Dataset Information

Modeling Interventions to Reduce the Spread of Multidrug-Resistant Organisms Between Health Care Facilities in a Region.

ABSTRACT:

Importance

Multidrug-resistant organisms (MDROs) can spread across health care facilities in a region. Because of limited resources, certain interventions can be implemented in only some facilities; thus, decision-makers need to evaluate which interventions may be best to implement.

Objective

To identify a group of target facilities and assess which MDRO intervention would be best to implement in the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, a large regional public health collaborative in Orange County, California.

Design, setting, and participants

An agent-based model of health care facilities was developed in 2016 to simulate the spread of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) for 10 years starting in 2010 and to simulate the use of various MDRO interventions for 3 years starting in 2017. All health care facilities (23 hospitals, 5 long-term acute care hospitals, and 74 nursing homes) serving adult inpatients in Orange County, California, were included, and 42 target facilities were identified via network analyses.

Exposures

Increasing contact precaution effectiveness, increasing interfacility communication about patients' MDRO status, and performing decolonization using antiseptic bathing soap and a nasal product in a specific group of target facilities.

Main outcomes and measures

MRSA and CRE prevalence and number of new carriers (ie, transmission events).

Results

Compared with continuing infection control measures used in Orange County as of 2017, increasing contact precaution effectiveness from 40% to 64% in 42 target facilities yielded relative reductions of 0.8% (range, 0.5%-1.1%) in MRSA prevalence and 2.4% (range, 0.8%-4.6%) in CRE prevalence in health care facilities countywide after 3 years, averting 761 new MRSA transmission events (95% CI, 756-765 events) and 166 new CRE transmission events (95% CI, 158-174 events). Increasing interfacility communication of patients' MDRO status to 80% in these target facilities produced no changes in the prevalence or transmission of MRDOs. Implementing decolonization procedures (clearance probability: 39% in hospitals, 27% in long-term acute care facilities, and 3% in nursing homes) yielded a relative reduction of 23.7% (range, 23.5%-23.9%) in MRSA prevalence, averting 3515 new transmission events (95% CI, 3509-3521 events). Increasing the effectiveness of antiseptic bathing soap to 48% yielded a relative reduction of 39.9% (range, 38.5%-41.5%) in CRE prevalence, averting 1435 new transmission events (95% CI, 1427-1442 events).

Conclusions and relevance

The findings of this study highlight the ways in which modeling can inform design of regional interventions and suggested that decolonization would be the best strategy for the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County.

SUBMITTER: Bartsch SM

PROVIDER: S-EPMC8339938 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Introduction: Multidrug-resistant organisms (MDRO) are a problem in medical facilities, including rehabilitation facilities in Germany. The national recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) for prevention of and dealing with patients affected by MDRO are obligatory in rehabilitation facilities. A survey on the management of patients with MDRO in rehabilitation facilities in the Rhine-Main area is presented below. Materials and methods: The questions from a recently published survey in 45 rehabilitation facilities in 26 European countries (Doherty et al., 2019) were largely adopted unchanged: the type, size, and organization of the facility, availability of guidelines on MDRO, screening and (estimated) prevalence of MDRO, as well as special hygiene measures or restrictions for patients with MDRO. Results: 22 of the 43 institutions contacted participated (58%). All facilities had specific recommendations on how to deal with MDRO and more than 95% had adequate hygiene staff. The facilities encompassed 4,369 beds, with 3,909 (89%) of them in single-bed rooms, and only a few offered 3-bed rooms. About 20% of patients in general rehabilitation and 100% in early neurological rehabilitation are screened on admission. Six (27%) facilities refused to accept patients with MDRO. 40% of the facilities treated these patients in their own room and/or in a separate area. 27% of the facilities prohibited eating in the dining room and participating in hydrotherapy. Only 6 (27%) of the rehabilitation centers indicated that patients with MDRO are allowed to participate in full rehabilitation programs. Discussion: In accordance with the results of Doherty et al. (2019), there were many restrictions for rehabilitation patients with MDRO, indicating considerable need for improvement. Necessary hygiene recommendations to avoid the transmission of MDRO must not lead to rejection of inpatient rehabilitation or to less intensive rehabilitation.

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.