Assessing Pathogen Transmission Opportunities: Variation in Nursing Home Staff-Resident Interactions |
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| Affiliation: | 1. Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA;2. IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA;3. Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA;4. Georgia Emerging Infections Program, Atlanta, GA, USA;5. Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA;6. Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA;7. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA;8. VA Maryland Health Care System, Baltimore, MD, USA;9. Maryland Emerging Infections Program, Baltimore, MD, USA;10. Maryland Department of Health, Baltimore, MD, USA;11. Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, USA;12. New York/Rochester Emerging Infections Program, Rochester, NY, USA;13. Minnesota Department of Health, St. Paul, MN, USA;14. California Emerging Infections Programs, Oakland, CA, USA;15. Oregon Public Health Division, Oregon Health Authority, Portland, OR, USA;p. Tennessee Emerging Infections Program, Nashville, TN, USA;q. Tennessee Department of Health, Nashville, TN, USA;r. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA;s. Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA;1. Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy;2. Healthy Aging Phenotypes Research Unit–“Salus in Apulia Study”–National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy;3. Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy;4. Neuroscience and Education, Human Resources Excellence in Research, University of Foggia, Foggia, Italy;5. Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;6. Hematology and Stem Cell Transplant Unit, "Vito Fazzi" Hospital, Lecce, Italy;7. Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy;8. Neurology Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy;9. Dipartimento Interdisciplinare di Medicina, Clinica Medica e Geriatria “Cesare Frugoni”, University of Bari Aldo Moro, Bari, Italy;1. RTI International, Research Triangle Park, NC, USA;2. Shirley Ryan Ability Lab, Chicago, IL, USA;3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;4. RTI International, Waltham, MA, USA;5. The Centers for Medicare and Medicaid Services, Woodlawn, MD, USA;1. Population Health Sciences Institute, Newcastle University, Newcastle, UK;2. NIHR Applied Research Collaboration North East and North Cumbria, Newcastle, UK;3. Birmingham Acute Care Research Group, University of Birmingham, Birmingham, UK;4. Department of Acute Medicine, Manchester University NHS Foundation Trust, Manchester, UK;5. Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK;6. NIHR Applied Research Collaboration–East Midlands, Nottingham, UK;7. School of Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, Bolton, UK;8. Department of Acute Medicine, Sandwell and West Birmingham NHS, Birmingham, UK;9. School of Medical Sciences, Bangor University, Bangor, UK;10. Department of Acute Medicine, Ysbyty Gwynedd, Bangor, UK;11. Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK;12. Division of Acute General Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK;1. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK;2. Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK;3. Care Quality Improvement Department, Royal College of Physicians, London, UK;4. National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK;5. University Hospital of Wales and School of Medicine, Cardiff University, UK;1. Department of Internal Medicine, Atrium Health, Charlotte, NC, USA;2. Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC, USA;3. Department of Pediatrics, Atrium Health, Charlotte, NC, USA;4. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, USA;5. Department of Internal Medicine, Wake Forest School of Medicine, Charlotte, NC, USA |
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| Abstract: | ObjectivesThe Centers for Disease Control and Prevention (CDC) recommends implementing Enhanced Barrier Precautions (EBP) for all nursing home (NH) residents known to be colonized with targeted multidrug-resistant organisms (MDROs), wounds, or medical devices. Differences in health care personnel (HCP) and resident interactions between units may affect risk of acquiring and transmitting MDROs, affecting EBP implementation. We studied HCP-resident interactions across a variety of NHs to characterize MDRO transmission opportunities.Design2 cross-sectional visits.Setting and ParticipantsFour CDC Epicenter sites and CDC Emerging Infection Program sites in 7 states recruited NHs with a mix of unit care types (≥30 beds or ≥2 units). HCP were observed providing resident care.MethodsRoom-based observations and HCP interviews assessed HCP-resident interactions, care type provided, and equipment use. Observations and interviews were conducted for 7-8 hours in 3-6-month intervals per unit. Chart reviews collected deidentified resident demographics and MDRO risk factors (eg, indwelling devices, pressure injuries, and antibiotic use).ResultsWe recruited 25 NHs (49 units) with no loss to follow-up, conducted 2540 room-based observations (total duration: 405 hours), and 924 HCP interviews. HCP averaged 2.5 interactions per resident per hour (long-term care units) to 3.4 per resident per hour (ventilator care units). Nurses provided care to more residents (n = 12) than certified nursing assistants (CNAs) and respiratory therapists (RTs) (CNA: 9.8 and RT: 9) but nurses performed significantly fewer task types per interaction compared to CNAs (incidence rate ratio (IRR): 0.61, P < .05). Short-stay (IRR: 0.89) and ventilator-capable (IRR: 0.94) units had less varied care compared with long-term care units (P < .05), although HCP visited residents in these units at similar rates.Conclusions and ImplicationsResident-HCP interaction rates are similar across NH unit types, differing primarily in types of care provided. Current and future interventions such as EBP, care bundling, or targeted infection prevention education should consider unit-specific HCP-resident interaction patterns. |
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| Keywords: | Infection prevention MDRO enhanced barrier precautions nursing homes care delivery patterns |
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