Nelson Chang Nai-Chung, Leecaster Molly, Fridkin Scott, Dube Will, Katz Morgan, Polgreen Philip, Roghmann Mary-Claire, Khader Karim, Li Linda, Dumyati Ghinwa, Tsay Rebecca, Lynfield Ruth, Mahoehney J P, Nadle Joelle, Hutson Jeré, Pierce Rebecca, Zhang Alexia, Wilson Christopher, Haroldsen Candace, Mulvey Diane, Reddy Sujan C, Stone Nimalie D, Slayton Rachel B, Thompson Nicola D, Stratford Kristina, Samore Matthew, Visnovsky Lindsay D
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.
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Georgia Emerging Infections Program, Atlanta, GA, USA.
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.
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.
2 cross-sectional visits.
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.
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).
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.
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.
美国疾病控制与预防中心（CDC）建议，对于所有已知携带目标多重耐药菌（MDRO）、有伤口或使用医疗设备的疗养院（NH）居民，实施强化屏障预防措施（EBP）。不同科室医护人员（HCP）与居民之间的互动差异可能会影响MDRO的获得和传播风险，进而影响EBP的实施。我们研究了各类疗养院中HCP与居民的互动情况，以确定MDRO传播的机会。
两次横断面访视。
来自7个州的4个CDC中心站点和CDC新发感染项目站点招募了具有多种科室护理类型（≥30张床位或≥2个科室）的疗养院。观察了HCP为居民提供护理的情况。
基于病房的观察和对HCP的访谈评估了HCP与居民的互动、提供的护理类型和设备使用情况。每个科室每隔3 - 6个月进行7 - 8小时的观察和访谈。病历审查收集了匿名的居民人口统计学信息和MDRO风险因素（如留置设备、压疮和抗生素使用情况）。
我们招募了25家疗养院（49个科室），无失访情况，进行了2540次基于病房的观察（总时长：405小时），并对924名HCP进行了访谈。HCP与居民的互动平均为每小时每位居民2.5次（长期护理科室）至3.4次（呼吸机护理科室）。护士护理的居民比注册护理助理（CNA）和呼吸治疗师（RT）更多（护士：n = 12；CNA：9.8；RT：9），但与CNA相比，护士每次互动执行的任务类型明显更少（发病率比（IRR）：0.61，P <.05）。与长期护理科室相比，短期住院科室（IRR：0.89）和配备呼吸机的科室（IRR：0.
