James A McKinnell1, Loren G Miller2, Raveena D Singh3, Gabrielle Gussin3, Ken Kleinman4, Job Mendez2, Bryn Laurner2, Tabitha D Catuna3, Lauren Heim3, Raheeb Saavedra3, James Felix2, Crystal Torres2, Justin Chang3, Marlene Estevez3, Joanna Mendez2, Gregory Tchakalian2, Leah Bloomfield2, Sandra Ceja2, Ryan Franco2, Aaron Miner2, Aura Hurtado2, Ratharo Hean2, Alex Varasteh2, Philip A Robinson5, Steven Park6, Steven Tam7, Thomas Tjoa3, Jiayi He3, Shalini Agrawal3, Stacey Yamaguchi3, Harold Custodio3, Jenny Nguyen3, Cassiana E Bittencourt6, Kaye D Evans6, Vincent Mor8, Kevin McConeghy8, Robert A Weinstein9, Mary K Hayden10, Nimalie D Stone11, Karl Steinberg12, Nancy Beecham13, Jocelyn Montgomery14, Walters DeAnn14, Ellena M Peterson6, Susan S Huang15. 1. Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA; Los Angeles County Department of Public Health, Healthcare Outreach Unit, Los Angeles, CA, USA; Expert Stewardship, Newport, CA, USA. Electronic address: Dr.McKinnell@gmail.com. 2. Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA. 3. Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA. 4. University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, USA. 5. Expert Stewardship, Newport, CA, USA; Hoag Hospital, Newport, CA, USA. 6. Department of Pathology and Laboratory Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA. 7. Division of Geriatrics, Department of Medicine, University of California Irvine, Orange, CA, USA. 8. Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Affairs Medical Center, Providence VA Medical Center, Providence, RI, USA; Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, RI, USA. 9. Cook County Health and Hospitals System, Chicago, IL, USA; Department of Medicine, Rush University Medical Center, Chicago, IL, USA. 10. Department of Medicine, Rush University Medical Center, Chicago, IL, USA. 11. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. 12. California Association of Long Term Care Medicine, Santa Clarita, CA, USA. 13. The National Association of Directors of Nursing Administration in Long Term Care, Springdale, OH, USA. 14. California Association of Health Facilities, Sacramento, CA, USA. 15. Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA; Department of Medicine, Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, USA.
Abstract
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.
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.
Authors: W E Trick; R A Weinstein; P L DeMarais; M J Kuehnert; W Tomaska; C Nathan; T W Rice; S K McAllister; L A Carson; W R Jarvis Journal: J Am Geriatr Soc Date: 2001-03 Impact factor: 5.562
Authors: James A McKinnell; Susan S Huang; Samantha J Eells; Eric Cui; Loren G Miller Journal: Infect Control Hosp Epidemiol Date: 2012-12-21 Impact factor: 3.254
Authors: Susan L Mitchell; Michele L Shaffer; Mark B Loeb; Jane L Givens; Daniel Habtemariam; Dan K Kiely; Erika D'Agata Journal: JAMA Intern Med Date: 2014-10 Impact factor: 21.873
Authors: Jon P Furuno; Joan N Hebden; Harold C Standiford; Eli N Perencevich; Ram R Miller; Anita C Moore; Sandra M Strauss; Anthony D Harris Journal: Am J Infect Control Date: 2008-09 Impact factor: 2.918
Authors: Susan S Huang; Edward Septimus; Ken Kleinman; Julia Moody; Jason Hickok; Taliser R Avery; Julie Lankiewicz; Adrijana Gombosev; Leah Terpstra; Fallon Hartford; Mary K Hayden; John A Jernigan; Robert A Weinstein; Victoria J Fraser; Katherine Haffenreffer; Eric Cui; Rebecca E Kaganov; Karen Lolans; Jonathan B Perlin; Richard Platt Journal: N Engl J Med Date: 2013-05-29 Impact factor: 91.245
Authors: Courtney R Murphy; Victor Quan; Diane Kim; Ellena Peterson; Matthew Whealon; Grace Tan; Kaye Evans; Hildy Meyers; Michele Cheung; Bruce Y Lee; Dana B Mukamel; Susan S Huang Journal: BMC Infect Dis Date: 2012-10-24 Impact factor: 3.090
Authors: Rachel B Slayton; Damon Toth; Bruce Y Lee; Windy Tanner; Sarah M Bartsch; Karim Khader; Kim Wong; Kevin Brown; James A McKinnell; William Ray; Loren G Miller; Michael Rubin; Diane S Kim; Fred Adler; Chenghua Cao; Lacey Avery; Nathan T B Stone; Alexander Kallen; Matthew Samore; Susan S Huang; Scott Fridkin; John A Jernigan Journal: MMWR Morb Mortal Wkly Rep Date: 2015-08-07 Impact factor: 17.586
Authors: Lona Mody; Kyle J Gontjes; Marco Cassone; Kristen E Gibson; Bonnie J Lansing; Julia Mantey; Mohammed Kabeto; Andrzej Galecki; Lillian Min Journal: JAMA Netw Open Date: 2021-07-01
Authors: Sarah M Bartsch; Kim F Wong; Leslie E Mueller; Gabrielle M Gussin; James A McKinnell; Thomas Tjoa; Patrick T Wedlock; Jiayi He; Justin Chang; Shruti K Gohil; Loren G Miller; Susan S Huang; Bruce Y Lee Journal: JAMA Netw Open Date: 2021-08-02