scholarly journals Methicillin-ResistantStaphylococcus aureus:Site of Acquisition and Strain Variation in High-Risk Nursing Home Residents with Indwelling Devices

2014 ◽  
Vol 35 (12) ◽  
pp. 1458-1465 ◽  
Author(s):  
Kristen E. Gibson ◽  
Sara E. McNamara ◽  
Marco Cassone ◽  
Mary Beth Perri ◽  
Marcus Zervos ◽  
...  
Keyword(s):  
Nursing Home ◽  
High Risk ◽  
Urinary Catheter ◽  
Insertion Site ◽  
Nursing Home Residents ◽  
Feeding Tube ◽  
Perianal Area ◽  
Multicenter Prospective Observational Study ◽  
Healthcare Associated ◽  
Mrsa Colonization

Objective.Characterize the clinical and molecular epidemiology of new methicillin-resistantStaphylococcus aureus(MRSA) acquisitions at nasal and extranasal sites among high-risk nursing home (NH) residents.Design.Multicenter prospective observational study.Setting.Six NHs in southeast Michigan.Participants.A total of 120 NH residents with an indwelling device (feeding tube and/or urinary catheter).Methods.Active surveillance cultures from the nares, oropharynx, groin, perianal area, wounds (if present), and device insertion site(s) were collected upon enrollment, at day 14, and monthly thereafter. Pulsed-field gel electrophoresis and polymerase chain reaction for SCCmec, agr, and Panton-Valentine leukocidin were performed.Results.Of 120 participants observed for 16,290 device-days, 50 acquired MRSA (78% transiently, 22% persistently). New MRSA acquisitions were common in extranasal sites, particularly at device insertion, groin, and perianal areas (27%, 23%, and 17.6% of all acquisitions, respectively). Screening extranasal sites greatly increases the detection of MRSA colonization (100% of persistent carriers and 97.4% of transient carriers detected with nares, groin, perianal, and device site sampling vs 54.5% and 25.6%, respectively, for nares samples alone). Colonization at suprapubic urinary catheter sites generally persisted. Healthcare-associated MRSA (USA100 and USA100 variants) were the dominant strains (79.3% of all new acquisition isolates). Strain diversity was more common in transient carriers, including acquisition of USA500 and USA300 strains.Conclusion.Indwelling device insertion sites as well as the groin and perianal area are important sites of new MRSA acquisitions in NH residents and play a role in the persistency of MRSA carriage. Clonal types differ among persistent and transient colonizers.

scholarly journals Prevalence of and Risk Factors for Multidrug-ResistantAcinetobacter baumanniiColonization Among High-Risk Nursing Home Residents

2015 ◽  
Vol 36 (10) ◽  
pp. 1155-1162 ◽  
Author(s):  
Lona Mody ◽  
Kristen E. Gibson ◽  
Amanda Horcher ◽  
Katherine Prenovost ◽  
Sara E. McNamara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
High Risk ◽  
Functional Disability ◽  
Insertion Site ◽  
Nursing Home Residents ◽  
Feeding Tube ◽  
Multidrug Resistant ◽  
Antibiotic Resistant ◽  
Nested Case Control

OBJECTIVETo characterize the epidemiology of multidrug-resistant (MDR)Acinetobacter baumanniicolonization in high-risk nursing home (NH) residents.DESIGNNested case-control study within a multicenter prospective intervention trial.SETTINGFour NHs in Southeast Michigan.PARTICIPANTSCase patients and control subjects were NH residents with an indwelling device (urinary catheter and/or feeding tube) selected from the control arm of the Targeted Infection Prevention study. Cases were residents colonized with MDR (resistant to ≥3 classes of antibiotics)A. baumannii; controls were never colonized with MDRA. baumannii.METHODSFor active surveillance cultures, specimens from the nares, oropharynx, groin, perianal area, wounds, and device insertion site(s) were collected upon study enrollment, day 14, and monthly thereafter.A. baumanniistrains and their susceptibilities were identified using standard microbiologic methods.RESULTSOf 168 NH residents, 25 (15%) were colonized with MDRA. baumannii. Compared with the 143 controls, cases were more functionally disabled (Physical Self-Maintenance Score >24; odds ratio, 5.1 [95% CI, 1.8–14.9];P<.004), colonized withProteus mirabilis(5.8 [1.9–17.9];P<.003), and diabetic (3.4 [1.2–9.9];P<.03). Most cases (22 [88%]) were colonized with multiple antibiotic-resistant organisms and 16 (64%) exhibited co-colonization with at least one other resistant gram-negative bacteria.CONCLUSIONFunctional disability,P. mirabiliscolonization, and diabetes mellitus are important risk factors for colonization with MDRA. baumanniiin high-risk NH residents.A. baumanniiexhibits widespread antibiotic resistance and a preference to colonize with other antibiotic-resistant organisms, meriting enhanced attention and improved infection control practices in these residents.Infect Control Hosp Epidemiol 2015;36(10):1155–1162

