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Examining Contact Precautions in Nursing Homes

APR 07, 2017 | SARAH ANWAR
Risk factors that contribute to infection with MDROs in nursing homes include “recent antibiotic exposure [within the past 4 months], dependence for assistance with ADLs (which means contact with healthcare workers), and, also, indwelling medical devices, as well as decubitus ulcers, other wounds, and urinary and fecal incontinence.”
In a study published in Infection Control and Hospital Epidemiology, a SHEA journal, in 2015, researchers investigated the frequency at which nursing home residents transfer MRSA (which Dr. Jump said was “a good surrogate in long-term care for other MDRO transmission”) to healthcare workers’ gowns and gloves during routine care. The researchers found that gloves were contaminated at a higher rate than gowns, and that residents with skin breakdown were more likely to transmit MRSA. “But here’s the thing that always fascinated me about this study. They looked at what the high-risk activities that healthcare workers were doing that were most likely to have them wind up with MRSA on their gowns and gloves: dressing, transferring, hygiene (brushing hair, brushing teeth), changing linens (which is not one I would have thought about), and toileting. So, there are a lot of things that are happening with long-term care residents that would lead to the acquisition of MRSA on the healthcare worker.”
Dr. Jump then went on to break down recommended isolation precautions based on syndrome. In the event of an outbreak of gastroenteritis or norovirus, healthcare personnel working with nursing home residents who have syndrome-specific symptoms should wear gowns, masks, and gloves in most cases; the same measures should be taken with outbreaks of respiratory infections. Most nursing home workers tend to take Respiratory Syncytial Virus (RSV) more seriously than, for example, a cold, and there tends to be much more compliance on precautions from healthcare workers, especially droplet precautions (which require the use of masks). “And finally, scabies; that gets everyone’s attention, and people are really good about wearing gowns and gloves when it comes to scabies.”
Of course, one of the most important infections when it comes to precautions in the nursing home setting is C. difficile. Since spores tend to stay around for longer periods because they’re much more difficult to get rid of, they remain a source of infection transmission, even after symptoms resolve. “As it turns out, the residents themselves will also remain a source of transmission long after symptoms have resolved, because they still have spores on their skin.” Therefore, nursing homes should institute contact precautions early, and use sporicidal agents to disinfect rooms. “In long-term care it makes sense to continue isolation and contact precautions beyond 48 hours to diarrhea resolution, and to keep going for a longer period of time.”

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