The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

doi:10.1093/cid/ciz119

. 2019 Oct 15;69(9):1566-1573.

doi: 10.1093/cid/ciz119.

The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

James A McKinnell¹, Raveena D Singh², Loren G Miller¹, Ken Kleinman³, Gabrielle Gussin², Jiayi He², Raheeb Saavedra², Tabitha D Dutciuc², Marlene Estevez², Justin Chang², Lauren Heim², Stacey Yamaguchi², Harold Custodio², Shruti K Gohil², Steven Park⁴, Steven Tam⁵, Philip A Robinson⁶, Thomas Tjoa², Jenny Nguyen², Kaye D Evans⁴, Cassiana E Bittencourt⁴, Bruce Y Lee⁷, Leslie E Mueller⁷, Sarah M Bartsch⁷, John A Jernigan⁸, Rachel B Slayton⁸, Nimalie D Stone⁸, Matthew Zahn⁹, Vincent Mor^{10

11

12}, Kevin McConeghy^{10

11

12}, Rosa R Baier^{10

12}, Lynn Janssen¹³, Kathleen O'Donnell^{9

13}, Robert A Weinstein^{14

15}, Mary K Hayden¹⁵, Micaela H Coady¹⁶, Megha Bhattarai¹⁶, Ellena M Peterson⁴, Susan S Huang^{2

17}

Affiliations

¹ Infectious Disease Clinical Outcomes Research, LA Biomed at Harbor-University of California Los Angeles Medical Center, Torrance.
² Division of Infectious Diseases, University of California Irvine School of Medicine, Orange.
³ University of Massachusetts Amherst School of Public Health and Health Sciences, Orange.
⁴ University of California Irvine Health, Orange.
⁵ Division of Geriatrics, Department of Medicine, University of California Irvine, Orange.
⁶ Hoag Hospital, Newport, California.
⁷ Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
⁸ Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
⁹ Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, California.
¹⁰ Department of Health Services, Policy and Practice, Brown University School of Public Health, Rhode Island.
¹¹ Center of Innovation in Long-Term Services and Supports, Veterans Affairs Medical Center, Providence VA Medical Center, Rhode Island.
¹² Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, Rhode Island.
¹³ Healthcare-associated Infections Program, Center for Healthcare Quality, California Department of Public Health, Richmond, California.
¹⁴ Cook County Health and Hospitals System, Chicago, Illinois.
¹⁵ Department of Medicine, Rush University Medical Center, Chicago, Illinois.
¹⁶ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
¹⁷ Health Policy Research Institute, University of California Irvine School of Medicine.

PMID: 30753383
PMCID: PMC7320073
DOI: 10.1093/cid/ciz119

The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

James A McKinnell et al. Clin Infect Dis. 2019.

. 2019 Oct 15;69(9):1566-1573.

doi: 10.1093/cid/ciz119.

Authors

Affiliations

¹ Infectious Disease Clinical Outcomes Research, LA Biomed at Harbor-University of California Los Angeles Medical Center, Torrance.
² Division of Infectious Diseases, University of California Irvine School of Medicine, Orange.
³ University of Massachusetts Amherst School of Public Health and Health Sciences, Orange.
⁴ University of California Irvine Health, Orange.
⁵ Division of Geriatrics, Department of Medicine, University of California Irvine, Orange.
⁶ Hoag Hospital, Newport, California.
⁷ Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
⁸ Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
⁹ Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, California.
¹⁰ Department of Health Services, Policy and Practice, Brown University School of Public Health, Rhode Island.
¹¹ Center of Innovation in Long-Term Services and Supports, Veterans Affairs Medical Center, Providence VA Medical Center, Rhode Island.
¹² Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, Rhode Island.
¹³ Healthcare-associated Infections Program, Center for Healthcare Quality, California Department of Public Health, Richmond, California.
¹⁴ Cook County Health and Hospitals System, Chicago, Illinois.
¹⁵ Department of Medicine, Rush University Medical Center, Chicago, Illinois.
¹⁶ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
¹⁷ Health Policy Research Institute, University of California Irvine School of Medicine.

