A Short-Term, Multicomponent Infection Control Program in Nursing Homes: A Cluster Randomized Controlled Trial

Chami, K.; Gavazzi, G.; Bar-Hen, Avner; Carrat, Fabrice; Wazières, B. de; Lejeune, B.; Armand, N.; Rainfray, Muriel; Hajjar, Joseph; Piette, F.; Rothan-Tondeur, Monique

doi:10.1016/j.jamda.2012.04.008

Cited by 24 publications

(29 citation statements)

References 36 publications

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“…18,19 Studies conducted at single NHs have generally focused on 1 of the following 4 types of interventions: hand hygiene, 17,20,21 gown use and contact precautions, 22 decolonization regimens, 23 or infection prevention education. 24,25 Although these studies show a trend toward reduced MDRO colonization and infections, the reduction in MDROs has not been statistically significant in most cases.…”

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confidence: 99%

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

et al. 2015

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Indwelling devices (eg, urinary catheters and feeding tubes) are often used in nursing homes (NHs). Inadequate care of residents with these devices contributes to high rates of multidrug-resistant organisms (MDROs) and device-related infections in NHs.OBJECTIVE To test whether a multimodal targeted infection program (TIP) reduces the prevalence of MDROs and incident device-related infections. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial at 12 community-based NHs from May 2010 to April 2013. Participants were high-risk NH residents with urinary catheters, feeding tubes, or both. INTERVENTIONS Multimodal, including preemptive barrier precautions, active surveillance for MDROs and infections, and NH staff education. MAIN OUTCOMES AND MEASURESThe primary outcome was the prevalence density rate of MDROs, defined as the total number of MDROs isolated per visit averaged over the duration of a resident's participation. Secondary outcomes included new MDRO acquisitions and new clinically defined device-associated infections. Data were analyzed using a mixed-effects multilevel Poisson regression model (primary outcome) and a Cox proportional hazards model (secondary outcome), adjusting for facility-level clustering and resident-level variables. RESULTSIn total, 418 NH residents with indwelling devices were enrolled, with 34 174 device-days and 6557 anatomic sites sampled. Intervention NHs had a decrease in the overall MDRO prevalence density (rate ratio, 0.77; 95% CI, 0.62-0.94). The rate of new methicillin-resistant Staphylococcus aureus acquisitions was lower in the intervention group than in the control group (rate ratio, 0.78; 95% CI, 0.64-0.96). Hazard ratios for the first and all (including recurrent) clinically defined catheter-associated urinary tract infections were 0.54 (95% CI, 0.30-0.97) and 0.69 (95% CI, 0.49-0.99), respectively, in the intervention group and the control group. There were no reductions in new vancomycin-resistant enterococci or resistant gram-negative bacilli acquisitions or in new feeding tube-associated pneumonias or skin and soft-tissue infections.CONCLUSIONS AND RELEVANCE Our multimodal TIP intervention reduced the overall MDRO prevalence density, new methicillin-resistant S aureus acquisitions, and clinically defined catheter-associated urinary tract infection rates in high-risk NH residents with indwelling devices. Further studies are needed to evaluate the cost-effectiveness of this approach as well as its effects on the reduction of MDRO transmission to other residents, on the environment, and on referring hospitals. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01062841

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confidence: 99%

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

et al. 2015

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“…Although most of the included studies involved hand hygiene as part of the intervention, four studies were primarily focused on improving hand hygiene [15e17,27]. In the other studies, the intervention topics were general infection control [24], hygiene [29], enteral feeding [18] and urinary tract infections [28].…”

Section: Non-randomized Trialsmentioning

confidence: 99%

Effectiveness and core components of infection prevention and control programmes in long-term care facilities: a systematic review

et al. 2019

Journal of Hospital Infection

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Background: Infection prevention and control (IPC) is a measure to prevent healthcareassociated infections in healthcare settings. There is limited evidence of the effectiveness of IPC programmes in long-term care facilities (LTCFs). Aim: To review and analyse the effectiveness and the components of IPC programmes in LTCFs for older adults. Methods: Electronic databases (PubMed, EMBASE, CINAHL and Cochrane CENTRAL) were searched systematically for English-language articles assessing IPC interventions in LTCFs, published over the last decade (2007e2016). The components of IPC programmes were analysed based on the World Health Organization (WHO) manuals for improving IPC activities. Two reviewers independently assessed the quality of studies using the Cochrane risk-of-bias tool and the risk-of-bias assessment tool for non-randomized studies. Findings: Seventeen studies met the eligibility criteria; 10 studies were randomized trials (58.8%) and the others were non-randomized trials to examine the impact of IPC programmes on infection and/or performance outcomes of healthcare workers. None of the included studies implemented all of the WHO core components. Behavioural change strategies using education, monitoring and feedback were reported to be successful interventions for reducing the threat of healthcare-associated infections. Generally, studies using four or more elements of the WHO multi-modal strategy reported significant reductions in infection rates. Conclusions: There is some evidence for the effectiveness of IPC interventions using education, monitoring, feedback and four or more elements of the WHO multi-modal strategy to control healthcare-associated infections in LTCFs.

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“…Among the 46 remaining studies, 33 investigated multifaceted interventions which covered other aspects of infection control besides HH, 39,43,46,50,52,53,56,59,61,63,65 whereas 13 described interventions based on HH only. 10,45,[47][48][49]51,54,55,57,58,60,62,64 The interventions on HH were diverse and included educational programs for the staff and the residents (in 57% of the 46 studies describing interventions), 10,14,20,21,23,27,29,39,43,45,47,48,50,51,53,55-65 implementation of new guidelines (28% of studies), [10][11][12][13]15,17,19,20,22,26,…”

Section: Interventionsmentioning

confidence: 99%

Impact of hand hygiene on the infectious risk in nursing home residents: A systematic review

Hocine

Temime

2015

American Journal of Infection Control

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A Short-Term, Multicomponent Infection Control Program in Nursing Homes: A Cluster Randomized Controlled Trial

Cited by 24 publications

References 36 publications

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

Effectiveness and core components of infection prevention and control programmes in long-term care facilities: a systematic review

Impact of hand hygiene on the infectious risk in nursing home residents: A systematic review

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