On the other hand, isolation precautions for specific pathogens, such as MRSA, VRE, ESBLs, CRE, is different. The duration of colonization is unknown (could be several months). Likewise, the risk of colonization turning into infection is also unclear. “We don’t have decolonization protocols that we know will work past the end of the decolonization protocol. For adults, and for long-term care, in general, it seems that after someone has been decolonized, they are at high risk of getting decolonized.” Therefore, what may be effective for one week after treatment cessation, may not be effective the second week thereafter.
“So, is there a better way to think about this in long-term care? Thankfully, the answer is ‘yes,’” said Dr. Jump before discussing a controlled targeted infection prevention study
This study focused on nursing home residents with either urinary catheters or feeding tubes. Healthcare workers assisting nursing home residents were required to practice proper hand hygiene before and after handling the resident, wear gowns and gloves during morning and evening care, and during device care. This study also required “weekly intense meetings” for staff education and active surveillance for MDROs.
More than 6,000 samples were collected from the 418 residents enrolled in the study. “Through this intensive intervention, focusing not on people with a bacterial syndrome, but on people with devices, regardless of what they may or may not be colonized with, [the researchers] were able to decrease MDRO prevalence (rate ratio, 0.77; 95% CI, 0.62-0.94). They decreased the rate of new MRSA acquisitions (rate ratio, 0.78; 95% CI, 0.64-0.96), they decreased the risk of a first CAUTI [catheter-associated urinary tract infections], and of all CAUTIs, and this is phenomenal.” According to the study, “Hazard ratios for the first and all (including recurrent) clinically defined CAUTIs was 0.54 (95% CI, 0.30-0.97) and 0.69 (95% CI, 0.49-0.99), respectively in the intervention group and the control group. There were no reductions in new vancomycin-resistant enterococci or resistant gram-negative bacilli acquisitions or in new feeding tube-associated pneumonias or skin and soft tissue infections.”
Dr. Jump said, “It’s much easier to not think about the alphabet soup of what someone might have, but [rather] to know that they have a wound, or they have a urinary catheter, or they have some kind of central line, and how to act with that device, or how to respond to that device.”
In terms of contact precautions for in-room care, on the other hand, Dr. Jump recommends, practicing proper hand hygiene and wearing gowns and gloves prior to room entry. Upon exiting a room, healthcare workers are to remove these gowns and gloves, and then do hand hygiene again. Healthcare workers should also use single-use equipment in long-term care when feasible and should try to dedicate equipment to individual residents when possible. Cleaning and disinfecting equipment that cannot be individualized is very important so as to not transmit infections between patients. All personal protective equipment should be sufficiently stocked at the site of care. “So the burden here falls on healthcare workers,” said Dr. Jump.