PMID: 30753383
PMCID: PMC7320073
DOI: 10.1093/cid/ciz119

Abstract

Background: Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NHs), and long-term acute care facilities (LTACs) via patient transfers. The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based on their high degree of patient sharing. We report baseline MDRO prevalence in 21 NHs/LTACs.

Methods: A random sample of 50 adults for 21 NHs/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase-producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, skin (axilla/groin), and peri-rectal swabs. Facility and resident characteristics associated with MDRO carriage were assessed using multivariable models clustering by person and facility.

Results: Prevalence of MDROs was 65% in NHs and 80% in LTACs. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). CRE prevalence was higher in facilities that manage ventilated LTAC patients and NH residents (8% vs <1%, P < .001). MDRO status was known for 18% of NH residents and 49% of LTAC patients. MDRO-colonized adults commonly harbored additional MDROs (54% MDRO+ NH residents and 62% MDRO+ LTACs patients). History of MRSA (odds ratio [OR] = 1.7; confidence interval [CI]: 1.2, 2.4; P = .004), VRE (OR = 2.1; CI: 1.2, 3.8; P = .01), ESBL (OR = 1.6; CI: 1.1, 2.3; P = .03), and diabetes (OR = 1.3; CI: 1.0, 1.7; P = .03) were associated with any MDRO carriage.

Conclusions: The majority of NH residents and LTAC patients harbor MDROs. MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.

Keywords: CRE; MRSA; chlorhexidine; decolonization; long term care; public health.

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References

1. Centers for Disease Control and Prevention US. Antibiotic resistant threats in the United States, 2013 Available at: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Accessed 28 February 2019.
1. Boucher HW, Talbot GH, Bradley JS, et al. . Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:1–12. - PubMed
1. Society for Healthcare Epidemiology of A, Infectious Diseases Society of A, Pediatric Infectious Diseases S. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012; 33:322–7. - PubMed
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1. Irvine PW, Van Buren N, Crossley K. Causes for hospitalization of nursing home residents: the role of infection. J Am Geriatr Soc 1984; 32:103–7. - PubMed

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[1] Centers for Disease Control and Prevention US. Antibiotic resistant threats in the United States, 2013 Available at: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Accessed 28 February 2019.

[2] Centers for Disease Control and Prevention US. Antibiotic resistant threats in the United States, 2013 Available at: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Accessed 28 February 2019.

[3] Boucher HW, Talbot GH, Bradley JS, et al. . Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:1–12. - PubMed

[4] Boucher HW, Talbot GH, Bradley JS, et al. . Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:1–12. - PubMed

[5] Society for Healthcare Epidemiology of A, Infectious Diseases Society of A, Pediatric Infectious Diseases S. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012; 33:322–7. - PubMed

[6] Society for Healthcare Epidemiology of A, Infectious Diseases Society of A, Pediatric Infectious Diseases S. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012; 33:322–7. - PubMed

[7] White House US. National strategy for combating antibiotic-resistant bacteria. Available at: https://obamawhitehouse.archives.gov/sites/default/files/docs/carb_natio.... Accessed 28 February 2019.

[8] White House US. National strategy for combating antibiotic-resistant bacteria. Available at: https://obamawhitehouse.archives.gov/sites/default/files/docs/carb_natio.... Accessed 28 February 2019.

[9] Irvine PW, Van Buren N, Crossley K. Causes for hospitalization of nursing home residents: the role of infection. J Am Geriatr Soc 1984; 32:103–7. - PubMed

[10] Irvine PW, Van Buren N, Crossley K. Causes for hospitalization of nursing home residents: the role of infection. J Am Geriatr Soc 1984; 32:103–7. - PubMed

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The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

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The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

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