A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial
- PMID: 25775048
- PMCID: PMC4420659
- DOI: 10.1001/jamainternmed.2015.132
A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial
Erratum in
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Error in Byline. A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices: A Randomized Clinical Trial.JAMA Intern Med. 2015 Jul;175(7):1247. doi: 10.1001/jamainternmed.2015.2672. JAMA Intern Med. 2015. PMID: 26146924 No abstract available.
Abstract
Importance: 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 measures: The 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.
Results: In 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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Comment in
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Revisiting standard precautions to reduce antimicrobial resistance in nursing homes.JAMA Intern Med. 2015 May;175(5):723-4. doi: 10.1001/jamainternmed.2015.137. JAMA Intern Med. 2015. PMID: 25774622 No abstract available.
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References
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- Centers for Medicare & Medicaid Services [Accessed December 3, 2014];Nursing Home Data Compendium. 2013 http: //www.cms.gov/Medicare/Provider-Enrollment -and-Certification/Cert....
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