Dataset Information

High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An "Iceberg Effect".

ABSTRACT: Objective: Determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBLs), and carbapenem-resistant Enterobacteriaceae (CRE) among residents and in the environment of nursing homes (NHs).

Design: Point prevalence sampling of residents and environmental sampling of high-touch objects in resident rooms and common areas.

Setting: Twenty-eight NHs in Southern California from 2016 to 2017.

Participants: NH participants in Project PROTECT, a cluster-randomized trial of enhanced bathing and decolonization vs routine care.

Methods: Fifty residents were randomly sampled per NH. Twenty objects were sampled, including 5 common room objects plus 5 objects in each of 3 rooms (ambulatory, total care, and dementia care residents).

Results: A total of 2797 swabs were obtained from 1400 residents in 28 NHs. Median prevalence of multidrug-resistant organism (MDRO) carriage per NH was 50% (range: 24%-70%). Median prevalence of specific MDROs were as follows: MRSA, 36% (range: 20%-54%); ESBL, 16% (range: 2%-34%); VRE, 5% (range: 0%-30%); and CRE, 0% (range: 0%-8%). A median of 45% of residents (range: 24%-67%) harbored an MDRO without a known MDRO history. Environmental MDRO contamination was found in 74% of resident rooms and 93% of common areas.

Conclusions and implications: In more than half of the NHs, more than 50% of residents were colonized with MDROs of clinical and public health significance, most commonly MRSA and ESBL. Additionally, the vast majority of resident rooms and common areas were MDRO contaminated. The unknown submerged portion of the iceberg of MDRO carriers in NHs may warrant changes to infection prevention and control practices, particularly high-fidelity adoption of universal strategies such as hand hygiene, environmental cleaning, and decolonization.

SUBMITTER: McKinnell JA

PROVIDER: S-EPMC7708431 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An "Iceberg Effect".

McKinnell James A JA Miller Loren G LG Singh Raveena D RD Gussin Gabrielle G Kleinman Ken K Mendez Job J Laurner Bryn B Catuna Tabitha D TD Heim Lauren L Saavedra Raheeb R Felix James J Torres Crystal C Chang Justin J Estevez Marlene M Mendez Joanna J Tchakalian Gregory G Bloomfield Leah L Ceja Sandra S Franco Ryan R Miner Aaron A Hurtado Aura A Hean Ratharo R Varasteh Alex A Robinson Philip A PA Park Steven S Tam Steven S Tjoa Thomas T He Jiayi J Agrawal Shalini S Yamaguchi Stacey S Custodio Harold H Nguyen Jenny J Bittencourt Cassiana E CE Evans Kaye D KD Mor Vincent V McConeghy Kevin K Weinstein Robert A RA Hayden Mary K MK Stone Nimalie D ND Steinberg Karl K Beecham Nancy N Montgomery Jocelyn J DeAnn Walters W Peterson Ellena M EM Huang Susan S SS

Journal of the American Medical Directors Association 20200616 12

<h4>Objective</h4>Determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBLs), and carbapenem-resistant Enterobacteriaceae (CRE) among residents and in the environment of nursing homes (NHs).<h4>Design</h4>Point prevalence sampling of residents and environmental sampling of high-touch objects in resident rooms and common areas.<h4>Setting</h4>Twenty-eight NHs in Southern ...[more]

PMID: 32553489

Similar Datasets

Project description:ImportanceMultidrug-resistant organisms (MDROs) can cause significant morbidity and mortality. Preventing MDROs can reduce the risk of subsequent transmission and infection.ObjectiveTo determine whether a multicomponent infection prevention intervention can reduce MDRO prevalence in nursing homes (NHs).Design, setting, and participantsThis cluster randomized clinical trial of a multicomponent intervention was conducted in 6 NHs in Michigan from September 2016 to August 2018. Three NHs adopted a multicomponent intervention, while 3 control NHs continued without investigator intervention. Study visits were conducted at baseline; days 7, 14, 21, and 30; and monthly thereafter for up to 6 months or discharge. Visits included clinical data collection and MDRO surveillance culturing of multiple body sites and high-touch surfaces in patient rooms. Any patients who provided informed consent within 14 days of admission to the NH were enrolled in this study. Non-English speakers and patients receiving hospice care were ineligible. Analysis was performed from November 2018 to February 2020.InterventionsIntervention NHs adopted a multicomponent intervention that included enhanced barrier precautions, chlorhexidine bathing, MDRO surveillance, environmental cleaning education and feedback, hand hygiene promotion, and health care worker education and feedback. Control nursing homes continued standard care practices.Main outcomes and measuresThe primary outcome, presence of MDROs, was measured longitudinally in the patient and room environment and was evaluated using generalized mixed effect models. The secondary outcome, time to new MDRO acquisition, was assessed using Cox proportional hazard models.ResultsA total of 6 NHs were included, with 245 patients (mean [SD] age, 72.5 [13.6] years; 134 [54.7%] women) enrolled; 3 NHs with 113 patients (46.1%) were randomized to the intervention group and 3 NHs with 132 patients (53.9%) were randomized to the control group. A total of 132 patients (53.9%) were White, and 235 patients (95.9%) were receiving postacute care. Over 808 study visits, 3654 patient cultures and 5606 environmental cultures were obtained. The intervention reduced the odds of MDRO prevalence in patients' environment by 43% (aOR, 0.57; 95% CI, 0.35-0.94), but there was no statistically significant difference on the patient level before or after adjustment (aOR, 0.57; 95% CI, 0.29-1.14). There were no significant reductions in time to new acquisition for methicillin-resistant Staphylococcus aureus (hazard ratio [HR], 0.20; 95% CI, 0.04-1.09), vancomycin-resistant enterococci (HR, 0.84; 95% CI, 0.46-1.53), or resistant gram-negative bacilli (HR, 1.14; 95% CI, 0.73-1.78).Conclusions and relevanceThis cluster randomized clinical trial found that the multicomponent intervention reduced the prevalence of MDROs in the environment of NH patients. Our findings highlight the potential for multicomponent interventions to directly and indirectly reduce MDRO prevalence in NHs.Trial registrationClinicalTrials.gov Identifier: NCT02909946.

Dataset Information

High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An "Iceberg Effect".

Publications

High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An "Iceberg Effect".

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets