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

McKinnell, James A.; Miller, Loren G.; Singh, Raveena; Gussin, Gabrielle; Kleinman, Ken; Mendez, Job; Laurner, Bryn; Catuna, Tabitha D.; Heim, Lauren; Saavedra, Raheeb; Felix, James; Torres, Crystal; Chang, Julia Yu Fong; Estevez, Marlene; Mendez, Joanna; Tchakalian, Gregory; Bloomfield, Leah; Ceja, Sandra; Franco, Ryan; Miner, Aaron; Hurtado, Aura; Hean, Ratharo; Varasteh, Alex; Robinson, Philip A.; Park, Steven; Tam, Steven; Tjoa, Thomas; He, Jiayi; Agrawal, Shalini; Yamaguchi, Stacey; Custodio, Harold; Nguyen, Jenny; Bittencourt, Cassiana E.; Evans, Kaye; Mor, Vincent; McConeghy, Kevin W.; Weinstein, Robert A.; Hayden, Mary K.; Stone, Nimalie D.; Steinberg, Karl; Beecham, Nancy; Montgomery, Jocelyn; Walters, DeAnn; Peterson, Ellena M.; Huang, Susan S.

doi:10.1016/j.jamda.2020.04.007

Cited by 29 publications

(23 citation statements)

References 29 publications

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“…Previous studies have conducted point prevalence studies among several nursing homes in California and found the prevalence of ESBL were about 34% and 16%, respectively. 1,2 In 2014, there were~15,600 nursing facilities with 1.7 million beds in the United States. 3 Of each 5 hospital stays covered by Medicare, 1 resulted in a discharge to a nursing home.…”

mentioning

confidence: 99%

Association between level of care and colonization with resistant gram-negative bacteria among nursing-home residents

Adediran

Sethuraman

Leekha

et al. 2021

Infect. Control Hosp. Epidemiol.

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confidence: 99%

Association between level of care and colonization with resistant gram-negative bacteria among nursing-home residents

Adediran

Sethuraman

Leekha

et al. 2021

Infect. Control Hosp. Epidemiol.

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“…Sensitivity analyses varied this probability from 18% to 42%. For agents in nursing homes, the baseline probability was lower at 3% because of differences in the quality and frequency of bathing (eg, lower staff to resident ratio or bathing 3 days per week) and resident characteristics (eg, comorbidities, indwelling devices, wounds, or bedbound status) that made it more difficult to clear colonization, 32 and this probability was applied to each decolonization round (eg, every other week). Sensitivity analyses varied this probability from 1% to 16.7%.…”

Section: Choosing Potential Interventionsmentioning

confidence: 99%

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

et al. 2021

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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 RELEVANCEThe findings of this study highlight the ways in which modeling can inform design of regional interventions and suggested that decolonization would be the best (continued) Key Points Question Which multidrug-resistant organism (MDRO) intervention is best to implement in a set of health care facilities to reduce the spread of MDROs regionwide? Findings In this computational simulation modeling study...

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“…Hospitals and long-term care facilities (LTCF) are open institutions with many new admissions and discharges. The risk factors for Clostridioides difficile and the MDROs including meticillin-resistant Staphylococcus (MRSA), vancomycin-resistant enterococcus (VRE), multidrug-resistant Acinetobacter, resistant Gram-negative bacilli and extended spectrum beta-lactamase (R-GNB and ESBL) organisms and healthcare-acquired infections (HAIs) are exposure in a hospital or LTCF environment contaminated with these pathogens, especially a room previously occupied by an infected or carrier patient [1], age 65 and older, multimorbidity, higher severity of illnesses, and length of hospital stay [2]. Influenza and RSV have been key viral infections of concern in medical institutions for seniors and are now joined by SARS-CoV-2.…”

Section: Introductionmentioning

confidence: 99%

“…MDRO carriage was found in 627 (45%, range 24% to 67%) patients that were previously unknown. Environmental colonisation, found in 74% of resident rooms and 93% of common areas, was assessed in each LTCF by sampling five objects in common areas (nursing station cart, table, chair, hallway handrail, and drinking fountain) and five or more objects in three resident rooms (bedside table, bedrail, call button, TV remote, door-knobs, light switch, bathroom sink and rail and flush handle) and MDROs were found in 74% of resident rooms and 93% of common areas [2].…”

Section: Introductionmentioning

confidence: 99%

Cleaning and disinfecting surfaces in hospitals and long-term care facilities for reducing hospital and facility-acquired bacterial and viral infections: A systematic review

Thomas¹,

Conly

Lorenzetti

2021

Preprint

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Background: Multiply drug-resistant organisms (MDROs) in hospitals and long-term care facilities (LTCFs) of particular concern include meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus, multidrug-resistant Acinetobacter species and extended spectrum beta-lactamase producing organisms. Respiratory viruses include influenza and SARS-CoV-2. Aim: To assess effectiveness of cleaning and disinfecting surfaces in hospitals and LTCFs. Methods: CINAHL, Cochrane CENTRAL Register of Controlled Trials, EMBASE, Medline, and Scopus searched inception to 28 June 2021, no language restrictions, for randomized controlled trials, cleaning, disinfection, hospitals, LTCFs. Abstracts and titles were assessed and data abstracted independently by two authors. Findings: Of fourteen c-RCTs in hospitals and LTCFs, interventions in ten were focused on reducing patient infections of four MDROs and/or healthcare-associated infections (HAIs). In four c-RCTs patient MDRO and/or HAI rates were significantly reduced with cleaning and disinfection strategies including bleach, quaternary ammonium detergents, ultraviolet irradiation, hydrogen peroxide vapour and copper-treated surfaces or fabrics. Of three c-RCTs focused on reducing MRSA rates, one had significant results and one on Clostridioides difficile had no significant results. Heterogeneity of populations, methods, outcomes and data reporting precluded meta-analysis. Overall risk of bias assessment was low but high for allocation concealment, and GRADE assessment was low risk. No study assessed biofilms. Conclusions: Ten c-RCTs focused on reducing multiple MDROs and/or HAIs and four had significant reductions. Three c-RCTs reported only patient MRSA colonization rates (one significant reductions), and one focused on Clostridioides difficile (no significant differences). Standardised primary and secondary outcomes are required for future c-RCTs including detailed biofilm cleaning/disinfection interventions.

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

Cited by 29 publications

References 29 publications

Association between level of care and colonization with resistant gram-negative bacteria among nursing-home residents

Association between level of care and colonization with resistant gram-negative bacteria among nursing-home residents

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

Cleaning and disinfecting surfaces in hospitals and long-term care facilities for reducing hospital and facility-acquired bacterial and viral infections: A systematic review

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