A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial

JAMA Internal Medicine
Lona ModySuzanne F Bradley

Abstract

Indwelling devices (eg, urinary catheters and feeding tubes) are often used in nursing homes (NHs). Inadequate care of residents with these devices contributes to high rates of multidrug-resistant organisms (MDROs) and device-related infections in NHs. To test whether a multimodal targeted infection program (TIP) reduces the prevalence of MDROs and incident device-related infections. Randomized clinical trial at 12 community-based NHs from May 2010 to April 2013. Participants were high-risk NH residents with urinary catheters, feeding tubes, or both. Multimodal, including preemptive barrier precautions, active surveillance for MDROs and infections, and NH staff education. The primary outcome was the prevalence density rate of MDROs, defined as the total number of MDROs isolated per visit averaged over the duration of a resident's participation. Secondary outcomes included new MDRO acquisitions and new clinically defined device-associated infections. Data were analyzed using a mixed-effects multilevel Poisson regression model (primary outcome) and a Cox proportional hazards model (secondary outcome), adjusting for facility-level clustering and resident-level variables. In total, 418 NH residents with indwelling devices were enro...Continue Reading

Citations

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