The Importance of Ventilator Skilled Nursing Facilities (vSNFs) in the Regional Epidemiology of Carbapenemase-Producing Organisms (CPOs)

Lin, Michael; Froilan, Mary Carl; Lolans, Karen; Bell, Pamela; Wirth, David A.; Kemble, Sarah K.; Pacilli, Massimo; Black, Stéphanie; Jegede, Olufemi; Runningdeer, Erica; Tang, Angela S; Alu, Chinyere; Slayton, Rachel B.; Fiore, Anthony E.; Jernigan, John A.; Trick, William; Weinstein, Robert A.; Hayden, Mary K

doi:10.1093/ofid/ofx163.204

Cited by 7 publications

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“…Lin and colleagues investigated the prevalence of carbapenemase-producing organisms (CPO) in ventilator skilled nursing facilities (vSNFs). 7 Across 7 vSNFs, the overall prevalence of CPO carriage was found to be 27%, significantly higher in ventilator wards (40%) compared to skilled wards (10%), P < 0.001. The investigators concluded that individuals residing in SNFs face increased susceptibility to CPO carriage, with the greatest vulnerability for those residing in a ventilator ward.…”

Section: Discussionmentioning

confidence: 85%

Stratifying nursing home care to further explore a locally validated risk factor for community-acquired pneumonia (SNAP-CAP Study)

Kutsar,

Awad,

Rastogi

2023

ASHE

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Section: Discussionmentioning

confidence: 85%

Stratifying nursing home care to further explore a locally validated risk factor for community-acquired pneumonia (SNAP-CAP Study)

Kutsar,

Awad,

Rastogi

2023

ASHE

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“…In the Chicago metropolitan region, the method selected LTACHs and vSNFs, which care for high-acuity patients, have longer LOS and greater bed size, and are highly connected to other facilities. These facility types have been identified to be important to CRE dissemination in Chicago [23][24][25][26]. Choosing facilities by combining metrics provided substantial benefits in both participating and nonparticipating facilities.…”

Section: Targeting Facilities By a Combination Of Metricsmentioning

confidence: 99%

How to Choose Target Facilities in a Region to Implement Carbapenem-resistant Enterobacteriaceae Control Measures

Lee

Bartsch

Hayden

et al. 2020

Clinical Infectious Diseases

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Background When trying to control regional spread of antibiotic-resistant pathogens such as carbapenem-resistant Enterobacteriaceae (CRE), decision makers must choose the highest-yield facilities to target for interventions. The question is, with limited resources, how best to choose these facilities. Methods Using our Regional Healthcare Ecosystem Analyst–generated agent-based model of all Chicago metropolitan area inpatient facilities, we simulated the spread of CRE and different ways of choosing facilities to apply a prevention bundle (screening, chlorhexidine gluconate bathing, hand hygiene, geographic separation, and patient registry) to a resource-limited 1686 inpatient beds. Results Randomly selecting facilities did not impact prevalence, but averted 620 new carriers and 175 infections, saving $6.3 million in total costs compared to no intervention. Selecting facilities by type (eg, long-term acute care hospitals) yielded a 16.1% relative prevalence decrease, preventing 1960 cases and 558 infections, saving $62.4 million more than random selection. Choosing the largest facilities was better than random selection, but not better than by type. Selecting by considering connections to other facilities (ie, highest volume of discharge patients) yielded a 9.5% relative prevalence decrease, preventing 1580 cases and 470 infections, and saving $51.6 million more than random selection. Selecting facilities using a combination of these metrics yielded the greatest reduction (19.0% relative prevalence decrease, preventing 1840 cases and 554 infections, saving $59.6 million compared with random selection). Conclusions While choosing target facilities based on single metrics (eg, most inpatient beds, most connections to other facilities) achieved better control than randomly choosing facilities, more effective targeting occurred when considering how these and other factors (eg, patient length of stay, care for higher-risk patients) interacted as a system.

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“…Ventilator-capable skilled nursing facilities (vSNFs) are influential in the regional epidemiology of antimicrobial resistance. [1][2][3] Such specialized facilities care for a distinct resident population that requires chronic respiratory care such as mechanical ventilation, and vSNFs contribute increasingly to the regional spread of multidrug-resistant organisms (MDROs) such as carbapenem-resistant Enterobacterales (CRE) and Candida auris. 4 However, the optimal methods to control MDRO transmission in vSNFs, and the human factors that impact the implementation of such methods, remain unclear.…”

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confidence: 99%

Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility—A qualitative analysis

Rynkiewich

Makhija

Froilan

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: Ventilator-capable skilled nursing facilities (vSNFs) are critical to the epidemiology and control of antibiotic-resistant organisms. During an infection prevention intervention to control carbapenem-resistant Enterobacterales (CRE), we conducted a qualitative study to characterize vSNF healthcare personnel beliefs and experiences regarding infection control measures. Design: A qualitative study involving semistructured interviews. Setting: One vSNF in the Chicago, Illinois, metropolitan region. Participants: The study included 17 healthcare personnel representing management, nursing, and nursing assistants. Methods: We used face-to-face, semistructured interviews to measure healthcare personnel experiences with infection control measures at the midpoint of a 2-year quality improvement project. Results: Healthcare personnel characterized their facility as a home-like environment, yet they recognized that it is a setting where germs were ‘invisible’ and potentially ‘threatening.’ Healthcare personnel described elaborate self-protection measures to avoid acquisition or transfer of germs to their own household. Healthcare personnel were motivated to implement infection control measures to protect residents, but many identified structural barriers such as understaffing and time constraints, and some reported persistent preference for soap and water. Conclusions: Healthcare personnel in vSNFs, from management to frontline staff, understood germ theory and the significance of multidrug-resistant organism transmission. However, their ability to implement infection control measures was hampered by resource limitations and mixed beliefs regarding the effectiveness of infection control measures. Self-protection from acquiring multidrug-resistant organisms was a strong motivator for healthcare personnel both outside and inside the workplace, and it could explain variation in adherence to infection control measures such as a higher hand hygiene adherence after resident care than before resident care.

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The Importance of Ventilator Skilled Nursing Facilities (vSNFs) in the Regional Epidemiology of Carbapenemase-Producing Organisms (CPOs)

Cited by 7 publications

References 0 publications

Stratifying nursing home care to further explore a locally validated risk factor for community-acquired pneumonia (SNAP-CAP Study)

Stratifying nursing home care to further explore a locally validated risk factor for community-acquired pneumonia (SNAP-CAP Study)

How to Choose Target Facilities in a Region to Implement Carbapenem-resistant Enterobacteriaceae Control Measures

Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility—A qualitative analysis

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