Nursing Home Antibiotic Resistant Infection Rates Impacted by Staffing Problems: Study

Approximately 20% of nursing homes account for half of all infections from the antibiotic-resistant bacteria MRSA, researchers conclude.

New research suggests that nursing home staffing problems may have a direct impact on antibiotic resistant infection rates at specific facilities, finding that nursing homes with more registered nurses on staff have fewer infections caused MRSA and other dangerous antibiotic-resistant bacteria.

Methicillin-resistant Staphylococcus aureus (MRSA) is a drug-resistant bacteria that can cause painful symptoms like boils, fever, chills and fatigue, and in severe cases, lead to life-threatening complications such as sepsis, bone infections, pneumonia and heart valve infections.

The growing threat of antibiotic-resistant infections like MRSA has led researchers to warn that these “superbugs” could cause up to 40 million deaths by 2050. Their resistance to traditional treatments, including antibiotics, makes them increasingly difficult to control.

In recent years, nursing homes have been at the epicenter of these infections, with studies indicating a lack of hand-washing etiquette among residents who have been prescribed antibiotics could be leading to the spread of treatment-resistant infections.

However, research published in the Journal of the American Geriatric Society earlier this month suggests that understaffed nursing homes may have higher rates of invasive MRSA infections, particularly in facilities serving residents with greater medical and functional care needs.

In the study, a team of researchers led by Dr. Isaac See of the U.S. Centers for Disease Control and Prevention (CDC) looked at data collected from 2011 through 2015 by the CDC’s Emerging Infections Program (EIP) on 626 nursing homes, which had a total of 2,824 MRSA cases.

Among the facilities observed, 82% had at least one case of the bacterial illness, and the 20% of facilities with the highest rates of MRSA infection accounted for 50% of all MRSA infections across the entire data set.

The researchers also determined that facilities with lower MRSA infection rates had a greater number of registered nurses on staff, leading them to conclude that adding trained nursing staff at facilities with higher MRSA rates could lower the number of patients suffering from the antibiotic-resistant infection.

“In conclusion, in this analysis of invasive MRSA infection data from >600 nursing homes, we found several factors to be associated with high rates of nursing home-onset invasive MRSA infection, including medical complexity of residents and lower (registered nurse) staffing hours per resident,” See said. “These findings suggest potential opportunities to improve infection prevention practices in U.S. nursing homes in general, such as increased focus on residents needing the most assistance with activities of daily living.”

Nursing Home Staffing Concerns

The report comes amid a series of concerns regarding nursing home staffing problems in the United States. A study published earlier this month indicated that nursing home problems with staffing should influence the federal 5-star ratings system for facilities. Researchers noted that information could raise or lower federal star ratings by one star in either direction.

This information came on the heels of the U.S. Centers for Medicare & Medicaid Services (CMS) passing new nursing home minimum staffing level standards in April 2024.

Three months after those standards were put in place, researchers from the U.S. Department of Health and Human Services concluded that two additional staff members per shift were needed for many facilities to meet the new CMS guidelines, determining that less than one-third of U.S. nursing homes had enough nursing assistants on staff.

In addition, research has also shown that insufficient nursing home staffing and frequent turnover can lead to reduced quality of care and could increase patient injury risks, including a greater risk of antibiotic-resistant bacterial infections.