Reduction of methicillin-resistant Staphylococcus aureus infection in long-term care is possible while maintaining patient socialization: A prospective randomized clinical trial

Peterson, Lance R.; Boehm, Susan; Beaumont, Jennifer L.; Patel, Parul; Schora, Donna; Peterson, Kari; Burdsall, Deborah; Hines, Carolyn; Fausone, Maureen; Robicsek, Ari; Smith, Becky

doi:10.1016/j.ajic.2016.04.251

Cited by 21 publications

(34 citation statements)

References 31 publications

(41 reference statements)

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“…Patients with these risk factors should be appropriate targets for interventions. MDRO colonization increases the risk of MDRO infection [4-6, 15, 16], but is typically amenable to interventions [28][29][30][31][32][33][34]. Current standard interventions for MDRO reduction (eg, curbing antibiotic use and discontinuing indwelling devices) and patients' improving health status throughout the post-acute care stay have been thought to be sufficient reasons to presume that MDROs would decolonize by the time of discharge to the community.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Assessment of Multidrug-Resistant Organisms in Newly Admitted Nursing Facility Patients: Implications for an Evolving Population

Mody

Foxman

Bradley

et al. 2018

Clinical Infectious Diseases

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Background. The spread of multidrug-resistant organisms (MDROs) is a global concern, and much about transmission in healthcare systems remains unknown. To reduce hospital stays, nursing facilities (NFs) have increasingly assumed care of post-acute populations. We estimate the prevalence of MDRO colonization in NF patients on enrollment and discharge to community settings, risk factors for colonization, and rates of acquiring MDROs during the stay.Methods. We conducted a prospective, longitudinal cohort study of newly admitted patients in 6 NFs in southeast Michigan using active microbial surveillance of multiple anatomic sites sampled at enrollment, days 14 and 30, and monthly thereafter for up to 6 months.Results. We enrolled 651 patients and collected 7526 samples over 1629 visits, with an average of 29 days of follow-up per participant. Nearly all participants were admitted for post-acute care (95%). More than half (56.8%) were colonized with MDROs at enrollment: methicillin-resistant Staphylococcus aureus (MRSA), 16.1%; vancomycin-resistant enterococci (VRE), 33.2%; and resistant gram-negative bacilli (R-GNB), 32.0%. Risk factors for colonization at enrollment included prolonged hospitalization (>14 days), functional disability, antibiotic use, or device use. Rates per 1000 patient-days of acquiring a new MDRO were MRSA, 3.4; VRE, 8.2; 13.6. MDRO colonization at discharge was similar to that at enrollment (56.4%): MRSA, 18.4%; VRE, 30.3%; and R-GNB, 33.6%.Conclusions. Short-stay NF patients exhibit a high prevalence of MDROs near the time of admission, as well as at discharge, and may serve as a reservoir for spread in other healthcare settings. Future interventions to reduce MDROs should specifically target this population.

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Section: Discussionmentioning

confidence: 99%

Longitudinal Assessment of Multidrug-Resistant Organisms in Newly Admitted Nursing Facility Patients: Implications for an Evolving Population

Mody

Foxman

Bradley

et al. 2018

Clinical Infectious Diseases

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“…Three systematic reviews and 3 studies (2 experimental, 1 quasi-experimental) found evidence that chlorhexidine bathing reduces MRSA acquisition and carriage, although one review did include studies where no reduction was found. 7 , 11 , 12 , 14 , 15 , 17 A prospective cohort study by Ruiz et al 16 (2017) found no reduction in MRSA colonization rates but did find a significant reduction in total MDRO colonization.…”

Section: Resultsmentioning

confidence: 99%

Chlorhexidine Bathing Strategies for Multidrug-Resistant Organisms: A Summary of Recent Evidence

Gall

Long²,

Hall³

2020

J Patient Saf

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Objective The aim of the study was to summarize the latest evidence for patient bathing with a 2% to 4% chlorhexidine gluconate solution to reduce multidrug-resistant organism (MDRO) transmission and infection. Methods We searched 3 databases (CINAHL, MEDLINE, and Cochrane) for a combination of the key words “chlorhexidine bathing” and MeSH terms “cross-infection prevention,” “drug resistance, multiple, bacterial,” and “drug resistance, microbial.” Articles from January 1, 2008, to December 31, 2018, were included, as well as any key articles published after December 31. Results Our findings focused on health care–associated infections (HAIs) and 3 categories of MDROs: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and carbapenem-resistant Enterobacteriaceae (CRE). Chlorhexidine bathing reduces MRSA acquisition and carriage, but not all studies found significant reductions in MRSA infections. Several studies found that chlorhexidine bathing reduced VRE acquisition and carriage, and one study showed lower VRE infections in the bathing group. Two studies found that bathing reduced CRE carriage (no studies examined CRE infections). Two very large studies (more than 140,000 total patients) found bathing significantly reduced HAIs, but these reductions may be smaller when HAIs are already well controlled by other means. Conclusions There is a high level of evidence supporting chlorhexidine bathing to reduce MDRO acquisition; less evidence is available on reducing infections. Chlorhexidine bathing is low cost to implement, and adverse events are rare and resolve when chlorhexidine use is stopped. There is evidence of chlorhexidine resistance, but not at concentrations in typical use. Further research is needed on chlorhexidine bathing’s impact on outcomes, such as mortality and length of stay.

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“…If one develops a targeted admission surveillance program based on risk factors for C. difficile colonization, which we have done for our system-wide surveillance implementation, one will likely test 1/3 of admissions (our practice) thereby reducing the cost to an effective level. Also, based on the performance of the test we used, the expectation is that there will be one unnecessary isolated patient per 200 admissions [21], which we consider an acceptable number resulting from a false positive test result. Finally, one could argue that our use of a NAAT for routine clinical diagnostic testing could result in an over estimation of the burden of HO-CDI at our organization [41].…”

Section: Plos Onementioning

confidence: 99%

“…Since large studies have demonstrated that AST at admission can lower MRSA clinical disease rates [18], it would be expected that C. difficile could respond to similar practice, with resulting lower CDI rates [19]. We had previously demonstrated the benefit of admission MRSA AST on lowering clinical infection [20,21], and our hypothesis was that this approach also would be successful for CDI. Thus, the goal of our pragmatic, stepped-wedge infection control initiative was to determine if admission AST for toxigenic C. difficile would lead to a reduced hospital onset CDI (HO-CDI) incidence at our healthcare organization.…”

Section: Introductionmentioning

confidence: 97%

Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization

et al. 2020

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Reduction of methicillin-resistant Staphylococcus aureus infection in long-term care is possible while maintaining patient socialization: A prospective randomized clinical trial

Abstract: On-site MRSA surveillance with targeted decolonization resulted in a significant decrease in clinical MRSA infection among LTCF residents.

Cited by 21 publications

References 31 publications

Longitudinal Assessment of Multidrug-Resistant Organisms in Newly Admitted Nursing Facility Patients: Implications for an Evolving Population

Longitudinal Assessment of Multidrug-Resistant Organisms in Newly Admitted Nursing Facility Patients: Implications for an Evolving Population

Chlorhexidine Bathing Strategies for Multidrug-Resistant Organisms: A Summary of Recent Evidence

Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization

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