Staph in Nursing Homes: Questions Families Should Ask

Why staph is common in nursing homes

Nursing homes bring together people who need a lot of hands-on help. Many residents have wounds or use medical devices, and staff move from room to room helping with bathing, dressing and toileting.¹ That close care is exactly how germs can travel.

The CDC says more than half of nursing home residents may carry a multidrug-resistant germ, such as MRSA.¹ Most of them have no symptoms, so you can’t tell who carries it just by looking. That is why the CDC asks facilities to use some precautions based on each resident’s risk, not only on known infections.¹

What the gowns and gloves mean

You may notice staff putting on a gown and gloves before they help your loved one. That often means the facility is using Enhanced Barrier Precautions. This CDC approach calls for gowns and gloves during close care, such as bathing, dressing, moving a resident, changing linens, helping with the toilet, and caring for wounds or devices.¹

These precautions apply to residents who have a wound or a medical device, or who carry or are infected with a resistant germ.¹ They are not a punishment, and they don’t mean your loved one must stay in their room. Residents under these precautions can still join group activities.¹ Stricter “contact precautions” are used in some other cases, so ask staff which kind applies and why.

Basic infection control, like hand cleaning, applies to every resident, whether or not they carry a germ.¹ So you should see staff clean their hands between residents, even when no gown is in sight.

Questions to ask the nursing home

Federal rules require nursing homes to run an infection prevention and control program, with at least one trained infection preventionist who works at the facility at least part time.² They also need an antibiotic stewardship program to track how antibiotics are used.² Good questions to ask:

• Who is your infection preventionist, and how can I reach them?
• How do you let families know when a resident has MRSA or another resistant germ?
• When do staff wear gowns and gloves, and why?
• How often do you check wounds, catheters and other devices, and how do you decide when a device can come out?
• How do you handle and wash residents’ laundry and linens?
• How do staff spot infections early in residents who can’t describe how they feel?
• Where can staff and visitors clean their hands near each room?

You can also look up a facility’s health inspection results on Medicare’s Care Compare website, whether you’re choosing a home or checking on the one you have.⁶

When you visit

The CDC says the chance of catching MRSA while visiting someone who has it is very low.⁴ A few simple habits keep it that way:

• Clean your hands when you walk into the room and again when you leave.⁴
• Ask staff whether you should wear a gown or gloves.⁴
• Stay home if you’re sick or have an open skin infection.
• Label your loved one’s own towels, razors and combs, and keep them out of shared spaces.
• Speak up. It’s okay to ask a nurse or aide to clean their hands before they care for your loved one.³

Our guide to hand hygiene for caregivers covers when to use soap and when sanitizer is enough.

When to see a doctor

In older adults, infections don’t always cause a fever. They may show up as new confusion, a fall, eating or drinking less, or trouble with daily tasks.⁵ Ask the nurse to have your loved one checked by a doctor if you notice:

• New or worse confusion, sleepiness or weakness⁵
• A fall, or a sudden change in what they can do for themselves⁵
• Eating or drinking much less than usual⁵
• Redness, swelling, warmth or drainage around a wound or device⁴
• A fever or chills

If your loved one has trouble breathing, is very hard to wake, or has a fever with fast-spreading redness, ask staff to call 911, or call yourself. You know your family member best, so trust it when something seems off. Mention small changes, too. You know what’s normal for your loved one, so you may notice things a busy shift can miss.

Working with the care team

Staff are your partners, and good questions help everyone. Bring your questions in writing, keep a short list of your loved one’s conditions, medicines and devices, and ask for a meeting with the care team if a worry keeps coming up. Write down who you spoke with and what they said.

For more on warning signs at any stage of later life, read our guide to staph and MRSA in older adults.