A reservoir is a place where bacteria hang out. There are many different reservoirs in the nursing home setting, including the residents, health care personnel and surfaces and shared patient equipment. All of these can harbor bad bugs and be the source of transmission to a resident. Colonization is defined as the presence of multiplying bacteria on host tissues that are in contact with the outside environment, like the skin, nose, and intestines. But does not cause signs and symptoms of infection, such as redness, puss or fever. With colonization, the bacteria are happy and thriving and the host is not aware of their presence. Infection is the invasion of bacteria in to normally sterile tissue with clinical signs and symptoms of infection present such as fever, redness or pus. With infection, the bacteria continue to remain happy, but are also now producing toxins and other products that are making the host sick. Antibiotic resistant bacteria are a serious issue for nursing homes. Studies have demonstrated that many residents are colonized with these bad bugs when they are admitted to nursing homes. It was estimated that 25% of residents in these studies were colonized with MRSA and 25% to 67% were colonized with VRE. This is a large reservoir of bad bugs that could lead to transmission to other residents. Once a resident is colonized, they will continue to carry those same antibiotic resistant bacteria for long periods of time. Estimates place the carriage duration for MRSA between three months and three years. And three to four months for VRE. Similar to MRSA, ESBL E.coli has a carriage duration of three months to four years. Again this long period of carriage increases the risk of transmission. Many residents may be colonized with more than one type of antibiotic resistant bacteria. This suggests that nursing homes can become reservoirs for multiple strains of antibiotic resistant bacteria when persistently colonized residents are accepted and transferred from many different outside facilities like other nursing homes or hospitals. Given that there is a high rate of colonization in nursing homes, how is it that some residents become colonized while others do not? When colonized residents are compared to non colonized residents, a variety of factors have been associated with an increased risk of colonization with antibiotic resistant bacteria. These include an underlying illness, presence of an invasive device, like a feeding tube, an IV, or a urinary catheter, prior antibiotic use, the presence of wounds, a decline in functional status, and an increased intensity of nursing care. Another contributing factor in nursing homes for residents acquiring antibiotic resistant bacteria is colonization pressure. Colonization pressure occurs when there is a large reservoir of residents with resistant bacteria, creating more opportunities for these bacteria to be passed from an infected resident to a non-infected resident. As we discussed in a previous slide there are already a lot of residents in nursing homes who are already colonized or infected when they are admitted to a facility making for a ready source of transmission. Residents get bad bugs from multiple sources. The main way these bad bugs are spread is by the hands of healthcare personnel. The hands of healthcare personnel can spread bad bugs by touching one infected resident and then touching another resident without washing their hands. It can also occur by indirect contact when a healthcare provider touches a contaminated surface or piece of equipment and then touches a resident without washing their hands. Similarly, residents can spread bad bugs in the same way to each other if they fail to wash their hands after they become contaminated. When a resident is found to be colonized or infected with a bad bug, a delicate balance is required to protect the residents quality of life, while protecting other residents from getting a bad bug. Let's check back at Sunnyside to see how they managed this delicate balance. >> Previously on Gowns & Gloves, nurse Priscilla breaks the news to Mr.Houston that his wife has been exposed and colonized with MRSA. Will Elaine become infected with MRSA? And what's going on between Dimitri and Priscilla? Find out on Gowns & Gloves. [MUSIC] [SOUND] >> Hi, I'm Vanessa. Priscilla's with another resident. She asked me to come in and talk to Mrs. Houston about the precautions that we'll be taking to help control the spread of MRSA here at Sunny Side. You're currently on standard precautions which is what we use for everyone here at the facility. >> We noticed when we were moved down here a lot of people had carts outside their rooms and signs on their doors. >> Yes, those residents have been placed under contact precautions. We use contact precautions for residents with infections from bacteria like MRSA to help control the spread between residents. I can't tell you about their specifics, but that is what those signs and carts indicate. >> I don't understand this scene at all. Why don't I have one of those signs or carts outside my room? >> At the moment your character is colonized, which means that you have the MRSA bacteria on your skin and in your nose. You don't have an active infection like some of the other residents. That's why it's not necessary right now. >> For you to be put on contact precautions, and put a sign on the door. See, the main thing is that the staff wear gloves, practice good hand hygiene, and never share personal items between residents. >> So, what do I do now that I'm colonized? Well Vanessa will be relaying all the information for what your character is to do. Again, the main thing is to practice good hand hygiene. Wash with antiseptic soap and water or an FDA approved alcohol-based hand gel. >> Great, good hand hygiene, I get that. Now, we ready, action. >> Mrs.Houston, since you're on stand up precaution, all staff will need to wear gloves when providing care for you, and wash their hands before, and after caring for you. If you see us and we're not washing our hands or using an alcohol based hand gel, you need to remind us. You two, both of you need to make sure that you wash your hands before leaving the room, and after you return to it. >> This is painful, I feel as though I'm being punished. And what happens If I want to have visitors or leave the room. >> Right now there is no restriction on your movement throughout the facility. Just make sure you wash your hands before you leave the room and before you participate in any activity. The same rules apply to you too Mr. Houston. Is there anything else I can help you out with? >> No, I just wish Priscilla were here. >> Elaine, that is so rude. >> But, I still feel that I'm being punished. I'm being penalized for something that I'm not responsible for. Please leave. >> But Mrs. Hughes. >> I said, get out! [MUSIC] I can't be isolated at the end of this hall. It ruins our plan. >> Not so fast, darling. We could use this to our advantage. Yes, it's me. [MUSIC]
