A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices: A Randomized Clinical Trial

摘要: Importance Indwelling devices (eg, urinary catheters and feeding tubes) are often used in nursing homes (NHs). Inadequate care of residents with these contributes to high rates multidrug-resistant organisms (MDROs) device-related infections NHs. Objective To test whether a multimodal targeted infection program (TIP) reduces the prevalence MDROs incident infections. Design, setting, participants Randomized clinical trial at 12 community-based NHs from May 2010 April 2013. Participants were high-risk NH catheters, tubes, or both. Interventions Multimodal, including preemptive barrier precautions, active surveillance for infections, staff education. Main outcomes measures The primary outcome was density rate MDROs, defined as total number isolated per visit averaged over duration resident's participation. Secondary included new MDRO acquisitions clinically device-associated Data analyzed using mixed-effects multilevel Poisson regression model (primary outcome) Cox proportional hazards (secondary outcome), adjusting facility-level clustering resident-level variables. Results In total, 418 indwelling enrolled, 34,174 device-days 6557 anatomic sites sampled. Intervention had decrease overall (rate ratio, 0.77; 95% CI, 0.62-0.94). methicillin-resistant Staphylococcus aureus lower intervention group than control 0.78; 0.64-0.96). Hazard ratios first all (including recurrent) catheter-associated tract 0.54 (95% 0.30-0.97) 0.69 0.49-0.99), respectively, group. There no reductions vancomycin-resistant enterococci resistant gram-negative bacilli tube-associated pneumonias skin soft-tissue Conclusions relevance Our TIP reduced density, S acquisitions, devices. Further studies needed evaluate cost-effectiveness this approach well its effects on reduction transmission other residents, environment, referring hospitals. Trial registration clinicaltrials.gov Identifier: NCT01062841.