The study reported:
“Nursing home (NH) residents in the United States routinely attend interactive visits for services such as therapy or dialysis, creating opportunities for pathogen transmission. A paucity of studies exist which delineate spread of pathogens beyond residents’ in-room environment. In this prospective cohort study, we recruited 197 newly-admitted residents across three Veterans Affairs NHs to characterize multidrug-resistant organism (MDRO) prevalence, acquisition, and transmission. Participant hands, nares, groin, and seven environmental surfaces were swabbed during 758 regularly scheduled in-room visits; participant hands, healthcare personnel hands, and equipment were swabbed during 345 unscheduled interactive visits. We demonstrate that baseline MDRO colonization and new acquisition is common, and one in six interactive visits result in MDRO transmission. Whole genome sequencing on a subset of participants enabled us to identify sources of transmission where it was unknown using microbiologic methods alone. Our results illustrate MDRO transmission pathways and highlight the need for innovative, multidisciplinary interventions.”
“In the U.S., 132 Department of Veterans Affairs (VA) NHs, also known as community living centers, provide care for a frail, complex population, serving approximately 46,000 Veterans annually. VA NHs are often co-located with VA medical centers and can provide a variety of services, such as rehabilitation therapy in a dedicated gym, dialysis, radiology, oncology treatments, dental care, and ophthalmology. These primarily out-of-room encounters (hereafter referred to as “interactive visits,” as they require substantial hands-on contact and have opportunity for bidirectional transmission), allow us to investigate MDRO transmission dynamics involving residents, healthcare providers (HCPs), and the environment, particularly in settings beyond the resident’s room and in shared environments.”
“In this prospective, longitudinal cohort study of nearly 200 residents newly admitted to three VA NHs in the Midwestern United States, over one-third of participants were colonized with at least one MDRO upon admission and over 40% acquired a new MDRO during their stay. Further, over one-third of those colonized at baseline were no longer colonized at discharge. In this study, researchers followed NH residents during interactive visits to the therapy gym, dialysis, and other hospital venues to understand spread of MDROs. Our study reveals that transmission of MDROs is common, occurring during one in six (16.5%) such visits.”
“In summary, MDRO prevalence on admission to NHs is high, new acquisition is common, and residents are frequently discharged to the community with MDROs. Transmission of MDROs during interactive visits is common, especially among residents with hand colonization. Residents with long prior hospitalizations and other risk factors are more likely to be colonized with MDROs, suggesting that a subpopulation of residents should be prioritized for MDRO preventive efforts that engage residents, prescribers, and frontline personnel, paying particular attention to transmissions occurring outside of resident rooms.”
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