1696. When a Home is Not a Home: MultiDrug-Resistant Organism (MDRO) Colonization and Environmental Contamination in 28 Nursing Homes (NHs)
Session: Oral Abstract Session: Resist! MDROs in Healthcare
Friday, October 6, 2017: 2:00 PM
Room: 01AB

Background:

The majority of healthcare-associated infections due to MDROs occur in the post-discharge setting. Understanding MDRO spread and containment in NHs can help identify infection prevention activities needed to care for vulnerable patients in a medical home setting.

Methods:

We conducted a baseline point prevalence study of MDRO colonization in residents of 28 Southern California NHs participating in a decolonization trial. In Fall 2016, residents were randomly sampled to obtain a set of 50 nares and skin (axilla/groin) swabs from each NH. Nasal swabs were processed for MRSA and skin swabs were processed for MRSA, VRE, ESBL, and CRE. In addition, environmental swabs were collected from high touch objects in resident rooms (bedrail, call button/TV remote, door knobs, light switch, bathroom) and common areas (nursing station, table, chair, railing, and drinking fountain).

Results:

A total of 2,797 body swabs were obtained from 1400 residents. Overall, 48.6% (N=680) of residents harbored MDROs. MRSA was found in 37% of residents (29.5% nares, 24.4% skin), followed by ESBL in 16% (Table 1). Resident MDRO status was only known for 11% of MRSA (59/518), 18% ESBL (40/228), 4% VRE (4/99), and none of the CRE (0/13) carriers. Colonization did not differ between long stay (48.8%, 534/1094) vs. post-acute (47.7%, 146/306) residents (p=NS), but bedbound residents were more likely to be MDRO colonized (58.7%, 182/310) vs ambulatory residents (45.7%, 497/1088, p<0.001). A total of 560 environmental swabs were obtained with 93% of common areas and 74% of resident rooms having an MDRO+ object with an average of 2.5 and 1.9 objects found to be contaminated (Table 2).

Conclusion:

One in two NH residents are colonized with MDROs, which is largely unknown to the facility. MDRO carriage is associated with total care needs, but not long stay status. Environmental contamination in resident rooms and common areas is common. The burden of MDRO colonization and contamination is sufficiently high that universal strategies to reduce colonization and transmission are warranted.

 

James A. McKinnell, MD1,2,3,4, Loren Miller, MD, MPH, FIDSA4, Raveena D. Singh, MA5, Job Mendez, RN, MD4, Ryan Franco, BS4, Gabrielle Gussin, MS5, Justin Chang, BS5, Tabitha D. Dutciuc, MPH5, Raheeb Saavedra, AS5, Ken Kleinman, ScD6, Ellena M. Peterson, PhD7, Kaye D. Evans, BA/MT7, Lauren Heim, MPH5, Aaron Miner, BA8, Marlene Estevez, BA5, Harold Custodio, MPH5, Stacey Yamaguchi, BA5, Jenny Nguyen, BA5, Alex Varasteh, BA4, Bryn Launer, BA9, Shalini Agrawal, BS4, Thomas Tjoa, MPH, MS5, Jiayi He, MS5, Steven Park, MD, PhD7, Steven Tam, MD10, Shruti K. Gohil, MD, MPH5, Nimalie D. Stone, MD, MS11, Karl Steinberg, MD12, Jocelyn Montgomery, RN PHN13, Nancy Beecham, RN14 and Susan S. Huang, MD, MPH, FIDSA, FSHEA5, (1)David Geffen School of Medicine at UCLA, Torrance, CA, (2)Expert Stewardship, LLC, Newport Beach, CA, (3)Los Angeles County Department of Public Health, Healthcare Outreach Unit (HOU), Los Angeles, CA, (4)Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, (5)Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, (6)University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, (7)University of California Irvine Health, Orange, CA, (8)Infectious Disease, LA BioMed Research Institute at Harbor-UCLA, Torrance, CA, (9)University of Colorado Denver School of Medicine, Aurora, CO, (10)Division of Geriatrics, Department of Medicine, University of California Irvine, Orange, CA, (11)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (12)The Society for Post-Acute and Long-Term Care Medicine (AMDA), San Diego, CA, (13)California Association of Health Facilities (CAHF), Sacramento, CA, (14)National Association Directors of Nursing Administration in Long-Term Care (NADONA), San Diego, CA

Disclosures:

J. A. McKinnell, Allergan: Research Contractor , Scientific Advisor and Speaker's Bureau , Consulting fee , Research support and Speaker honorarium
Achaogen: Research Contractor , Scientific Advisor and Shareholder , Research support
Cempra: Research Contractor and Scientific Advisor , Research support
Theravance: Research Contractor , Research support
Science 37: Research Contractor , Salary
Expert Stewardship, LLC: Board Member and Employee , Salary
Thermo Fisher: Scientific Advisor , Salary
3M: 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
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

L. Miller, 3M: 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
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

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. Mendez, 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 Laboratories: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

R. Franco, 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 Laboratories: 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

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

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

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

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

K. D. Evans, None

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

A. Miner, 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 Laboratories: 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

H. Custodio, Xttrium Laboratories: 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
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

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

A. Varasteh, Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Sage Product: 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

B. Launer, 3M: 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
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

S. Agrawal, 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 Laboratories: 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

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

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

N. D. Stone, None

K. Steinberg, None

J. Montgomery, None

N. Beecham, None

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

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