One in three of Hong Kong’s elderly care home residents carries MRSA superbug – three times the rate in Shanghai

Hong Kong’s elderly care homes are a hotbed of the superbug MRSA, with close to a third of residents found carrying it in a new study, spurring calls for the institutions to improve infection control.

The study, published in the latest issue of the Hong Kong Medical Journal, found that about 30 per cent of elderly people at residential care homes in Kowloon City carried Methicillin-resistant Staphylococcus aureus (MRSA), a superbug common in Hong Kong.

MRSA can cause severe problems such as bloodstream infections and pneumonia. It is commonly found in health care facilities and was described in the study as placing “a substantial burden” on health care resources. Long-term care facilities, where residents might frequently use antibiotics and be in hospital for prolonged periods, provide a favourable environment for the growth of superbugs.

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In the latest study, led by Dr Chen Hong from the Centre for Health Protection, 1,028 residents from 20 elderly care homes were covered. Samples such as nasal or rectal swabs were collected from them from September to December 2015 and tested for four types of superbug.

The median length of stay for respondents in those care homes was 1.8 years. More than half of them had been in hospital and used antibiotics in the previous 12 months.

The study described a high prevalence of MRSA among elderly care home residents, with 30.1 per cent of respondents found to be carriers, a rate similar to another survey done at elderly care homes on Hong Kong Island.

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But the study’s authors said the figure in Hong Kong was higher than that in nursing home studies done in Britain, which had a rate of 4.7 per cent, and Shanghai, which had a rate of 10.6 per cent.

However, only three residents were found with multidrug-resistant Acinetobacter (MDRA). No respondents were found with Vancomycin-resistant Enterococcus (VRE) or carbapenemase-producing Enterobacteriaceae (CPE), known as “enemy No 1” to medical experts.

The study also noted that residents of privately run care homes were more likely to carry MRSA than those from non-private, or government-subsidised, homes.

The authors said that could be due to privately run care homes being “more resource-limited, as reflected by the typically lower staff-to-residents ratio”.

Dr Chen said: “The present study is like taking a photo to understand the situation of multidrug-resistant organisms in residential care homes. We hope to explore in future studies why the rates of MRSA in some care homes were higher and some were lower.”

The authors called for stronger measures against infection.

“Enhanced infection control is important to mitigate further increases in multidrug-resistant organisms’ prevalence in residential care homes for the elderly,” the study stated.

Some of the suggested measures included cleaning hands when handling patients’ food or medication, and regular disinfection of areas frequently touched by residents.

Grace Li Fai, chairwoman of the Elderly Services Association of Hong Kong, said every care home was required to have two infection control officers. She said the government also gave subsidies to care homes if specific types of superbug – not including MRSA – were found there.

She said eligibility for subsidies could be widened.

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“Criteria for the subsidy should not be limited to a few types of superbug only,” she said. “For example, the requirement of personal protective equipment against MRSA is the same as other types of superbug.”

She said such help would be good for care homes, especially the privately run ones, with fewer resources.