MDRO Infections in NHs: Isolation Precautions

Researchers from the Columbia University School of Nursing (New York, NY) recently conducted the first study to investigate multidrug-resistant organism (MDRO) infections in nursing homes (NHs) using the new Minimum Data Set 3.0 isolation items and found that isolation was infrequently used; also, the proportion of isolated infections varied between facilities (J Am Geriatr Soc. 2017; doi:10.1111/jgs.14740).

Investigators led by Catherine C Cohen, PhD, RN, (Columbia University, New York, NY) conducted a retrospective, cross-sectional analysis to study factors related to isolation precautions in NH residents with MDRO infection. The study analyzed data from October 2010 to December 2013 that included only NHs with Centers for Medicare and Medicaid Services’ certifications.
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Participants included long-stay NH residents who were found to be positive for MDRO infections. The MDS 3.0, the Certification and Survey Provider Enhanced Reporting, and the Area Health Resource File were used to obtain the data.

Researchers ultimately analyzed 191,816 assessments of residents with MDRO infection; isolation use was initiated for 12.8% of those residents. Of the NHs who reported MDRO infection, 31% used isolation at least once for these residents. Resident characteristics that researchers found associated with isolation use includes: locomotion (23.6%, P < .001) and eating (17.9%, P < .001) support.

In addition, findings showed that in those with MDRO history (P < .001) isolation use was 14.3% lower. And residents that received infection control-related citations in the past year had a greater likelihood of isolation use (3.4%, P = .02); residents who had received a quality-of-care citation had a lower probability of isolation use as well (-3.3%, P = .03).

Dr Cohen and colleagues concluded that while the amount of isolated MDRO infections varied between NHs, overall, isolation was not often used. According to researchers, “Further research is needed to determine whether and when isolation should be used to best decrease risk of MDRO transmission and improve quality of care.”—Amanda Del Signore