scholarly journals Transmission of Resistant Gram-Negative Bacteria to Health Care Worker Gowns and Gloves during Care of Nursing Home Residents in Veterans Affairs Community Living Centers

2017 ◽  
Vol 61 (10) ◽  
Author(s):  
Natalia Blanco ◽  
Lisa Pineles ◽  
Alison D. Lydecker ◽  
J. Kristie Johnson ◽  
John D. Sorkin ◽  
...  
Keyword(s):  
Health Care ◽  
Nursing Home ◽  
High Risk ◽  
Glucose Monitoring ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Veterans Affairs ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Multicenter Prospective Observational Study

ABSTRACT The objectives of the study were to estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves (G&G) worn by health care workers (HCWs) when providing care to nursing home residents and to identify the types of care and resident characteristics associated with transmission. A multicenter, prospective observational study was conducted with residents and HCWs from Veterans Affairs (VA) nursing homes. Perianal swabs to detect RGNB were collected from residents. HCWs wore G&G during usual care activities, and the G&G were swabbed at the end of the interaction in a standardized manner. Transmission of RGNB from a colonized resident to G&G by type of care was measured. Odds ratios (ORs) associated with type of care or resident characteristics were estimated. Fifty-seven (31%) of 185 enrolled residents were colonized with ≥1 RGNB. RGNB transmission to HCW gloves or gowns occurred during 9% of the interactions (n = 905): 7% to only gloves and 2% to only gowns. Bathing the resident and providing hygiene and toilet assistance were associated with a high risk of transmission. Glucose monitoring and assistance with feeding or medication were associated with a low risk of transmission. In addition, antibiotic use by the resident was strongly associated with greater transmission (OR, 2.51; P < 0.01). RGNB were transferred to HCWs during ∼9% of visits. High-risk types of care were identified for which use of G&G may be prioritized. Antibiotic use was associated with 2.5 times greater risk of transmission, emphasizing the importance of antibiotic stewardship. (This study has been registered at ClinicalTrials.gov under registration no. NCT01350479.)

1035-P: HbA1c Does Not Identify Nursing Home Residents at High Risk of Hypoglycemia and Hyperglycemia

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 1035-P
Author(s):  
ALEXANDRA K. LEE ◽  
SEI J. LEE ◽  
BOCHENG JING ◽  
MEDHA MUNSHI ◽  
ANDREW J. KARTER
Keyword(s):  
Nursing Home ◽  
High Risk ◽  
Nursing Home Residents

Hospitalization for Pneumonia Carries High Risk of Severe Disability and Death for Nursing Home Residents

2020 ◽  
Vol 21 (3) ◽  
pp. B31
Author(s):  
Matthew Griffith ◽  
Matthew Griffith ◽  
Cari Levy ◽  
Toral Parikh ◽  
Pedro Gozalo ◽  
...  
Keyword(s):  
Nursing Home ◽  
High Risk ◽  
Nursing Home Residents ◽  
Severe Disability

scholarly journals Paramedics’ Perspectives on the Hospital Transfers of Nursing Home Residents—A Qualitative Focus Group Study

