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Effectiveness of a Multicomponent Intervention to Reduce Multidrug-Resistant Organisms in Nursing Homes
- Source :
- JAMA Network Open
- Publication Year :
- 2021
- Publisher :
- American Medical Association (AMA), 2021.
-
Abstract
- Key Points Question What is the effect of a multicomponent infection prevention intervention on multidrug-resistant organisms in nursing homes? Findings In this cluster randomized clinical trial of 6 nursing homes, including 245 patients, a multicomponent intervention consisting of enhanced barrier precautions, chlorhexidine bathing, microbial surveillance, and staff engagement statistically significantly reduced the odds of multidrug-resistant organism contamination in patients’ environments. Meaning These findings suggest that multicomponent interventions can be tailored to reduce multidrug-resistant organisms burden and transmission potential in nursing homes.<br />This cluster randomized clinical trial examines the effectiveness of a multicomponent infection prevention intervention for multidrug resistant organisms in nursing homes.<br />Importance Multidrug-resistant organisms (MDROs) can cause significant morbidity and mortality. Preventing MDROs can reduce the risk of subsequent transmission and infection. Objective To determine whether a multicomponent infection prevention intervention can reduce MDRO prevalence in nursing homes (NHs). Design, Setting, and Participants This cluster randomized clinical trial of a multicomponent intervention was conducted in 6 NHs in Michigan from September 2016 to August 2018. Three NHs adopted a multicomponent intervention, while 3 control NHs continued without investigator intervention. Study visits were conducted at baseline; days 7, 14, 21, and 30; and monthly thereafter for up to 6 months or discharge. Visits included clinical data collection and MDRO surveillance culturing of multiple body sites and high-touch surfaces in patient rooms. Any patients who provided informed consent within 14 days of admission to the NH were enrolled in this study. Non-English speakers and patients receiving hospice care were ineligible. Analysis was performed from November 2018 to February 2020. Interventions Intervention NHs adopted a multicomponent intervention that included enhanced barrier precautions, chlorhexidine bathing, MDRO surveillance, environmental cleaning education and feedback, hand hygiene promotion, and health care worker education and feedback. Control nursing homes continued standard care practices. Main Outcomes and Measures The primary outcome, presence of MDROs, was measured longitudinally in the patient and room environment and was evaluated using generalized mixed effect models. The secondary outcome, time to new MDRO acquisition, was assessed using Cox proportional hazard models. Results A total of 6 NHs were included, with 245 patients (mean [SD] age, 72.5 [13.6] years; 134 [54.7%] women) enrolled; 3 NHs with 113 patients (46.1%) were randomized to the intervention group and 3 NHs with 132 patients (53.9%) were randomized to the control group. A total of 132 patients (53.9%) were White, and 235 patients (95.9%) were receiving postacute care. Over 808 study visits, 3654 patient cultures and 5606 environmental cultures were obtained. The intervention reduced the odds of MDRO prevalence in patients’ environment by 43% (aOR, 0.57; 95% CI, 0.35-0.94), but there was no statistically significant difference on the patient level before or after adjustment (aOR, 0.57; 95% CI, 0.29-1.14). There were no significant reductions in time to new acquisition for methicillin-resistant Staphylococcus aureus (hazard ratio [HR], 0.20; 95% CI, 0.04-1.09), vancomycin-resistant enterococci (HR, 0.84; 95% CI, 0.46-1.53), or resistant gram-negative bacilli (HR, 1.14; 95% CI, 0.73-1.78). Conclusions and Relevance This cluster randomized clinical trial found that the multicomponent intervention reduced the prevalence of MDROs in the environment of NH patients. Our findings highlight the potential for multicomponent interventions to directly and indirectly reduce MDRO prevalence in NHs. Trial Registration ClinicalTrials.gov Identifier: NCT02909946
- Subjects :
- Male
Methicillin-Resistant Staphylococcus aureus
Michigan
medicine.medical_specialty
Bathing
media_common.quotation_subject
Psychological intervention
Health Promotion
law.invention
Randomized controlled trial
Informed consent
Hygiene
law
Drug Resistance, Multiple, Bacterial
Health care
Disease Transmission, Infectious
medicine
Cluster Analysis
Homes for the Aged
Humans
Infection control
Hand Hygiene
Aged
Original Investigation
media_common
Aged, 80 and over
Cross Infection
Infection Control
business.industry
Research
Chlorhexidine
Hazard ratio
Baths
Bacterial Infections
General Medicine
Staphylococcal Infections
Nursing Homes
Online Only
Infectious Diseases
Emergency medicine
Female
business
Subjects
Details
- ISSN :
- 25743805
- Volume :
- 4
- Database :
- OpenAIRE
- Journal :
- JAMA Network Open
- Accession number :
- edsair.doi.dedup.....7c10393eed10c6a487ff4362551cd193