Targeted Infection Control in Long-term Care
| Status: | Completed |
|---|---|
| Conditions: | Infectious Disease |
| Therapuetic Areas: | Immunology / Infectious Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 10/19/2013 |
| Start Date: | April 2010 |
| End Date: | March 2013 |
| Contact: | Tisha L Moore, BA |
| Email: | mortisha@umich.edu |
| Phone: | 734.647.8445 |
Targeted Infection Control Program (TIP) to Reduce Resistant Pathogens and Infections
This is an interventional study aimed at reducing multi-drug resistance and infections in
nursing home (NH) residents. Each year, a staggering 1.5-2.0 million infections occur in
NHs. Many of these infections are caused by multiple drug resistant organisms (MDROs)
including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant
enterococci (VRE), and multidrug resistant Gram-negative bacilli (R-GNB). Antimicrobial
resistance among common bacteria are adversely affecting the clinical course and
exponentially increasing healthcare costs. Recognizing a need for action, legislators,
policy makers, and consumer groups are advocating for pathogen-based universal preemptive
screening for these MDROs, particularly MRSA in hospitals and NHs. However, implementing
this sweeping mandate is controversial, costly, reactive, and not based on empirical
evidence. It can result in a 10-20-fold increase in the number of NH residents placed in
isolation precautions with the potential for reduced attention by healthcare workers,
isolation and functional decline. The investigators proposal evaluates a novel focused
approach between 'do nothing' and 'search all and destroy' strategies by targeting a
subgroup of NH residents with indwelling devices who are at a high risk of acquiring MDROs
and infections.
The investigators hypothesize that the investigators targeted infection control program
(TIP) will reduce MDRO colonization and infections in NH residents with indwelling devices.
This cluster randomized trial will involve 12 NHs; 6 will be randomized to the TIP arm and 6
to the routine care arm. The investigators TIP intervention will include four components.
Component 1: Institute enhanced barrier precautions for all NH residents with indwelling
devices; active screening for MDROs (monthly) using cultures collected from multiple body
sites to identify asymptomatic MDRO carriage in these residents; and dissemination of
results to clinical staff and administration.
Component 2: Structured, active surveillance for infections using standardized definitions
in residents with indwelling devices and dissemination of results to clinical staff and
administration.
Component 3: A hand hygiene promotion program.
Component 4: A structured educational program pertaining to indwelling device care for
healthcare workers.
Inclusion Criteria:
- Any short- or long-stay resident with an indwelling urinary catheter or feeding tube
for more than 72 hours
- Ability to get informed consent from either the resident or his/her durable power of
attorney
Exclusion Criteria:
- Having an indwelling device for less than 72 hours
- Refusal of consent to get surveillance cultures and data collection by the resident
or his/her durable power of attorney
- Residents who are receiving end-of-life care
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