-term care fee incentives are also needed to pro-mote support from public health centers and regional core hospitals.