scholarly journals The Potential Regional Impact of Contact Precaution Use in Nursing Homes to Control Methicillin-ResistantStaphylococcus aureus

2013 ◽  
Vol 34 (2) ◽  
pp. 151-160 ◽  
Author(s):  
Bruce Y. Lee ◽  
Ashima Singh ◽  
Sarah M. Bartsch ◽  
Kim F. Wong ◽  
Diane S. Kim ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Policy Making ◽  
Orange County ◽  
Nursing Home Residents ◽  
Contact Precaution ◽  
Agent Based ◽  
Contact Precautions ◽  
Relative Decrease ◽  
Multiple Health ◽  
Over Time

Objective.Implementation of contact precautions in nursing homes to prevent methicillm-resistantStaphylococcus aureus(MRSA) transmission could cost time and effort and may have wide-ranging effects throughout multiple health facilities. Computational modeling could forecast the potential effects and guide policy making.Design.Our multihospital computational agent-based model, Regional Healthcare Ecosystem Analyst (RHEA).Setting.All hospitals and nursing homes in Orange County, California.Methods.Our simulation model compared the following 3 contact precaution strategies: (1) no contact precautions applied to any nursing home residents, (2) contact precautions applied to those with clinically apparent MRSA infections, and (3) contact precautions applied to all known MRSA carriers as determined by MRSA screening performed by hospitals.Results.Our model demonstrated that contact precautions for patients with clinically apparent MRSA infections in nursing homes resulted in a median 0.4% (range, 0%–1.6%) relative decrease in MRSA prevalence in nursing homes (with 50% adherence) but had no effect on hospital MRSA prevalence, even 5 years after initiation. Implementation of contact precautions (with 50% adherence) in nursing homes for all known MRSA carriers was associated with a median 14.2% (range, 2.1%–21.8%) relative decrease in MRSA prevalence in nursing homes and a 2.3% decrease (range, 0%–7.1%) in hospitals 1 year after implementation. Benefits accrued over time and increased with increasing compliance.Conclusions.Our modeling study demonstrated the substantial benefits of extending contact precautions in nursing homes from just those residents with clinically apparent infection to all MRSA carriers, which suggests the benefits of hospitals and nursing homes sharing and coordinating information on MRSA surveillance and carriage status.

scholarly journals Decreased Hospitalizations and Costs From Infection in Sixteen Nursing Homes in the SHIELD OC Regional Decolonization Initiative

2020 ◽  
Vol 41 (S1) ◽  
pp. s7-s8
Author(s):  
Gabrielle M. Gussin ◽  
James A. McKinnell ◽  
Raveena D. Singh ◽  
Ken Kleinman ◽  
Amherst Loren Miller ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Hospital Admissions ◽  
Orange County ◽  
Baseline Period ◽  
Primary Diagnosis ◽  
Healthcare Intervention ◽  
Contact Precautions ◽  
Hospitalization Rates ◽  
Hospital Bed ◽  
Bed Days

Distinguished OralBackground: Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, California (SHIELD OC) was a CDC-funded regional decolonization intervention from April 2017 through July 2019 involving 38 hospitals, nursing homes (NHs), and long-term acute-care hospitals (LTACHs) to reduce MDROs. Decolonization in NH and LTACHs consisted of universal antiseptic bathing with chlorhexidine (CHG) for routine bathing and showering plus nasal iodophor decolonization (Monday through Friday, twice daily every other week). Hospitals used universal CHG in ICUs and provided daily CHG and nasal iodophor to patients in contact precautions. We sought to evaluate whether decolonization reduced hospitalization and associated healthcare costs due to infections among residents of NHs participating in SHIELD compared to nonparticipating NHs. Methods: Medicaid insurer data covering NH residents in Orange County were used to calculate hospitalization rates due to a primary diagnosis of infection (counts per member quarter), hospital bed days/member-quarter, and expenditures/member quarter from the fourth quarter of 2015 to the second quarter of 2019. We used a time-series design and a segmented regression analysis to evaluate changes attributable to the SHIELD OC intervention among participating and nonparticipating NHs. Results: Across the SHIELD OC intervention period, intervention NHs experienced a 44% decrease in hospitalization rates, a 43% decrease in hospital bed days, and a 53% decrease in Medicaid expenditures when comparing the last quarter of the intervention to the baseline period (Fig. 1). These data translated to a significant downward slope, with a reduction of 4% per quarter in hospital admissions due to infection (P < .001), a reduction of 7% per quarter in hospitalization days due to infection (P < .001), and a reduction of 9% per quarter in Medicaid expenditures (P = .019) per NH resident. Conclusions: The universal CHG bathing and nasal decolonization intervention adopted by NHs in the SHIELD OC collaborative resulted in large, meaningful reductions in hospitalization events, hospitalization days, and healthcare expenditures among Medicaid-insured NH residents. The findings led CalOptima, the Medicaid provider in Orange County, California, to launch an NH incentive program that provides dedicated training and covers the cost of CHG and nasal iodophor for OC NHs that enroll.Funding: NoneDisclosures: Gabrielle M. Gussin, University of California, Irvine, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

