Care institutions, such as hospitals and nursing homes, are places where resistant bacteria can easily develop and spread. For this reason, these institutions have guidelines for the use of antimicrobials and for the care of patients

Patients in care institutions run a greater risk of getting an infection. This is because they usually have health problems, are usually elderly, and/or have had to undergo various treatments or procedures. For this reason, patients like these are often given antimicrobials. As a result, resistant bacteria occur more often in care institutions. The patients in these institutions live in close proximity to one another. This means that these bacteria can easily spread during care-related activities. For this reason, good hygiene is very important. It can help prevent infections, thus cutting the amount of antimicrobials that doctors need to prescribe. That is vital, as infections caused by resistant bacteria can have a serious impact on people with vulnerable health.

  • No-one can obtain antimicrobials without a doctor’s prescription.
  • When prescribing antimicrobials , doctors must follow general guidelines.
  • The staff of care institutions must follow strict general guidelines for hygiene. This will prevent resistant bacteria being transferred from one patient to another.
  • Any patients in hospitals or nursing homes who are infected with a resistant bacterium must be cared for in isolation. In these cases, the nursing staff will apply strict hygiene measures.

Resistance in nursing homes

On the instructions of the Dutch Ministry of Health, Welfare and Sport, RIVMNational Institute for Public Health and the Environment carried out research into the occurrence of bacteria that are not susceptible to antimicrobials (resistant bacteria) in nursing homes. This was because people suspected that resistance is common in this sector. The research showed that nursing homes have antimicrobial resistance under control. We know that this is an ongoing threat, so it is important that we continue to focus on effective hygiene measures.

Results

The research spotlighted two types of resistant intestinal bacteria (ESBL and CPE). It showed that no CPE was found in any of the Dutch nursing homes that participated in this research. That is very good news, because there are very few antimicrobials that can be used to treat infections with this bacterium. One third of these nursing homes were found to have higher than average levels of ESBL bacteria. Further research at these homes showed that half of them needed to implement extra hygiene measures. A total of 4,420 clients in 159 nursing homes participated in the research.

The One Health approach

It is important to understand the situation in the nursing home sector, with regard to antimicrobial resistance. Thanks to this work, we now have a complete picture of the situation here in the Netherlands. Resistant bacteria are found everywhere – in the healthcare system, in animals, in food, in the environment, in innovative systems, and in every country in the world. This calls for an integrated approach (One Health). In the Netherlands, we are taking steps to effectively fight antimicrobial resistance in all these areas.