Multidrug-resistant organism carriage among residents from residential care homes for the elderly in Hong Kong: a prevalence survey with stratified cluster sampling

Chen, H; Au, Kaoje; Hsu, K E; Lai, Christopher K C; Myint, J; Mak, Y F; Lee, S Y; Wong, Teck Yee; Tsang, Ngai Chong

doi:10.12809/hkmj176949

Cited by 18 publications

(22 citation statements)

References 33 publications

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“…Methicillin-resistant Staphylococcus aureus (MRSA), a common pathogen causing HAIs, is endemic in Hong Kong. The prevalence of MRSA was estimated at 30.1% in Hong Kong RCHs, much higher than those reported in previous studies in 2005 (2.8%) and 2001 (21.6%) [8] [9]. The MRSA transmission was also reported to be more serious in RCHs than in hospitals [10].…”

Section: Introductioncontrasting

confidence: 53%

Observational study of compliance with infection control practices among healthcare workers in subsidized and private residential care homes

Suen

Lam

2020

Preprint

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Background: The elderly population in Hong Kong is rapidly growing, and the need for residential care homes (RCHs) is increasing. The risk of being infected with micro-organisms increases among the frail and the vulnerable elderly population as their immunity system begins to deteriorate. Furthermore, the residents in RCHs are at high risk of healthcare-associated infections (HAIs) due to the confined living environments and individual co-morbidities. In relation to this, infection control practice (ICP) is considered a crucial and effective approach in preventing HAIs. This study aimed to observe the daily ICP of healthcare workers in RCH settings.Methods: An observational study was conducted to observe daily ICP among healthcare workers in private and subsidized RCHs. Each RCH was separated into different units based on the location (common area and bedroom area) and nature of residents for successive days. The ICP episodes were observed until 200 opportunities in each unit. The ICP episodes were recorded by an electronic tool called “eRub,” which is an ICP checklist based on international guidelines.Results: The most frequent observed ICP episodes were hand hygiene (n=1053), the use of gloves (n=1053) and respiratory protection (n=1053). The overall compliance of hand hygiene was poor, with only 15% of participants performing this during the “five moments for hand hygiene.” Furthermore, the observations showed that 77.9% improperly performed the use of gloves, and 31.8% failed to wear a mask during the care provision for the elderly. However, the results showed that most healthcare workers can wear the mask in a proper way when they should. Generally, the personal care workers were the worst in terms of hand hygiene and use of gloves compared with the other types of healthcare workers. Conclusions: Despite the fact that the practice of hand hygiene, the use of gloves, and respiratory protection were the important elements of ICP, overall compliance to these elements was still poor. Personal care workers had the most frequent contact with the residents, but they had the worst compliance rate. Hence, continued monitoring and training among healthcare workers is needed, particularly personal care workers, in this healthcare service setting.

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Section: Introductioncontrasting

confidence: 53%

Observational study of compliance with infection control practices among healthcare workers in subsidized and private residential care homes

Suen

Lam

2020

Preprint

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“…We estimated these two parameters by fitting the mathematical transmission model to the prevalence data. Four MRSA point-prevalence rates and their 95% confidence interval (CI) of nursing homes in Hong Kong were identified from prior studies (Table 6) [30,[34][35][36]. We denoted the date of these four point-prevalence rates as Day 1, Day 108, Day 1600, and Day 2239.…”