scholarly journals Assessments, evolutions and transformations in French nursing homes

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
T Delespierre ◽  
P E Haÿ ◽  
D Armaingaud ◽  
L Josseran
Keyword(s):  
Standard Deviation ◽  
Nursing Homes ◽  
Data Warehouse ◽  
Gender Gap ◽  
Data Extraction ◽  
Nursing Home Residents ◽  
Daily Basis ◽  
Population Evolution ◽  
The Usa ◽  
Over Time

Abstract Background Korian is a private group specialized in medical accommodation for elderly and dependent people. A professional data warehouse EasySoins® set up in 2010 hosted 126 nursing homes (NH) residents’ data. Then in 2013, another data warehouse NetSoins® replaced the former; with a completely new information system (IS). Deployment ended in July 2014 with 151 NH but since then, the number of NH has increased steadily to reach 288 at the end of 2018. Inside both systems, the transmissions’ table fed on a daily basis by the caregiver contains key data about the residents’ care and health. It also allows us to build residents’ life trajectories. A recent study compared the 2011 and 2015 NH populations in France. Other research papers explored similar issues in the USA, Belgium and Great Britain. The objective of this study is to show that our data extraction method offers a vivid image and faithful reflection of the French residents’ population evolution over time. Methods Wanting to replicate and update the French study, we built two sets of Korian residents: those having at least one transmission over the last six weeks of 2014 and 2018. We then joined these two tables with their socio-demographic profile. Finally, we searched among the residents’ autonomy level evaluations (GIR=ISO resource group), the ‘nearest’ ones to each periods. We were then able to assess the residents’ population evolution. Results We found respectively 12,279 residents living in 156 NH and then 23,926 residents, living in 288 NH. In 2014, 9,174 women with a mean age of 87.5 (standard deviation=7.4) and 3,105 men with a mean age of 84.6 (standard deviation=9). In 2018, 3,075 were still there (25%) with 17,561 women, mean age of 88.4 (standard deviation=7.5) and 6,365 men, mean age of 85.2 (standard deviation=9.4). The GIR modal class stayed stable at two for both sexes at 30%. Conclusions As elsewhere, men and women are growing a little older, reaching a glass ceiling, with a narrowed gender gap. Key messages As nursing home residents’ profiles are rapidly changing over time and caregiver resources do not increase accordingly, allocating adequate resources to every resident becomes essential. The transmissions’ table with its nursing care narratives textual content can help us track every resident on almost real time and, through this process, define health paths and health subgroups.

scholarly journals Mathematical modeling to inform vaccination strategies and testing approaches for COVID-19 in nursing homes

2021 ◽  
Author(s):  
Rebecca Kahn ◽  
Inga Holmdahl ◽  
Sujan Reddy ◽  
John Jernigan ◽  
Michael J Mina ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Vaccination Coverage ◽  
Nursing Home Residents ◽  
The United States ◽  
Limited Data ◽  
Agent Based ◽  
Symptomatic Disease ◽  
Testing Strategies ◽  
Protection Against Infection

