Targeted Infection Control in Long-term Care

University of Michigan

Status: Completed

Conditions: Infection

Treatments: Behavioral: Targeted Infection Control

Study type: Interventional

Funder types: Other

Identifiers

NCT01062841

AG032298-01A1

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 418 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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418 participants in 2 patient groups

Intervention: Targeted Infection Control

Active Comparator group

Description:

Nursing homes allocated to the Intervention Arm will implement a series of new infection control programs.

Treatment:

Behavioral: Targeted Infection Control

Control

No Intervention group

Description:

Nursing homes allocated to the control group will continue with their standard infection control procedures. No changes will be made to their practices.