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Targeted gown and glove use to prevent Staphylococcus aureus acquisition in community-based nursing homes: A pilot study

Published online by Cambridge University Press:  20 October 2020

Alison D. Lydecker ,
Patience A. Osei ,
Lisa Pineles ,
J. Kristie Johnson ,
Jacquelyn Meisel ,
O. Colin Stine ,
Laurence Magder ,
Ayse P. Gurses ,
Joan Hebden  and
Cagla Oruc
...Show all authors
Alison D. Lydecker
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Patience A. Osei
Affiliation:
Armstrong Institute Center for Health Care Human Factors, Johns Hopkins School of Medicine, Baltimore, Maryland
Lisa Pineles
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Jacquelyn Meisel
Affiliation:
Center for Bioinformatics and Computational Biology, University of Maryland, College Park, Maryland
O. Colin Stine
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Laurence Magder
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Ayse P. Gurses
Affiliation:
Armstrong Institute Center for Health Care Human Factors, Johns Hopkins School of Medicine, Baltimore, Maryland Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Joan Hebden
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Cagla Oruc
Affiliation:
Armstrong Institute Center for Health Care Human Factors, Johns Hopkins School of Medicine, Baltimore, Maryland
Lona Mody
Affiliation:
Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
Kara Jacobs Slifka
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Nimalie D. Stone
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Mary-Claire Roghmann*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
*
Author for correspondence: Mary-Claire Roghmann, E-mail: [email protected]
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Abstract

Objective:

To test the feasibility of targeted gown and glove use by healthcare personnel caring for high-risk nursing-home residents to prevent Staphylococcus aureus acquisition in short-stay residents.

Design:

Uncontrolled clinical trial.

Setting:

This study was conducted in 2 community-based nursing homes in Maryland.

Participants:

The study included 322 residents on mixed short- and long-stay units.

Methods:

During a 2-month baseline period, all residents had nose and inguinal fold swabs taken to estimate S. aureus acquisition. The intervention was iteratively developed using a participatory human factors engineering approach. During a 2-month intervention period, healthcare personnel wore gowns and gloves for high-risk care activities while caring for residents with wounds or medical devices, and S. aureus acquisition was measured again. Whole-genome sequencing was used to assess whether the acquisition represented resident-to-resident transmission.

Results:

Among short-stay residents, the methicillin-resistant S. aureus acquisition rate decreased from 11.9% during the baseline period to 3.6% during the intervention period (odds ratio [OR], 0.28; 95% CI, 0.08–0.92; P = .026). The methicillin-susceptible S. aureus acquisition rate went from 9.1% during the baseline period to 4.0% during the intervention period (OR, 0.41; 95% CI, 0.12–1.42; P = .15). The S. aureus resident-to-resident transmission rate decreased from 5.9% during the baseline period to 0.8% during the intervention period.

Conclusions:

Targeted gown and glove use by healthcare personnel for high-risk care activities while caring for residents with wounds or medical devices, regardless of their S. aureus colonization status, is feasible and potentially decreases S. aureus acquisition and transmission in short-stay community-based nursing-home residents.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 4 , April 2021 , pp. 448 - 454
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Authors of equal contribution.

ClinicalTrials.gov study number: NCT03319368.

