Assessing Pathogen Transmission Opportunities: Variation in Nursing Home Staff-Resident Interactions

Nai-Chung Nelson Chang; Molly Leecaster; Scott Fridkin; Will Dube; Morgan Katz; Philip Polgreen; Mary-Claire Roghmann; Karim Khader; Linda Li; Ghinwa Dumyati; Rebecca Tsay; Ruth Lynfield; J P Mahoehney; Joelle Nadle; Jeré Hutson; Rebecca Pierce; Alexia Zhang; Christopher Wilson; Candace Haroldsen; Diane Mulvey; Sujan C Reddy; Nimalie D Stone; Rachel B Slayton; Nicola D Thompson; Kristina Stratford; Matthew Samore; Lindsay D Visnovsky

doi:10.1016/j.jamda.2023.02.018

Assessing Pathogen Transmission Opportunities: Variation in Nursing Home Staff-Resident Interactions

J Am Med Dir Assoc. 2023 May;24(5):735.e1-735.e9. doi: 10.1016/j.jamda.2023.02.018. Epub 2023 Mar 27.

Authors

Nai-Chung Nelson Chang¹, Molly Leecaster¹, Scott Fridkin², Will Dube³, Morgan Katz⁴, Philip Polgreen⁵, Mary-Claire Roghmann⁶, Karim Khader¹, Linda Li⁷, Ghinwa Dumyati⁸, Rebecca Tsay⁸, Ruth Lynfield⁹, J P Mahoehney⁹, Joelle Nadle¹⁰, Jeré Hutson⁷, Rebecca Pierce¹¹, Alexia Zhang¹¹, Christopher Wilson¹², Candace Haroldsen¹, Diane Mulvey¹, Sujan C Reddy¹³, Nimalie D Stone¹³, Rachel B Slayton¹³, Nicola D Thompson¹⁴, Kristina Stratford¹, Matthew Samore¹, Lindsay D Visnovsky¹⁵

Affiliations

¹ Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
² Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Georgia Emerging Infections Program, Atlanta, GA, USA.
³ Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
⁴ Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
⁶ Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; VA Maryland Health Care System, Baltimore, MD, USA.
⁷ Maryland Emerging Infections Program, Baltimore, MD, USA; Maryland Department of Health, Baltimore, MD, USA.
⁸ Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, USA; New York/Rochester Emerging Infections Program, Rochester, NY, USA.
⁹ Minnesota Department of Health, St. Paul, MN, USA.
¹⁰ California Emerging Infections Programs, Oakland, CA, USA.
¹¹ Oregon Public Health Division, Oregon Health Authority, Portland, OR, USA.
¹² Tennessee Emerging Infections Program, Nashville, TN, USA; Tennessee Department of Health, Nashville, TN, USA.
¹³ Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
¹⁴ Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
¹⁵ Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA. Electronic address: lindsay.visnovsky@hsc.utah.edu.

PMID: 36996876
DOI: 10.1016/j.jamda.2023.02.018

Abstract

Objectives: The Centers for Disease Control and Prevention (CDC) recommends implementing Enhanced Barrier Precautions (EBP) for all nursing home (NH) residents known to be colonized with targeted multidrug-resistant organisms (MDROs), wounds, or medical devices. Differences in health care personnel (HCP) and resident interactions between units may affect risk of acquiring and transmitting MDROs, affecting EBP implementation. We studied HCP-resident interactions across a variety of NHs to characterize MDRO transmission opportunities.

Design: 2 cross-sectional visits.

Setting and participants: Four CDC Epicenter sites and CDC Emerging Infection Program sites in 7 states recruited NHs with a mix of unit care types (≥30 beds or ≥2 units). HCP were observed providing resident care.

Methods: Room-based observations and HCP interviews assessed HCP-resident interactions, care type provided, and equipment use. Observations and interviews were conducted for 7-8 hours in 3-6-month intervals per unit. Chart reviews collected deidentified resident demographics and MDRO risk factors (eg, indwelling devices, pressure injuries, and antibiotic use).

Results: We recruited 25 NHs (49 units) with no loss to follow-up, conducted 2540 room-based observations (total duration: 405 hours), and 924 HCP interviews. HCP averaged 2.5 interactions per resident per hour (long-term care units) to 3.4 per resident per hour (ventilator care units). Nurses provided care to more residents (n = 12) than certified nursing assistants (CNAs) and respiratory therapists (RTs) (CNA: 9.8 and RT: 9) but nurses performed significantly fewer task types per interaction compared to CNAs (incidence rate ratio (IRR): 0.61, P < .05). Short-stay (IRR: 0.89) and ventilator-capable (IRR: 0.94) units had less varied care compared with long-term care units (P < .05), although HCP visited residents in these units at similar rates.

Conclusions and implications: Resident-HCP interaction rates are similar across NH unit types, differing primarily in types of care provided. Current and future interventions such as EBP, care bundling, or targeted infection prevention education should consider unit-specific HCP-resident interaction patterns.

Keywords: Infection prevention; MDRO; care delivery patterns; enhanced barrier precautions; nursing homes.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Anti-Bacterial Agents
Cross-Sectional Studies
Health Personnel
Humans
Infection Control*
Nursing Homes*

Substances

Anti-Bacterial Agents

Grants and funding

U01 CK000555/CK/NCEZID CDC HHS/United States