1712. The CDC SHIELD Orange County Project – Baseline Multi Drug-Resistant Organism (MDRO) Prevalence in a Southern California Region
Session: Oral Abstract Session: SHEA Featured Oral Abstract
Friday, October 6, 2017: 4:15 PM
Room: 20ABCD

Background:

MDROs can spread between hospitals, nursing homes (NH), and long-term acute care facilities (LTACs) via shared patients. SHIELD OC is a regional decolonization collaborative involving 38 of 104 countywide adult facilities identified by their high degree of direct and indirect patient sharing with one another. We report baseline MDRO prevalence in these facilities.    

Methods:

Adult patients in 38 facilities (17 hospitals, 18 NHs, 3 LTACs) underwent point-prevalence screening between Sept 2016-April 2017 for MRSA, VRE, ESBL, and CRE using nares, skin (axilla/groin), and peri-rectal swabs. In NHs and LTACs, residents were randomly selected until 50 sets of swabs were obtained.  Swabbing in hospitals involved all patients in contact precautions. An additional set of swabs were also performed for all LTAC admissions from Nov 2016-Feb 2017.

Results:

The overall prevalence of any MDRO among patients was 64% (44%-88%) in NHs, 80% (range 72%-86%) in LTACs, and 64% (54-84%) in hospitals (contact precaution patients) (Table 1). Only 25%, 64%, and 81% of patients were already known to harbor an MDRO in NHs, LTACs, and hospitals, respectively. Known MDRO patients also harbored another MDRO 49%, 63%, and 34% of the time for NHs, LTACs, and hospitals, respectively. In LTACs, MDRO point prevalence was 38% higher than the usual admission prevalence (65% higher for MRSA, 34% higher for VRE, 95% higher for ESBL, and 50% higher for CRE).  

 

Conclusion:

MDRO carriage in highly inter-connected NHs and LTACs was widespread, rivaling that found in hospitalized patients on contact precautions. MRSA, VRE, and ESBL carriage far outnumbered CRE carriage. A history of MDRO was insensitive for identifying MDRO carriers, and many patients carried multiple MDROs. The extensive MDRO burden and transmission in long term care settings suggests that regional MDRO prevention efforts must include MDRO control in long term care facilities.

Raveena D. Singh, MA1, John A. Jernigan, MD, MS2, Rachel Slayton, PhD, MPH2, Nimalie D. Stone, MD, MS2, James A. McKinnell, MD3, Loren Miller, MD, MPH, FIDSA3, Ken Kleinman, ScD4, Lauren Heim, MPH1, Tabitha D. Dutciuc, MPH1, Marlene Estevez, BA1, Gabrielle Gussin, MS1, Justin Chang, BS1, Ellena M. Peterson, PhD5, Kaye D. Evans, BA/MT5, Bruce Y. Lee, MD, MBA6, Leslie E. Mueller, MPH6, Sarah M. Bartsch, MPH6, Matthew Zahn, MD, FIDSA7, Lynn Janssen, MS, CIC, CPHQ8, Robert A. Weinstein, MD, FIDSA, FSHEA, FACP9, Mary K. Hayden, MD, FIDSA, FSHEA10, Shruti K. Gohil, MD, MPH1, Steven Park, MD, PhD5, Steven Tam, MD11, Raheeb Saavedra, AS1, Stacey Yamaguchi, BA1, Harold Custodio, MPH1, Jenny Nguyen, BA1, Thomas Tjoa, MPH, MS1, Jiayi He, MS1, Kathleen O'Donnell, MPH7, Micaela H. Coady, MS12, Richard Platt, MD, MS, FIDSA, FSHEA12, Susan S. Huang, MD, MPH, FIDSA, FSHEA1 and CDC Safety and Healthcare Epidemiology Prevention Research Development (SHEPheRD) Program, (1)Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, (2)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (3)Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, (4)University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, (5)University of California Irvine Health, Orange, CA, (6)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (7)Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, CA, (8)Healthcare-Associated Infections Program, Center for Healthcare Quality, California Department of Public Health, Richmond, CA, (9)Cook County Health and Hospitals System, Chicago, IL, (10)Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, (11)Division of Geriatrics, Department of Medicine, University of California Irvine, Orange, CA, (12)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA

Disclosures:

R. D. Singh, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

J. A. Jernigan, None

R. Slayton, None

N. D. Stone, None

J. A. McKinnell, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

L. Miller, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

K. Kleinman, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

L. Heim, Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

T. D. Dutciuc, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

M. Estevez, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

G. Gussin, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
L'Oreal: Consultant , Consulting fee

J. Chang, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

E. M. Peterson, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

K. D. Evans, None

B. Y. Lee, GSK: Consultant , Consulting fee

L. E. Mueller, None

S. M. Bartsch, None

M. Zahn, None

L. Janssen, None

R. A. Weinstein, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
OpGen Company: Study support , Provided services at no charge

M. K. Hayden, Sage Products: Receipt of contributed product , Sage is contributing product to healthcare facilities participating in a regional collaborative on which I am a co-investigator. Neither I nor my hospital receive product.
Clorox: Receipt of contributed product , Research support
CDC: Grant Investigator and Receipt of contributed product , Research grant
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
OpGen Company: Study support , Provided services at no charge for studies

S. K. Gohil, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

S. Park, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

S. Tam, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

R. Saavedra, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

S. Yamaguchi, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

H. Custodio, Xttrium Laboratories: Study coordination , Conducting studies in healthcare facilities that are receiving contributed product
Sage Products: Study coordination , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Study coordination , Conducting studies in healthcare facilities that are receiving contributed product

J. Nguyen, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

T. Tjoa, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

J. He, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

K. O'Donnell, None

M. H. Coady, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

R. Platt, Sage Products: Receipt of contributed product , Conducting clinical studies in which participating healthcare facilities are receiving contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting clinical studies in which participating healthcare facilities are receiving contributed product
Clorox: Receipt of contributed product , Conducting clinical studies in which participating healthcare facilities are receiving contributed product; receive research funds from Clorox, but Clorox has no role in the design
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

S. S. Huang, Sage Products: Receipt of contributed product , Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product
Clorox: Receipt of contributed product , Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product
3M: Receipt of contributed product , Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product
Molnlycke: Receipt of contributed product , Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.