Background: Nursing home residents and staff were included in the first phase of COVID-19 vaccination in the United States. Because the primary trial endpoint was vaccine efficacy (VE) against symptomatic disease, there are limited data on the extent to which vaccines protect against SARS-CoV-2 infection and the ability to infect others (infectiousness). Assumptions about VE against infection and infectiousness have implications for possible changes to infection prevention guidance for vaccinated populations, including testing strategies. Methods: We use a stochastic agent-based SEIR model of a nursing home to simulate SARS-CoV-2 transmission. We model three scenarios, varying VE against infection, infectiousness, and symptoms, to understand the expected impact of vaccination in nursing homes, increasing staff vaccination coverage, and different screening testing strategies under each scenario. Results: Increasing vaccination coverage in staff decreases total symptomatic cases in each scenario. When there is low VE against infection and infectiousness, increasing staff coverage reduces symptomatic cases among residents. If vaccination only protects against symptoms, but asymptomatic cases remain infectious, increased staff coverage increases symptomatic cases among residents through exposure to asymptomatic but infected staff. High frequency testing is needed to reduce total symptomatic cases if the vaccine has low efficacy against infection and infectiousness, or only protects against symptoms. Conclusions: Encouraging staff vaccination is not only important for protecting staff, but might also reduce symptomatic cases in residents if a vaccine confers at least some protection against infection or infectiousness.

scholarly journals Interpreting COVID-19 deaths among nursing home residents in the US: The changing role of facility quality over time

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256767
Author(s):  
Debasree Das Gupta ◽  
Uma Kelekar ◽  
Sidney C. Turner ◽  
Anupam A. Sule ◽  
Taya G. Jerman
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Critical Role ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Cross Sectional ◽  
The Us ◽  
Prior Literature ◽  
Over Time

A report published last year by the Centers for Medicare & Medicaid Services (CMS) highlighted that COVID-19 case counts are more likely to be high in lower quality nursing homes than in higher quality ones. Since then, multiple studies have examined this association with a handful also exploring the role of facility quality in explaining resident deaths from the virus. Despite this wide interest, no previous study has investigated how the relation between quality and COVID-19 mortality among nursing home residents may have changed, if at all, over the progression of the pandemic. This understanding is indeed lacking given that prior studies are either cross-sectional or are analyses limited to one specific state or region of the country. To address this gap, we analyzed changes in nursing home resident deaths across the US between June 1, 2020 and January 31, 2021 (n = 12,415 nursing homes X 8 months) using both descriptive and multivariable statistics. We merged publicly available data from multiple federal agencies with mortality rate (per 100,000 residents) as the outcome and CMS 5-star quality rating as the primary explanatory variable of interest. Covariates, based on the prior literature, consisted of both facility- and community-level characteristics. Findings from our secondary analysis provide robust evidence of the association between nursing home quality and resident deaths due to the virus diminishing over time. In connection, we discuss plausible reasons, especially duration of staff shortages, that over time might have played a critical role in driving the quality-mortality convergence across nursing homes in the US.

scholarly journals Development and Validation of a Clinical Prediction Rule to Predict Transmission of Methicillin-Resistant Staphylococcus aureus in Nursing Homes

2018 ◽  
Vol 188 (1) ◽  
pp. 214-221
Author(s):  
Sarah S Jackson ◽  
Alison D Lydecker ◽  
Laurence S Magder ◽  
Mary-Claire Roghmann
Keyword(s):  
Staphylococcus Aureus ◽  
Nursing Homes ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Nursing Home Residents ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Veterans Affairs ◽  
Clinical Prediction ◽  
Contact Precautions ◽  
Mrsa Colonization

Abstract The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among nursing home residents is high. Health-care workers (HCWs) often serve as a vector in MRSA transmission. The ability to identify residents who are likely to transmit MRSA to HCWs’ hands and clothing during clinical care is important so that infection control measures, such as Contact Precautions, can be employed. Using data on demographic and clinical characteristics collected from residents of community nursing homes in Maryland and Michigan between 2012 and 2014, we developed a clinical prediction rule predicting the probability of MRSA transmission to HCWs’ gowns. We externally validated this model in a cohort of Department of Veterans Affairs nursing home residents from 7 states between 2012 and 2016. The prediction model, which included sex, race, resident dependency on HCWs for care, the presence of any medical device, diabetes mellitus, and chronic skin breakdown, showed good performance (C statistic = 0.70; sensitivity = 76%, specificity = 49%) in the development set. The decision curve analysis indicated that this model has greater clinical utility than use of a nares surveillance culture for MRSA colonization, which is current clinical practice for placing hospital inpatients on Contact Precautions. The prediction rule demonstrated less utility in the validation cohort, suggesting that a separate rule should be developed for residents of Veterans Affairs nursing homes.

