High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An 'Iceberg Effect'
| Autor: | Loren G. Miller, Jiayi He, Aura Hurtado, Philip A. Robinson, Vincent Mor, Sandra Ceja, Steven Tam, Thomas Tjoa, Ratharo Hean, Justin Chang, Gregory Tchakalian, Nimalie D. Stone, Nancy Beecham, Mary K. Hayden, Robert A. Weinstein, Raveena D. Singh, Kaye D. Evans, Ken Kleinman, Walters DeAnn, Joanna Mendez, Jocelyn Montgomery, Raheeb Saavedra, Steven Park, Shalini Agrawal, Kevin W. McConeghy, Crystal Torres, Karl E. Steinberg, Stacey Yamaguchi, Ellena M. Peterson, James McKinnell, Lauren Heim, James Felix, Cassiana E. Bittencourt, Marlene Estevez, Bryn Laurner, Jenny Nguyen, Ryan Franco, Aaron Miner, Alex Varasteh, Job Mendez, Susan S. Huang, Tabitha D. Catuna, Leah Bloomfield, Gabrielle M. Gussin, Harold Custodio |
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| Rok vydání: | 2020 |
| Předmět: |
Bathing
Drug Resistance Prevalence MRSA 0302 clinical medicine Hygiene Drug Resistance Multiple Bacterial Epidemiology MDRO colonization Infection control Medicine 030212 general & internal medicine General Nursing media_common Infectious disease Cross Infection Health Policy Bacterial CRE General Medicine Health Services infection control Infectious Diseases Public Health and Health Services Total care epidemiology Multiple Methicillin-Resistant Staphylococcus aureus medicine.medical_specialty media_common.quotation_subject Clinical Sciences Nursing Article Vancomycin-Resistant Enterococci Vaccine Related 03 medical and health sciences Clinical Research Environmental health Humans business.industry Prevention Public health biochemical phenomena metabolism and nutrition Nursing Homes Emerging Infectious Diseases Carriage ESBL Geriatrics Antimicrobial Resistance Geriatrics and Gerontology business 030217 neurology & neurosurgery |
| Zdroj: | J Am Med Dir Assoc Journal of the American Medical Directors Association, vol 21, iss 12 |
| ISSN: | 1525-8610 |
| Popis: | Objective Determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBLs), and carbapenem-resistant Enterobacteriaceae (CRE) among residents and in the environment of nursing homes (NHs). Design Point prevalence sampling of residents and environmental sampling of high-touch objects in resident rooms and common areas. Setting Twenty-eight NHs in Southern California from 2016 to 2017. Participants NH participants in Project PROTECT, a cluster-randomized trial of enhanced bathing and decolonization vs routine care. Methods Fifty residents were randomly sampled per NH. Twenty objects were sampled, including 5 common room objects plus 5 objects in each of 3 rooms (ambulatory, total care, and dementia care residents). Results A total of 2797 swabs were obtained from 1400 residents in 28 NHs. Median prevalence of multidrug-resistant organism (MDRO) carriage per NH was 50% (range: 24%-70%). Median prevalence of specific MDROs were as follows: MRSA, 36% (range: 20%-54%); ESBL, 16% (range: 2%-34%); VRE, 5% (range: 0%-30%); and CRE, 0% (range: 0%-8%). A median of 45% of residents (range: 24%-67%) harbored an MDRO without a known MDRO history. Environmental MDRO contamination was found in 74% of resident rooms and 93% of common areas. Conclusions and Implications In more than half of the NHs, more than 50% of residents were colonized with MDROs of clinical and public health significance, most commonly MRSA and ESBL. Additionally, the vast majority of resident rooms and common areas were MDRO contaminated. The unknown submerged portion of the iceberg of MDRO carriers in NHs may warrant changes to infection prevention and control practices, particularly high-fidelity adoption of universal strategies such as hand hygiene, environmental cleaning, and decolonization. |
| Databáze: | OpenAIRE |
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