1208. Targeted Infection Prevention (TIP) Study: Cluster-randomized study to reduce MDROs in nursing home residents with indwelling devices
Session: Oral Abstract Session: Identifying and Overcoming Challenges in Preventing Transmission of MDRO GNR Bacterial Infections in Healthcare Settings
Saturday, October 5, 2013: 8:45 AM
Room: The Moscone Center: 250-262

Background : Nursing home (NH) residents with indwelling devices such as urinary catheters & feeding tubes are at high risk for colonization with multi-drug resistant organisms (MDROs) and infections.

Methods :  In a cluster-randomized study, we evaluated the effect of a multi-modal bundle in reducing MDRO prevalence (primary) & device-associated infections (secondary outcome) among residents with urinary catheters or feeding tubes in 12 NHs (6 intervention & 6 control). Our intervention included: 1) active surveillance for MDRO colonization & infection; 2) enhanced preemptive barrier precautions for all device residents irrespective of their colonization status; 3) hand hygiene promotion; 4) a highly interactive educational intervention. Cultures (from multiple anatomic sites) and clinical infection data were obtained at enrollment, after 15 days, and every 30 days thereafter.

Results : A total of 418 NH residents with devices were enrolled over 3 years with 1816 follow-up visits (34174 follow-up days) & 6525 anatomic sites cultured. Follow-up visits, total samples/visit and no. of anatomic sites cultured did not differ between the intervention and control patients.  There were no significant differences in age, comorbidity or functional status scores between the two groups.  Compared with the control sites, intervention sites showed a significantly lower prevalence of any MDROs (32.5% vs. 26.0% positive samples, p<.001), as well as individual MDRO including MRSA (10.8% vs. 8.1%, p < .001), VRE (5.3% vs. 3.9%, p = .005), ciprofloxacin-resistant gram-negative bacilli (GNB) (23.6% vs. 19%, p< .001), & ceftazidime-resistant GNB (8.5% vs. 5.2%, p< .001). Intervention site residents showed a reduced MDRO prevalence in nares, groin, rectum & wounds. Poisson regression models adjusted for facility-level clustering showed a significant decrease in expected no. of MRSA (23%, p=0.04) among intervention group residents. Univariate analyses revealed that clinical urethral catheter-associated urinary tract infections (CAUTI) were reduced by 31% (p=.03).

Conclusion : Our innovative multi-modal TIP bundle significantly reduced MDRO prevalence rates and a trend in reduced CAUTI rates in NH residents with indwelling devices.

Lona Mody, MD, MSc1, Sarah Krein, PhD, RN2, Sanjay Saint, MD, MPH2, Ana Montoya, MD3, Bonnie Lansing, LPN1, Sara McNamara, MT(ASCP), MPH1, Kathy Symons, BA4, Kay Cherian3, Ruth Anne Rye, RN, BS3, Andrezj Galecki, MD, PhD3, James Thomas Fitzgerald, PhD1, Russell Olmsted, MPH, CIC5, Carol A. Kauffman, MD6 and Suzanne Bradley, MD, FIDSA, FSHEA7, (1)University of Michigan and Ann Arbor VA Healthcare System, Ann Arbor, MI, (2)Ann Arbor VA Medical Center, Ann Arbor, MI, (3)University of Michigan, Ann Arbor, MI, (4)Geriatrics, Ann Arbor VA Healthcare System, Ann Arbor, MI, (5)St. Joseph Mercy Health System, Ypsilanti, MI, (6)University of Michigan & Ann Arbor VA Healthcare System, Ann Arbor, MI, (7)Internal Medicine, University of Michigan and Ann Arbor VA Healthcare System, Ann Arbor, MI


L. Mody, None

S. Krein, None

S. Saint, None

A. Montoya, None

B. Lansing, None

S. McNamara, None

K. Symons, None

K. Cherian, None

R. A. Rye, None

A. Galecki, None

J. T. Fitzgerald, None

R. Olmsted, None

C. A. Kauffman, None

S. Bradley, SHEA: Editor-in-Chief, Infection Control and Hospital Epidemiology, Salary

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