Pathway From Functional Disability to Antimicrobial Resistance in Nursing Home Residents

University of Michigan

Status: Completed

Conditions: Multi-antibiotic Resistance

Treatments: Behavioral: Multi-modal Infection Control Program

Study type: Interventional

Funder types: Other

Identifiers

NCT02909946

R01AG041780

Details and patient eligibility

About

Multidrug-resistant organisms (MDROs) are endemic in nursing homes (NHs) with prevalence rates surpassing those in hospitals. The aim of the study is to design and evaluate the effectiveness of a multi-component intervention to reduce new acquisition of MDROs in NH residents. The intervention will incorporate resident-level, environmental, and caregiver based strategies. Using a cluster-randomized study design, three NHs will be randomized to the intervention group and three to the control group. Control NHs will be allowed to continue standard infection prevention practices. Nursing homes will serve as the unit of allocation. Analyses will be performed both at the resident and the cluster level. The primary outcomes of the study are reduction in MDRO prevalence, and reduction in new MDRO acquisition .

Full description

The NH intervention will incorporate resident-level, environmental, and caregiver based strategies, including: a. Standard precautions and hand hygiene for care of all residents. Enhanced barrier precautions including hand hygiene, glove use, and gown use for healthcare workers (HCW) when providing activities of daily living (ADL) assistance for residents at highest-risk (caregiver intervention); b. Hand hygiene education to residents and families (resident-level intervention); c. Standardized bathing practices including using chlorhexidine-based cloths to reduce resident MDRO colonization (resident-level intervention); d. Standardized environmental protocol and education to reduce contamination on inanimate objects and surfaces (environmental intervention); e. Feedback monthly of facility-level microbial data and new MDRO acquisition rates to infection preventionists, front-line healthcare personnel, and facility leadership (facility intervention).

Enrollment: 246 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age ≥ 18 years old
• Residing in a participating NH facility
• Provided informed consent for participation

Exclusion criteria

• Receiving end-of-life care
• Non-English language speaking

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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246 participants in 2 patient groups

Intervention Arm

Active Comparator group

Description:

NHs randomized to the Intervention Arm will implement a new multi-modal infection control program.

Treatment:

Behavioral: Multi-modal Infection Control Program

Control Arm

No Intervention group

Description:

NHs randomized to the Control Arm will continue their current standard infection control practices.