2020 ◽  
Vol 17 (11) ◽  
pp. 3778
Author(s):  
Alexandra Pulst ◽  
Alexander Maximilian Fassmer ◽  
Falk Hoffmann ◽  
Guido Schmiemann
Keyword(s):  
Nursing Home ◽  
Nursing Staff ◽  
Hospital Admissions ◽  
Urinary Catheter ◽  
Nursing Home Residents ◽  
Point Of View ◽  
Focus Group Study ◽  
Professional Groups ◽  
Catheter Complications ◽  
Ed Visits

Emergency department (ED) visits and hospital admissions are common among nursing home residents (NHRs). Little is known about the perspectives of emergency medical services (EMS) which are responsible for hospital transports. The aim of this study was to explore paramedics’ experiences with transfers from nursing homes (NHs) and their ideas for possible interventions that can reduce transfers. We conducted three focus groups following a semi-structured question guide. The data were analyzed by content analysis using the software MAXQDA. In total, 18 paramedics (mean age: 33 years, male n = 14) participated in the study. Paramedics are faced with complex issues when transporting NHRs to hospital. They mainly reported on structural reasons (e.g., understaffing or lacking availability of physicians), which led to the initiation of an emergency call. Handovers were perceived as poorly organized because required transfer information (e.g., medication lists, advance directives (ADs)) were incomplete or nursing staff was insufficiently prepared. Hospital transfers were considered as (potentially) avoidable in case of urinary catheter complications, exsiccosis/infections and falls. Legal uncertainties among all involved professional groups (nurses, physicians, dispatchers, and paramedics) seemed to be a relevant trigger for hospital transfers. In paramedics’ point of view, emergency standards in NHs, trainings for nursing staff, the improvement of working conditions and legal conditions can reduce potentially avoidable hospital transfers from NHs.

scholarly journals Screening for atrial fibrillation in high-risk nursing home residents

2020 ◽  
Vol 1 (1) ◽  
pp. 10-13
Author(s):  
Hassan A. Khan ◽  
Nader Hanna ◽  
Michael J. Chaskes ◽  
Gregory D. Gudleski ◽  
Piotr Karmilowicz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nursing Home ◽  
High Risk ◽  
Nursing Home Residents

Preferences for Feeding Tube Use and Their Determinants Among Cognitively Intact Nursing Home Residents in Wuhan, China: A Cross-Sectional Study

2019 ◽  
Vol 31 (1) ◽  
pp. 13-21 ◽  
Author(s):  
Ping Ni ◽  
Eunjeong Ko ◽  
Jing Mao
Keyword(s):  
Nursing Home ◽  
Health Care Professionals ◽  
Mainland China ◽  
Nursing Home Residents ◽  
Feeding Tube ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Chinese Older Adults ◽  
Face To Face ◽  
Advance Care

Introduction: Standard advance care planning practice is yet to be established in Mainland, China, and little is known about feeding tube preferences among Chinese nursing home residents. The purpose of the study was to examine preferences for feeding tube use and its predictors among frail and cognitively competent nursing home residents in Wuhan, China. Method: A cross-sectional sample of 682 nursing home residents were interviewed face-to-face using a structured questionnaire from 2012 to 2014. Results: A total of 54.5% of participants would accept feeding tube. Participants who reported greater quality of life (odds ratio [OR] = 2.67), having health insurance (OR = 2.09) were more willing to accept feeding tube. Participants with greater impairment in physical health (OR = 0.94) were less willing to accept it. Discussion: Health care professionals need to routinely assess nursing home residents’ feeding tube preferences. It is imperative to consider sociocultural perspectives in understanding Chinese older adults’ decision making for end-of-life care.

scholarly journals Natural History of Feeding-Tube Use in Nursing Home Residents With Advanced Dementia

2009 ◽  
Vol 10 (4) ◽  
pp. 264-270 ◽  
Author(s):  
Sylvia Kuo ◽  
Ramona L. Rhodes ◽  
Susan L. Mitchell ◽  
Vincent Mor ◽  
Joan M. Teno
Keyword(s):  
Nursing Home ◽  
Natural History ◽  
Nursing Home Residents ◽  
Feeding Tube ◽  
Advanced Dementia ◽  
History Of
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