Abstract
Objective
Determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBLs), and carbapenem-resistant
Enterobacteriaceae (CRE) among residents and in the environment of nursing homes (NHs).
Design
Point prevalence sampling of residents and environmental sampling of high-touch objects
in resident rooms and common areas.
Setting
Twenty-eight NHs in Southern California from 2016 to 2017.
Participants
NH participants in Project PROTECT, a cluster-randomized trial of enhanced bathing
and decolonization vs routine care.
Methods
Fifty residents were randomly sampled per NH. Twenty objects were sampled, including
5 common room objects plus 5 objects in each of 3 rooms (ambulatory, total care, and
dementia care residents).
Results
A total of 2797 swabs were obtained from 1400 residents in 28 NHs. Median prevalence
of multidrug-resistant organism (MDRO) carriage per NH was 50% (range: 24%-70%). Median
prevalence of specific MDROs were as follows: MRSA, 36% (range: 20%-54%); ESBL, 16%
(range: 2%-34%); VRE, 5% (range: 0%-30%); and CRE, 0% (range: 0%-8%). A median of
45% of residents (range: 24%-67%) harbored an MDRO without a known MDRO history. Environmental
MDRO contamination was found in 74% of resident rooms and 93% of common areas.
Conclusions and Implications
In more than half of the NHs, more than 50% of residents were colonized with MDROs
of clinical and public health significance, most commonly MRSA and ESBL. Additionally,
the vast majority of resident rooms and common areas were MDRO contaminated. The unknown
submerged portion of the iceberg of MDRO carriers in NHs may warrant changes to infection
prevention and control practices, particularly high-fidelity adoption of universal
strategies such as hand hygiene, environmental cleaning, and decolonization.
Keywords
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Article info
Publication history
Published online: June 16, 2020
Footnotes
The authors declare no conflicts of interest.
This project was funded by the Agency for Healthcare Research and Quality (AHRQ) via grant R01HS024286 (PI: Huang). The views expressed are those of the authors and do not necessarily reflect the official policy or position of the U.S. Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