Section: Parameter Estimationmentioning

confidence: 99%

Synergistic Effect of Combination Interventions for Methicillin-Resistant Staphylococcus aureus Transmission Control in Nursing Homes: A Computation Modelling Evaluation with Heterogeneous Contact Mixing

et al. 2021

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The endemic threat of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes poses a serious and escalating challenge to public health administration in infection control. Nursing homes are considered as major reservoirs for MRSA colonization, with considerable high levels of colonization prevalence. We employed a computation model to evaluate effects of three intervention scenarios on MRSA colonization prevalence rate in nursing homes. Simulations were conducted using a deterministic compartmental model featuring heterogeneous contact matrix between residents and health-care workers (HCWs). Contact parameters were derived from a nursing home survey. Three intervention scenarios were simulated: (1) hand-hygiene compliance by HCWs, (2) screening-and-isolation upon admission, and (3) implementing both interventions at the same time. For every 10% reduction in average contamination duration in HCWs, the estimated average reduction in prevalence rate was 1.29 percentage point compared with the prevalence rate before the intervention was implemented. Screening-and-isolation intervention resulted in an average reduction of 19.04 percentage point in prevalence rate (S.D. = 1.58; 95% CI = 18.90–19.18). In intervention scenario 3, synergistic effects were observed when implementing hand-hygiene compliance by HCWs and screening-and-isolation together. Our results provide evidence showing that implementing multiple interventions together has a synergistic effect on colonization prevalence reduction.

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“…We estimated these two parameters by tting the mathematical transmission model to the prevalence data. Four MRSA point-prevalence rates and their 95% con dence interval (CI) of nursing homes in Hong Kong were identi ed from prior studies (Table 3) [17,[21][22][23]. We denoted the date of these four pointprevalence rates as Day 1, Day 108, Day 1600 and Day 2239.…”

Section: Parameter Estimationmentioning

confidence: 99%

Synergistic Effect of Combination Interventions for Methicillin-resistant Staphylococcus aureus Transmission Control in Nursing Homes: A Computation Modelling Evaluation with Heterogeneous Contact Mixing

Tang

Kwok

Wei

et al. 2020

Preprint

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Background The endemic threat of Methicillin-Resistant Staphylococcus aureus (MRSA) in nursing homes pose a serious and escalating challenge to public health administration in infection control. Nursing homes are considered as major reservoirs for MRSA colonization, with considerable high levels of colonization prevalence. Aim Direct contact is the major transmission mode of MRSA colonization. This study employed a computation model to evaluate the effect of 3 intervention scenarios on MRSA colonization prevalence rate in nursing homes. Methods Simulations were conducted using a deterministic compartmental model featuring heterogeneous contact matrix between residents and health-care workers (HCWs). Contact parameters were derived from a nursing home survey. Three intervention scenarios were simulated: (1) hand-hygiene compliance by HCWs, (2) screening-and-isolation upon admission, and (3) implementing both interventions at the same time. Results For every 10% reduction in average contamination duration in HCWs, the estimated average reduction in prevalence rate is 1.29 percentage point compared with the prevalence rate before the intervention was implemented. Screening-and-isolation intervention results in an average reduction of 19.04 percentage point in prevalence rate (s.d. = 1.58; 95% CI = 18.90-19.18) compared with the prevalence rate before the intervention was implemented. In intervention scenario 3, synergistic effects were observed when implementing hand-hygiene compliance by HCWs and screening-and-isolation together. Conclusion Our results provide quantitative data for nursing home administrators in interventions planning, design, adjustment, effect estimation and comparison.

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Multidrug-resistant organism carriage among residents from residential care homes for the elderly in Hong Kong: a prevalence survey with stratified cluster sampling

Abstract: This survey provided information about multidrug-resistant organism carriage among RCHE residents. This information will enable us to formulate targeted surveillance and control strategies for multidrug-resistant organisms.

Cited by 18 publications

References 33 publications

Observational study of compliance with infection control practices among healthcare workers in subsidized and private residential care homes

Observational study of compliance with infection control practices among healthcare workers in subsidized and private residential care homes

Synergistic Effect of Combination Interventions for Methicillin-Resistant Staphylococcus aureus Transmission Control in Nursing Homes: A Computation Modelling Evaluation with Heterogeneous Contact Mixing

Synergistic Effect of Combination Interventions for Methicillin-resistant Staphylococcus aureus Transmission Control in Nursing Homes: A Computation Modelling Evaluation with Heterogeneous Contact Mixing

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