Amid disgrace of U.S. nursing homes lurks epidemic of drug-resistant bacteria
The care in U.S. nursing homes is deplorable and a stain on our national legacy. In the face of this, the federal rollback of nursing home penalties seemed preposterous, even being “Fake News”, triggering a Snopes investigation which verified the reports. The greatest threats to nursing home residents are the lack of facility staff, medication errors and antibiotic resistant bacteria, which permeates these facilities.
Lax federal regulations only see a problem with medication errors if there is a mistake in at least one in twenty drug administrations. Up to 75 percent of antibiotic usage in nursing homes may be inappropriate. Overworked hurried staff set the stage for these errors.
A recent study in California found that over 50 percent of nursing home residents harbor dangerous antibiotic resistant bacteria. Unfortunately, there are few regulations which safeguard the health and well-being of either the facility’s residents or the nursing home’s staff.
An industry friendly solution is to develop and bring new antibiotics to the market. This will further enable the cost saving strategy of inadequate staffing and when infections do occur, they can be treated with expensive antibiotics, further increasing profits for the healthcare industry.
However, even this perverted strategy no longer seems achievable. As recently reported in the New York Times, the feasibility of developing new antibiotics has been brought into question with many pharmaceutical companies approaching insolvency. Simply put, the easy to develop antibiotics have been found, new ones are extremely expensive to develop, and their sustained effectiveness is doubtful against the ever-mutating enemy.
Recently, the CDC has proposed “Enhanced Barrier Precautions”(EBP), industry friendly guidelines to prevent the spread of dangerous pathogens in Nursing Homes. EBP largely makes not isolating patients with dangerous contagions an acceptable practice. Even residents harboring two of the CDC’s most urgent bacterial threats, candida auris and CRE, can now roam freely around a facility. Gowns are not required for “low transmission” activities, such as passing meds, but using the same research studies these recommendations are based upon, we calculate that following EBP, a healthcare worker would contaminate their clothes with the deadly pathogen MRSA ten times a week. The industry states resident isolation creates a dignity issue, but what dignity does a resident have in the knowledge they may have infected their visiting grandchildren.
There is an over reliance on hand hygiene. Although this is the single most important intervention in stopping the spread of pathogens, a recent study of MRSA found that wearing gloves only stops the spread under two thirds of the time, not enough to reliably stop an outbreak.
What needs to be done? First is surveillance of a resident’s microbiome (what bacteria they are carrying) upon admission to a facility. Strategies for decontamination, isolation (even if in a particular facility area) and the protection of our healthcare workers need to be implemented. Periodic surveillance of healthcare workers for endemic dangerous pathogens along with implantation of an economic safety net, will not only protect the worker, but also their families and nursing home residents.
Unfortunately, public health is where science and politics intersect. Similar to global warming, the effective strategies are extremely expensive, and the benefit may be decades away. In climate change there is a denial of the problem, in antibiotic resistance there is a denial of effective interventions. Both types of denials obviate the need for immediately implementing expensive strategies.
It needs to be remembered that these resistant bacteria do not care about policy and politics, they are out to win. And unless we decisively act, the prophetic tragedy predicted by several commentators in a La Times OpEd may come true. The epidemic of antibiotic resistant organisms may be the final solution to global warming.
Kevin Kavanagh of Somerset is a retired physician and board chairman of Health Watch USA.