Pathway From Functional Disability to Antimicrobial Resistance in Nursing Home Residents
- Conditions
- Multi-antibiotic Resistance
- Interventions
- Behavioral: Multi-modal Infection Control Program
- Registration Number
- NCT02909946
- Lead Sponsor
- University of Michigan
- Brief Summary
Multidrug-resistant organisms (MDROs) are endemic in nursing homes (NHs) with prevalence rates surpassing those in hospitals. The aim of the study is to design and evaluate the effectiveness of a multi-component intervention to reduce new acquisition of MDROs in NH residents. The intervention will incorporate resident-level, environmental, and caregiver based strategies. Using a cluster-randomized study design, three NHs will be randomized to the intervention group and three to the control group. Control NHs will be allowed to continue standard infection prevention practices. Nursing homes will serve as the unit of allocation. Analyses will be performed both at the resident and the cluster level. The primary outcomes of the study are reduction in MDRO prevalence, and reduction in new MDRO acquisition .
- Detailed Description
The NH intervention will incorporate resident-level, environmental, and caregiver based strategies, including: a. Standard precautions and hand hygiene for care of all residents. Enhanced barrier precautions including hand hygiene, glove use, and gown use for healthcare workers (HCW) when providing activities of daily living (ADL) assistance for residents at highest-risk (caregiver intervention); b. Hand hygiene education to residents and families (resident-level intervention); c. Standardized bathing practices including using chlorhexidine-based cloths to reduce resident MDRO colonization (resident-level intervention); d. Standardized environmental protocol and education to reduce contamination on inanimate objects and surfaces (environmental intervention); e. Feedback monthly of facility-level microbial data and new MDRO acquisition rates to infection preventionists, front-line healthcare personnel, and facility leadership (facility intervention).
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 246
- Age ≥ 18 years old
- Residing in a participating NH facility
- Provided informed consent for participation
- Receiving end-of-life care
- Non-English language speaking
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention Arm Multi-modal Infection Control Program NHs randomized to the Intervention Arm will implement a new multi-modal infection control program.
- Primary Outcome Measures
Name Time Method Prevalence density of multidrug-resistant organisms (MDRO) From enrollment up to 6 months of study followup, or until study withdrawal (discharged from facility, at resident request, death) Total number of MDROs isolated across all MDROs and all anatomic sites for all enrolled residents over the duration of the study period
- Secondary Outcome Measures
Name Time Method Incidence of multidrug-resistant organisms (MDRO) From enrollment up to 6 months of study followup, or until study withdrawal (discharged from facility, at resident request, death) Total number of MDROs newly acquired (resident not colonized at baseline) isolated across all MDROs for all enrolled residents over the duration of the study period
Incidence of healthcare-associated infections From enrollment up to 6 months of study followup, or until study withdrawal (discharged from facility, at resident request, death) Total number of new infections acquired at the nursing home for all enrolled residents over the duration of the study period
Trial Locations
- Locations (1)
University of Michigan and partner nursing homes
🇺🇸Ann Arbor, Michigan, United States