Impact of Detection, Education, Research and Decolonization without Isolation in Long-term care (DERAIL) on methicillin-resistant Staphylococcus aureus colonization and transmission at 3 long-term care facilities

Schora, Donna; Boehm, Susan; Das, Sanchita; Patel, Parul; OʼBrien, Jennifer; Hines, Carolyn; Burdsall, Deborah; Beaumont, Jennifer L.; Peterson, Kari; Fausone, Maureen; Peterson, Lance R.

doi:10.1016/j.ajic.2014.05.011

Cited by 20 publications

(34 citation statements)

References 11 publications

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“…Our findings also suggest that variation is likely driven by a combination of factors including quality of life perception and prioritisation, limited availability of private rooms, and lack of routine laboratory services and other resources. In particular, the desire among interviewees to balance resident quality of life and infection prevention and control practices was striking and represents a specific challenge to infection reduction in this setting 26. However, the degree to which NH staff are adjusting practice based on perception rather than evidence highlights ambiguity in published infection prevention and control guidelines and an overall lack of infection intervention effectiveness data specific to this setting.…”

Section: Discussionmentioning

confidence: 99%

Infection prevention and control in nursing homes: a qualitative study of decision-making regarding isolation-based practices

et al. 2015

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Background Isolation-based practices in nursing homes (NHs) differ from those in acute care. NHs must promote quality of life while preventing infection transmission. Practices used in NHs to reconcile these goals of care have not been characterized. Purpose To explore decision-making regarding isolation-based infection prevention and control practices in NHs. Methods A qualitative study was conducted with staff (e.g., staff nurses, infection prevention directors and directors of nursing) employed in purposefully sampled U.S. NHs. Semi-structured, role-specific interview guides were developed and interviews were digitally recorded, transcribed verbatim and analyzed using directed content analysis. The research team discussed emerging themes in weekly meetings to confirm consensus. Results We inferred from 73 interviews in 10 NHs that there was variation between NHs in practices regarding who was isolated, when isolation-based practices took place, how they were implemented, and how they were tailored for each resident. Interviewees’ decision-making depended on staff perceptions of acceptable transmission risk and resident quality of life. NH resources also influenced decision-making, including availability of private rooms, extent to which staff can devote time to isolation-based practices and communication tools. A lack of understanding of key infection prevention and control concepts was also revealed. Conclusions and Implications Current clinical guidelines are not specific enough to ensure consistent practice that meets care goals and resource constraints in NHs. However, new epidemiological research regarding effectiveness of varying isolation practices in this setting is needed to inform clinical practice. Further, additional infection prevention and control education for NH staff may be required.

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Section: Discussionmentioning

confidence: 99%

Infection prevention and control in nursing homes: a qualitative study of decision-making regarding isolation-based practices

et al. 2015

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“…Less than 1% of the patients or their families in this 'Op-Out design' declined participation. Schora et al have reported that the program significantly reduced MRSA colonization (14). For that analysis the baseline MRSA colonization rate was 16.64%.…”

Section: Resultsmentioning

confidence: 96%

“…The clones (e.g., pulsotypes) are depicted in Table 3. Of interest is that while individual MRSA clones predominated at each facility, they were not the same clone (14). All three of the facilities maintain a close contact with our Infection Control group at the Acute Care organization with two of the three developing a contractual relationship for supervising and managing their Infection Control program.…”

Section: Resultsmentioning

confidence: 99%

Reduction of methicillin-resistant Staphylococcus aureus infection in long-term care is possible while maintaining patient socialization: A prospective randomized clinical trial

Peterson

Boehm

Beaumont

et al. 2016

American Journal of Infection Control

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“…A recent report by Schora et al, demonstrated reduced MRSA colonization prevalence (e.g., less transmission) when only targeted decolonization was used for new admissions to long-term care (31). Another report by Das et al found that targeted decolonization with no isolation prevented MRSA transmission in an inpatient psychiatry unit (32).…”

Section: Discussionmentioning

confidence: 99%

Nonimpact of Decolonization as an Adjunctive Measure to Contact Precautions for the Control of Methicillin-Resistant Staphylococcus aureus Transmission in Acute Care

Peterson

Wright

Beaumont

et al. 2016

Antimicrob Agents Chemother

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gThis was an observational study comparing methicillin-resistant Staphylococcus aureus (MRSA) transmission with no decolonization of medical patients to required decolonization of all MRSA carriers during two consecutive periods: baseline with no decolonization of medical patients (16 months) and universal MRSA carrier decolonization (13 months). The setting was a one-hospital, 156-bed facility with 9,200 annual admissions. Regression models were used to compare rates of MRSA acquisition. The chi-square test was used to compare event frequencies. We used rates of MRSA clinical disease as an outcome monitor of the program. Analysis was done on 15,666 patients who had admission and discharge tests; 27.9% of inpatient days were occupied by a MRSA-positive patient (colonized patient-days) who received decolonization while hospitalized during the baseline period (this 27.9% represented those who had planned surgery) compared to 76.0% during the intervention period (P < 0.0001). The rate of MRSA transmission was 97 events (1.0%) for 9,415 admissions (2.0 transmission events/1,000 patient-days) during baseline and was 87 (1.4%) for 6,251 admissions (2.7 transmission events/1,000 patient-days) during intervention (P ‫؍‬ 0.06; rate ratio, 0.74; 95% confidence interval [CI], 0.55 to 1.00). The MRSA nosocomial clinical disease rate was 5.9 infections/10,000 patient-days in the baseline period and was 7.2 infections/10,000 patient-days for the intervention period (rate ratio, 0.82; 95% CI, 0.46 to 1.45; P ‫؍‬ 0.49). Decolonization of MRSA patients does not add benefit when contact precautions are used for patients colonized with MRSA in acute (hospital) care.

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Impact of Detection, Education, Research and Decolonization without Isolation in Long-term care (DERAIL) on methicillin-resistant Staphylococcus aureus colonization and transmission at 3 long-term care facilities

Cited by 20 publications

References 11 publications

Infection prevention and control in nursing homes: a qualitative study of decision-making regarding isolation-based practices

Infection prevention and control in nursing homes: a qualitative study of decision-making regarding isolation-based practices

Reduction of methicillin-resistant Staphylococcus aureus infection in long-term care is possible while maintaining patient socialization: A prospective randomized clinical trial

Nonimpact of Decolonization as an Adjunctive Measure to Contact Precautions for the Control of Methicillin-Resistant Staphylococcus aureus Transmission in Acute Care

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