scholarly journals The Spread and Control of Norovirus Outbreaks Among Hospitals in a Region: A Simulation Model

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Sarah M. Bartsch ◽  
Susan S. Huang ◽  
Kim F. Wong ◽  
Taliser R. Avery ◽  
Bruce Y. Lee
Keyword(s):  
Simulation Model ◽  
Acute Care ◽  
Orange County ◽  
Reproductive Rate ◽  
Agent Based ◽  
Contact Precautions ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Almost All ◽  
And Control

Abstract Background.  Because hospitals in a region are connected via patient sharing, a norovirus outbreak in one hospital may spread to others. Methods.  We utilized our Regional Healthcare Ecosystem Analyst software to generate an agent-based model of all the acute care facilities in Orange County (OC), California and simulated various norovirus outbreaks in different locations, both with and without contact precautions. Results.  At the lower end of norovirus reproductive rate (R0) estimates (1.64), an outbreak tended to remain confined to the originating hospital (≤6.1% probability of spread). However, at the higher end of R0 (3.74), an outbreak spread 4.1%–17.5% of the time to almost all other OC hospitals within 30 days, regardless of the originating hospital. Implementing contact precautions for all symptomatic cases reduced the probability of spread to other hospitals within 30 days and the total number of cases countywide, but not the number of other hospitals seeing norovirus cases. Conclusions.  A single norovirus outbreak can continue to percolate throughout a system of different hospitals for several months and appear as a series of unrelated outbreaks, highlighting the need for hospitals within a region to more aggressively and cooperatively track and control an initial outbreak.

scholarly journals Mathematical modeling to inform vaccination strategies and testing approaches for COVID-19 in nursing homes

2021 ◽  
Author(s):  
Rebecca Kahn ◽  
Inga Holmdahl ◽  
Sujan Reddy ◽  
John Jernigan ◽  
Michael J Mina ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Vaccination Coverage ◽  
Nursing Home Residents ◽  
The United States ◽  
Limited Data ◽  
Agent Based ◽  
Symptomatic Disease ◽  
Testing Strategies ◽  
Protection Against Infection

Abstract Background Nursing home residents and staff were included in the first phase of COVID-19 vaccination in the United States. Because the primary trial endpoint was vaccine efficacy (VE) against symptomatic disease, there are limited data on the extent to which vaccines protect against SARS-CoV-2 infection and the ability to infect others (infectiousness). Assumptions about VE against infection and infectiousness have implications for changes to infection prevention guidance for vaccinated populations, including testing strategies. Methods We use a stochastic agent-based SEIR model of a nursing home to simulate SARS-CoV-2 transmission. We model three scenarios, varying VE against infection, infectiousness, and symptoms, to understand the expected impact of vaccination in nursing homes, increasing staff vaccination coverage, and different screening testing strategies under each scenario. Results Increasing vaccination coverage in staff decreases total symptomatic cases in the nursing home (among staff and residents combined) in each VE scenario. In scenarios with 50% and 90% VE against infection and infectiousness, increasing staff coverage reduces symptomatic cases among residents. If vaccination only protects against symptoms, and asymptomatic cases remain infectious, increased staff coverage increases symptomatic cases among residents. However, this is outweighed by the reduction in symptomatic cases among staff. Higher frequency testing—more than once weekly—is needed to reduce total symptomatic cases if the vaccine has lower efficacy against infection and infectiousness, or only protects against symptoms. Conclusions Encouraging staff vaccination is not only important for protecting staff, but might also reduce symptomatic cases in residents if a vaccine confers at least some protection against infection or infectiousness.

