Infrequent Use of Isolation Precautions in Nursing Homes: Implications for an Evolving Population

Mody, Lona; Roghmann, Mary-Claire

doi:10.1111/jgs.14781

Cited by 2 publications

(2 citation statements)

References 20 publications

(43 reference statements)

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“…7 It has been noted that MDRO colonization predisposes nursing home residents to acquiring MDRO infections and becoming septic. 8 –10 Infections caused by MDROs transfer between healthcare settings and are further associated with a higher mortality, while the development of new effective therapeutic agents against MDROs has slowed. 11 –13…”

Section: Introductionmentioning

confidence: 99%

“…7 It has been noted that MDRO colonization predisposes nursing home residents to acquiring MDRO infections and becoming septic. [8][9][10] Infections caused by MDROs transfer between healthcare settings and are further associated with a higher mortality, while the development of new effective therapeutic agents against MDROs has slowed. [11][12][13] While the prevalence of MDRO colonization in nursing homes has been well documented, their impact on cost, hospital length of stay (LOS), intensive care unit (ICU) LOS, mortality, and appropriateness of empiric antimicrobial treatment has not been studied.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital

Aliyu

McGowan

Hussain

et al. 2021

J Intensive Care Med

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Objective: The prevalence of multi-drug resistant organism (MDRO) colonization in nursing home residents has been well documented, but little is known about the impact of MDRO bloodstream infections (BSIs). The aim of this study was to assess the prevalence, cost, and outcomes of MDRO-BSI vs. non-MDRO-BSI among nursing home residents. Design: Retrospective cohort study Setting: 960 bed tertiary academic medical center Patients: Persons ≥18 years old admitted to an acute care tertiary hospital from Skilled Nursing Facilities with a diagnosis of sepsis between 2015 and 2018. Interventions: Retrospective analysis of prevalence and outcomes. Measurements and Main Results: Among patients admitted to the study hospital with a diagnosis of sepsis during the study period, 7% were from nursing homes. The prevalence of MDRO-BSI was 47%. We identified 54 (50%) gram positive BSIs, 48 (45%) gram negative BSI and 5 (5%) fungal BSI. Thirty-one (57%) of the gram-positive infections and 14 (30%) of the gram-negative infections were with MDROs. The prevalence of BSI organisms were Staphylococcus aureus in 24%, Escherichia coli in 14%, Proteus mirabilis in 13%, Staphylococcus epidermidis in 8%, Enterococcus faecalis in 7%, and Klebsiella pneumoniae in 6%. We found that intensive care unit length of stay (7 days vs 5 days, P = .009), direct cost ($13,639 vs $9,922, P = .027), and total cost ($23,752 vs $17,900 P = .032) were significantly higher in patients with MDRO-BSI vs. non-MDRO-BSI. Patients with MDRO-BSI were twice as likely to receive inappropriate empiric antiinfective therapy (31% vs 16%, P = .006) and were more likely to die (49.1% vs 29.6%, P = .049). Conclusion: Nursing home residents have a high prevalence of MDRO-BSI, which is associated with higher risk of receiving inappropriate initial anti-infective therapy, higher cost, higher ICU LOS, and higher mortality. Our research adds new information about the prevalence of fungemia in this population.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital

Aliyu

McGowan

Hussain

et al. 2021

J Intensive Care Med

View full text Add to dashboard Cite

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Development and Validation of a Clinical Prediction Rule to Predict Transmission of Methicillin-Resistant Staphylococcus aureus in Nursing Homes

Jackson

Lydecker

Magder

et al. 2018

American Journal of Epidemiology

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The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among nursing home residents is high. Health-care workers (HCWs) often serve as a vector in MRSA transmission. The ability to identify residents who are likely to transmit MRSA to HCWs’ hands and clothing during clinical care is important so that infection control measures, such as Contact Precautions, can be employed. Using data on demographic and clinical characteristics collected from residents of community nursing homes in Maryland and Michigan between 2012 and 2014, we developed a clinical prediction rule predicting the probability of MRSA transmission to HCWs’ gowns. We externally validated this model in a cohort of Department of Veterans Affairs nursing home residents from 7 states between 2012 and 2016. The prediction model, which included sex, race, resident dependency on HCWs for care, the presence of any medical device, diabetes mellitus, and chronic skin breakdown, showed good performance (C statistic = 0.70; sensitivity = 76%, specificity = 49%) in the development set. The decision curve analysis indicated that this model has greater clinical utility than use of a nares surveillance culture for MRSA colonization, which is current clinical practice for placing hospital inpatients on Contact Precautions. The prediction rule demonstrated less utility in the validation cohort, suggesting that a separate rule should be developed for residents of Veterans Affairs nursing homes.

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Infrequent Use of Isolation Precautions in Nursing Homes: Implications for an Evolving Population

Cited by 2 publications

References 20 publications

Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital

Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital

Development and Validation of a Clinical Prediction Rule to Predict Transmission of Methicillin-Resistant Staphylococcus aureus in Nursing Homes

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