Targeted Program Reduced Superbugs and Infections In Nursing Home Residents

Lona Mody, MBBS, MSc Associate Division Chief, Clinical and Translational Research Associate Director, Clinical Programs, VA GRECC Associate Professor, Internal Medicine Research Associate Professor, Institute of Gerontology University of Michigan Geriatrics Ann Arbor, MIMedicalResearch.com Interview with:
Lona Mody, MBBS, MSc
Associate Division Chief, Clinical and Translational Research
Associate Director, Clinical Programs, VA GRECC
Associate Professor, Internal Medicine
Research Associate Professor, Institute of Gerontology
University of Michigan Geriatrics Ann Arbor, MI

Medical Research: What is the background for this study? What are the main findings?

Response: Over 1.5 million residents live in 15,600 Nursing Homes in the US. The acuity of illness in this population has increased substantially in the last decade, as has the risk of acquiring new infections. Multi-drug resistant organisms, also known as MDROs, are endemic in this setting with prevalence estimates upwards of 35% and surpassing those in the hospitals. Nursing homes historically have had few infection prevention resources, which contributes to these high rates. Patients with indwelling devices such as urinary catheters and feeding tubes present an attractive habitat for these ‘superbugs’ and thus carry the added burden of device-related infections.

The authors examined the effect of a targeted infection program, or TIP, to reduce the prevalence of Multi-drug resistant organisms and new catheter or feeding tube infections among patients with indwelling devices. The TIP intervention was three-fold:

  1. Surveillance for infections and Multi-drug resistant organism colonization with regular feedback to facilities;
  2. Extensive and interactive staff education using adult learning theory about key infection prevention practices and hand hygiene; and
  3. Use of gowns and gown when providing assistance to patients for high-risk activities such as bathing and grooming.

Staff education emphasized precautionary measures against the spread of infection and included mock game shows, songs and dances. Hands were cultured for bacteria before and after hand washing. Outcomes were measured by results of the cultures taken for each patient and monitoring infection rates.

A team of researchers from the University of Michigan and the Veterans Affairs Ann Arbor Health System has demonstrated that simple measures might be all it takes to push back at the spread of Multi-drug resistant organisms or ‘superbugs’ in nursing homes as well as reduce infections. In their study of patients with indwelling devices, MDROs were reduced by 23 percent among 418 residents in six southeast Michigan nursing homes who participated over the course of the three-year study. The numbers of catheter-associated urinary tract infections and MRSA acquisitions also decreased, 46 percent and 22 percent respectively.

The trial examined the relationship between acquisition of antimicrobial resistance among nursing home and assisted living facility residents with the use of devices by adapting new methodological approaches and study designs to study infection prevention interventions including the use of cluster-randomized study design for infection prevention interventions, adopting adult learning practices to engage frontline healthcare personnel and using multi-anatomic site sampling to demonstrate effectiveness of the program.

Medical Research: What should clinicians and patients take away from your report?

Response: This research program engages community-based nursing homes with little experience in conducting prospective research. They have few infection prevention resources, but these do not have to be barriers to implementing best practices and enhancing patient safety. The strategies we demonstrate in this study can successfully be adopted in traditionally resource-poor settings, and applied as narrowly or as broadly as desired.

With the move towards integrated healthcare systems and reducing hospital length of stay, 40% of Medicare beneficiaries now require post-acute care. As a result, today’s nursing home population is sicker, making it increasingly imperative to adapt and enhance evidence-based infection prevention practices accordingly. With the increasing acuity of care in nursing homes, transfers back to hospitals increase as well. Reduction in MDROs among the high risk short-stay and long-stay nursing home population will decrease transmission of these superbugs between institutions.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: This study provides a strong argument to reconsider MDRO management in nursing homes. More research on cost-effectiveness of this intervention and designing innovative interventions to reduce infections and superbugs in other high-risk populations is needed. In the meantime, this article addresses an important safety issue for high risk older adults in institutional settings and demonstrates effectiveness of several infection prevention practices

Citation:

Mody L, Krein SL, Saint SK, et al. A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices: A Randomized Clinical Trial. JAMA Intern Med. Published online March 16, 2015. doi:10.1001/jamainternmed.2015.132.


MedicalResearch.com Interview with Lona Mody, MBBS, MSc (2015). Targeted Program Reduced Superbugs and Infections In Nursing Home Residents

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