The effect of the implementation of a good medical practice booklet on nursing home residents’ drug prescriptions: a difference-in-differences analysis based on data from electronic pill dispensers (Preprint)

2019 ◽  
Author(s):  
Stéphane Sanchez ◽  
Cécile Payet ◽  
Marie Herr ◽  
Anne Dazinieras ◽  
Caroline Blochet ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Medical Practice ◽  
Intervention Group ◽  
Medication Use ◽  
Nursing Home Residents ◽  
Control Group ◽  
Multilevel Regression ◽  
Difference In Differences ◽  
Good Medical Practice ◽  
The Impact

BACKGROUND The elderly are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. OBJECTIVE We aimed to evaluate the impact of the implementation of a good medical practice booklet on polypharmacy in nursing homes. METHODS We identified nursing homes belonging to a geriatric care provider that had launched a policy of proper medication use using a good medical practice booklet delivered to prescribers and pharmacists. Data were derived from electronic pill dispensers. The effect of the intervention on polypharmacy was assessed with multilevel regression models, with a control group to account for natural trends over time. The main outcomes were the average daily number of times when medication was administered and the number of drugs with different presentation identifier codes per resident per month. RESULTS 96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (-0.05 and -0.06). The good medical practice booklet did not have a statistically significant effect (exponentiated difference-in-differences coefficient 1.00, 95% confidence interval 0.99-1.02, P=.45). CONCLUSIONS Although the good medical practice booklet itself did not seem effective in decreasing medication use, our data show the effectiveness of a higher-level policy to decrease polypharmacy.

scholarly journals A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial

2021 ◽  
pp. 1-13
Author(s):  
Julie L. O’Sullivan ◽  
Sonia Lech ◽  
Paul Gellert ◽  
Ulrike Grittner ◽  
Jan-Niklas Voigt-Antons ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Nursing Home ◽  
Nursing Homes ◽  
Psychotropic Medication ◽  
Controlled Trial ◽  
Nursing Home Residents ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Objectives: To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. Design: Cluster-randomized controlled trial. Setting: Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). Participants: N = 162 residents with dementia. Intervention: Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. Measurements: Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer’s Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. Results: Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI −3.54, 2.33 for TBI and .36 points, 95% CI −3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen’s d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. Conclusions: Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

scholarly journals Reducing Loneliness in Stationary Geriatric Care with Robots and Virtual Encounters—A Contribution to the COVID-19 Pandemic

2021 ◽  
Vol 18 (9) ◽  
pp. 4846
Author(s):  
Andreas Follmann ◽  
Franziska Schollemann ◽  
Andrea Arnolds ◽  
Pauline Weismann ◽  
Thea Laurentius ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Social Isolation ◽  
Nursing Home Residents ◽  
Phone Call ◽  
Observational Trial ◽  
General Acceptance ◽  
Frequency Of Use ◽  
Geriatric Hospital ◽  
Hospital Patients ◽  
The Subject

The bans on visiting nursing homes during the COVID-19 pandemic, while intended to protect residents, also have the risk of increasing the loneliness and social isolation that already existed among the older generations before the pandemic. To combat loneliness and social isolation in nursing homes, this trial presents a study during which social networks of nursing home residents and elderly hospital patients were maintained through virtual encounters and robots, respectively. The observational trial included volunteers who were either residents of nursing homes or patients in a geriatric hospital. Each volunteer was asked to fill in a questionnaire containing three questions to measure loneliness. The questionnaire also documented whether video telephony via the robot, an alternative contact option (for example, a phone call), or no contact with relatives had taken place. The aim was to work out the general acceptance and the benefits of virtual encounters using robots for different roles (users, relatives, nursing staff, facilities). Seventy volunteers with three possible interventions (non-contact, virtual encounters by means of a robot, and any other contact) took part in this trial. The frequency of use of the robot increased steadily over the course of the study, and it was regularly used in all facilities during the weeks of visitor bans (n = 134 times). In the hospital, loneliness decreased significantly among patients for whom the robot was used to provide contact (F(1,25) = 7.783, p = 0.01). In the nursing homes, no demonstrable effect could be achieved in this way, although the subject feedback from the users was consistently positive.

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