Infections caused by multi-drug resistant organisms (MDRO) and C. difficile result in significant morbidity and mortality in nursing homes (NHs). There is a paucity of data on the implementation of infection prevention and control (IPC) policies aimed at these organisms in this setting, therefore, the purpose of this study was to identify IPC policies used to prevent MDRO and C. difficile in a national sample of NHs.
A cross-sectional survey of 2,550 randomly sampled free-standing U.S. NHs was conducted over a one year period starting in December 2013. Survey data were linked to the Certification and Survey Provider Enhanced Reporting dataset, which includes data on NH characteristics. Descriptive statistics were utilized to describe the presence of policies.
A total of 990 NHs completed the survey (39% response rate). The majority of NHs were for-profit (69%) and the average bed size was 117 (SD ± 69). Most NHs reported implementing policies for isolation precautions (91%), instructing infected staff to stay home (87%), confining residents to rooms (75%), cohorting infected residents (67%) and restricting visitors (66%) to control and/or prevent outbreaks. The following antimicrobial stewardship activities were reported most frequently: collection of data on antibiotic utilization (51%), written guidelines in place for antibiotic use (46%), review of cases to assess antibiotic appropriateness (43%) and providing feedback to clinicians on antibiotic prescribing (32%). The use of specific policies aimed at decreasing the spread of infections such as use of contact or other isolation precautions varied depending on the type of causative organism with methicillin-resistant Staphylococcus aureus and C. difficile most often resulting in implementation of different policies (See Figure). A quarter of facilities reported lack of availability of private rooms for isolation of infected residents.
Most NHs are involved in activities to control MDRO and C. difficile, although there is considerable variation in which measures are employed. Future studies should focus on identifying the most effective strategies to combat infections in this setting.
C. C. Cohen, None
E. Larson, None
P. Stone, None