Multi-antibiotic Resistance
Conditions
Keywords
multidrug-resistant organisms, nursing home, post-acute care, long-term care, infection control
Brief summary
Multidrug-resistant organisms (MDROs) are endemic in nursing homes (NHs) with prevalence rates surpassing those in hospitals. The aim of the study is to design and evaluate the effectiveness of a multi-component intervention to reduce new acquisition of MDROs in NH residents. The intervention will incorporate resident-level, environmental, and caregiver based strategies. Using a cluster-randomized study design, three NHs will be randomized to the intervention group and three to the control group. Control NHs will be allowed to continue standard infection prevention practices. Nursing homes will serve as the unit of allocation. Analyses will be performed both at the resident and the cluster level. The primary outcomes of the study are reduction in MDRO prevalence, and reduction in new MDRO acquisition .
Detailed description
The NH intervention will incorporate resident-level, environmental, and caregiver based strategies, including: a. Standard precautions and hand hygiene for care of all residents. Enhanced barrier precautions including hand hygiene, glove use, and gown use for healthcare workers (HCW) when providing activities of daily living (ADL) assistance for residents at highest-risk (caregiver intervention); b. Hand hygiene education to residents and families (resident-level intervention); c. Standardized bathing practices including using chlorhexidine-based cloths to reduce resident MDRO colonization (resident-level intervention); d. Standardized environmental protocol and education to reduce contamination on inanimate objects and surfaces (environmental intervention); e. Feedback monthly of facility-level microbial data and new MDRO acquisition rates to infection preventionists, front-line healthcare personnel, and facility leadership (facility intervention).
Interventions
BEHAVIORALMulti-modal Infection Control Program
1. Standard precautions and hand hygiene for care of all residents. Enhanced barrier precautions including hand hygiene, glove use, and gown use for HCW when providing ADL assistance for residents at highest-risk (caregiver intervention). 2. Hand hygiene education to residents and families (resident-level intervention). 3. Standardized bathing practices including using chlorhexidine-based cloths to reduce resident MDRO colonization (resident-level intervention). 4. Standardized environmental protocol and education to reduce contamination on inanimate objects and surfaces (environmental intervention). 5. Feedback monthly of facility-level microbial data and new MDRO acquisition rates to infection control practitioners, HCWs, and facility leadership (facility intervention).
Sponsors
University of Michigan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years old * Residing in a participating NH facility * Provided informed consent for participation
Exclusion criteria
* Receiving end-of-life care * Non-English language speaking
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence density of multidrug-resistant organisms (MDRO) | From enrollment up to 6 months of study followup, or until study withdrawal (discharged from facility, at resident request, death) | Total number of MDROs isolated across all MDROs and all anatomic sites for all enrolled residents over the duration of the study period |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of multidrug-resistant organisms (MDRO) | From enrollment up to 6 months of study followup, or until study withdrawal (discharged from facility, at resident request, death) | Total number of MDROs newly acquired (resident not colonized at baseline) isolated across all MDROs for all enrolled residents over the duration of the study period |
| Incidence of healthcare-associated infections | From enrollment up to 6 months of study followup, or until study withdrawal (discharged from facility, at resident request, death) | Total number of new infections acquired at the nursing home for all enrolled residents over the duration of the study period |
Countries
United States
Outcome results
None listed