References

Bradley, SF. Methicillin-resistant Staphylococcus aureus in nursing homes. Epidemiology, prevention and management. Drugs Aging 1997;10:185–198.CrossRefGoogle Scholar
Weissert, WG. Seven reasons why it is so difficult to make community-based long-term care cost-effective. Health Serv Res 1985;20:423–433.Google ScholarPubMed
Furuno, JP, Shurland, SM, Zhan, M, et al. Comparison of the methicillin-resistant Staphylococcus aureus acquisition among rehabilitation and nursing home residents. Infect Control Hosp Epidemiol 2011;32:244–249.CrossRefGoogle ScholarPubMed
Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.CrossRefGoogle ScholarPubMed
Datta, R, Huang, SS. Risk of infection and death due to methicillin-resistant Staphylococcus aureus in long-term carriers. Clin Infect Dis 2008;47:176–181.CrossRefGoogle ScholarPubMed
Epstein, L, Mu, Y, Belflower, R, et al. Risk factors for invasive methicillin-resistant Staphylococcus aureus infection after recent discharge from an acute-care hospitalization, 2011–2013. Clin Infect Dis 2016;62:45–52.CrossRefGoogle ScholarPubMed
Roghmann, M-C, Johnson, JK, Sorkin, JD, et al. Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents. Infect Control Hosp Epidemiol 2015;36:1050–1057.CrossRefGoogle ScholarPubMed
Mody, L, Krein, SL, Saint, S, et al. A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial. JAMA Intern Med 2015;175:714–723.CrossRefGoogle ScholarPubMed
Dumyati, G, Stone, ND, Nace, DA, Crnich, CJ, Jump, RLP. Challenges and strategies for prevention of multidrug-resistant organism transmission in nursing homes. Curr Infect Dis Rep 2017;19:18.CrossRefGoogle ScholarPubMed
Furuno, JP, Krein, S, Lansing, B, Mody, L. Health care worker opinions on use of isolation precautions in long-term care facilities. Am J Infect Control 2012;40:263–266.CrossRefGoogle ScholarPubMed
Gurses, AP, Rosen, MA, Pronovost, PJ. Improving guideline compliance andhealthcare safety using human factors engineering: the case of Ebola. J Patient Safety Risk Managem 2018;23:93–95.CrossRefGoogle Scholar
Gurses, AP, Seidl, KL, Vaidya, V, et al. Systems ambiguity and guideline compliance: a qualitative study of how intensive care units follow evidence-based guidelines to reduce healthcare-associated infections. Qual Saf Health Care 2008;17:351–359.CrossRefGoogle ScholarPubMed
McGlynn, EA, Asch, SM, Adams, J, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003;348:2635–2645.CrossRefGoogle ScholarPubMed
Gyi, D, Shalloe, S, Wilson, JR. Participatory ergonomics. In: Wilson, JR, Sharples, S, eds. Evaluation of Human Work, vol 4. Boca Raton, FL: CRC Press; 2015: 883–906.Google Scholar
Xie, A, Rock, C, Hsu, Y-J, et al. Improving daily patient room cleaning: an observational study using a human factors and systems engineering approach. IISE Trans Occup Ergon Hum Factors 2018;6:178–191.CrossRefGoogle ScholarPubMed
Qualitative longitudinal interview data: men’s transition to fatherhood. SAGE research methods datasets website. http://methods.sagepub.com/base/download/DatasetStudentGuide/qualitative-longitudinal-interviews-men-transition-to-fatherhood. Published 2015. Accessed October 11, 2019.Google Scholar
Pineles, L, Morgan, DJ, Lydecker, A, et al. Transmission of methicillin-resistant Staphylococcus aureus to health care worker gowns and gloves during care of residents in Veterans’ Affairs nursing homes. Am J Infect Control 2017;45:947–953.CrossRefGoogle Scholar
Bolger, AM, Lohse, M, Usadel, B. Trimmomatic: a flexible trimmer for Illumina sequence data. Bioinformatics 2014;30:2114–2120.CrossRefGoogle ScholarPubMed
Brown, J, Pirrung, M, McCue, LA. FQC Dashboard: integrates FastQC results into a web-based, interactive, and extensible FASTQ quality control tool. Bioinformatics 2017;33:3137–3139.CrossRefGoogle ScholarPubMed
Treangen, TJ, Ondov, BD, Koren, S, Phillippy, AM. The Harvest suite for rapid core-genome alignment and visualization of thousands of intraspecific microbial genomes. Genome Biol 2014;15:524.CrossRefGoogle ScholarPubMed
Stine, OC, Burrowes, S, David, S, Johnson, JK, Roghmann, MC. Transmission clusters of methicillin-resistant Staphylococcus aureus in long-term care facilities based on whole-genome sequencing. Infect Control Hosp Epidemiol 2016;37:685–691.Google ScholarPubMed
Blanco, N, Johnson, JK, Sorkin, JD, et al. Transmission of resistant gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities. Infect Control Hosp Epidemiol 2018;39:1425–1430.CrossRefGoogle ScholarPubMed
Bohr, PC, Evanoff, BA, Wolf, LD. Implementing participatory ergonomics teams among health care workers. Am J Ind Med 1997;32:190–196.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Evanoff, BA, Bohr, PC, Wolf, LD. Effects of a participatory ergonomics team among hospital orderlies. Am J Ind Med 1999;35:358–365.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
Fragala, G, Santamaria, D. Heavy duties? On-the-job back injuries are a bigger—and costlier—pain than you think. Health Facil Manage 1997;10:22–27.Google Scholar
Xie, A, Carayon, P, Cox, ED, et al. Application of participatory ergonomics to the redesign of the family-centred rounds process. Ergonomics 2015;58:1726–1744.CrossRefGoogle ScholarPubMed
Rock, C, Cosgrove, SE, Keller, SC, et al. Using a human factors engineering approach to improve patient room cleaning and disinfection. Infect Control Hosp Epidemiol 2016;37:1502–1506.Google ScholarPubMed
Gurses, AP, Dietz, AS, Nowakowski, E, et al. Human factors-based risk analysis to improve the safety of doffing enhanced personal protective equipment. Infect Control Hosp Epidemiol 2019;40:178–186.CrossRefGoogle ScholarPubMed
Jun, GT, Canham, A, Altuna-Palacios, A, et al. A participatory systems approach to design for safer integrated medicine management. Ergonomics 2018;61:48–68.CrossRefGoogle ScholarPubMed
Katz, MJ, Osei, PM, Vignesh, A, Montalvo, A, Oresanwo, I, Gurses, AP. Respiratory practices in the long-term care setting: a human factors-based risk analysis. J Am Med Dir Assoc 2019.Google ScholarPubMed
Udo, H, Kobayashi, M, Udo, A, Branlund, B. Participatory ergonomic improvement in nursing home. Ind Health 2006;44:128–134.CrossRefGoogle ScholarPubMed
Albrecht, JS, Croft, L, Morgan, DJ, Roghmann, MC. Perceptions of gown and glove use to prevent methicillin-resistant Staphylococcus aureus transmission in nursing homes. J Am Med Dir Assoc 2017;18:158–161.CrossRefGoogle ScholarPubMed
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