Evaluation of Critically Ill Patients for Transfer to Long-term Acute-care Facilities

Abstract Background Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NHs), and long-term acute care facilities (LTACs) via patient transfers. The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based on their high degree of patient sharing. We report baseline MDRO prevalence in 21 NHs/LTACs. Methods A random sample of 50 adults for 21 NHs/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase–producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, skin (axilla/groin), and peri-rectal swabs. Facility and resident characteristics associated with MDRO carriage were assessed using multivariable models clustering by person and facility. Results Prevalence of MDROs was 65% in NHs and 80% in LTACs. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). CRE prevalence was higher in facilities that manage ventilated LTAC patients and NH residents (8% vs <1%, P < .001). MDRO status was known for 18% of NH residents and 49% of LTAC patients. MDRO-colonized adults commonly harbored additional MDROs (54% MDRO+ NH residents and 62% MDRO+ LTACs patients). History of MRSA (odds ratio [OR] = 1.7; confidence interval [CI]: 1.2, 2.4; P = .004), VRE (OR = 2.1; CI: 1.2, 3.8; P = .01), ESBL (OR = 1.6; CI: 1.1, 2.3; P = .03), and diabetes (OR = 1.3; CI: 1.0, 1.7; P = .03) were associated with any MDRO carriage. Conclusions The majority of NH residents and LTAC patients harbor MDROs. MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.

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Efficacy of recombinant human erythropoietin in critically ill patients admitted to a long-term acute care facility: A randomized, double-blind, placebo-controlled trial*

Critical Care Medicine ◽

10.1097/01.ccm.0000233873.17954.42 ◽

2006 ◽

Vol 34 (9) ◽

pp. 2310-2316 ◽

Cited By ~ 58

Author(s):

Michael Silver ◽

Michael J. Corwin ◽

Andrea Bazan ◽

Andrew Gettinger ◽

Christopher Enny ◽

...

Keyword(s):

Critically Ill ◽

Acute Care ◽

Critically Ill Patients ◽

Recombinant Human Erythropoietin ◽

Controlled Trial ◽

Care Facility ◽

Double Blind ◽

Double Blind Placebo ◽

Human Erythropoietin

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Efficacy of recombinant human erythropoietin in critically ill patients admitted to a long-term acute care facility: A randomized, double-blind, placebo-controlled trial

Yearbook of Critical Care Medicine ◽

10.1016/s0734-3299(08)70590-2 ◽

2008 ◽

Vol 2008 ◽

pp. 227-229

Author(s):

C. Bekes

Keyword(s):

Critically Ill ◽

Acute Care ◽

Critically Ill Patients ◽

Recombinant Human Erythropoietin ◽

Controlled Trial ◽

Care Facility ◽

Double Blind ◽

Double Blind Placebo ◽

Human Erythropoietin

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Establishment of a Statewide Network for Carbapenem-Resistant Enterobacteriaceae Prevention in a Low-Incidence Region

Infection Control and Hospital Epidemiology ◽

10.1086/675605 ◽

2014 ◽

Vol 35 (4) ◽

pp. 356-361 ◽

Cited By ~ 15

Author(s):

Christopher D. Pfeiffer ◽

Margaret C. Cunningham ◽

Tasha Poissant ◽

Jon P. Furuno ◽

John M. Townes ◽

...

Keyword(s):

Acute Care ◽

Infection Prevention ◽

Long Term Care ◽

Term Care ◽

Carbapenem Resistant ◽

Care Facilities ◽

Low Incidence ◽

Acute Care Facilities ◽

Carbapenem Resistant Enterobacteriaceae

Objective.To establish a statewide network to detect, control, and prevent the spread of carbapenem-resistant Enterobacteriaceae (CRE) in a region with a low incidence of CRE infection.Design.Implementation of the Drug Resistant Organism Prevention and Coordinated Regional Epidemiology (DROP-CRE) Network.Setting and Participants.Oregon infection prevention and microbiology laboratory personnel, including 48 microbiology laboratories, 62 acute care facilities, and 140 long-term care facilities.Methods.The DROP-CRE working group, comprising representatives from academic institutions and public health, convened an interdisciplinary advisory committee to assist with planning and implementation of CRE epidemiology and control efforts. The working group established a statewide CRE definition and surveillance plan; increased the state laboratory capacity to perform the modified Hodge test and polymerase chain reaction for carbapenemases in real time; and administered surveys that assessed the needs and capabilities of Oregon infection prevention and laboratory personnel. Results of these inquiries informed CRE education and the response plan.Results.Of 60 CRE reported from November 2010 through April 2013, only 3 were identified as carbapenemase producers; the cases were not linked, and no secondary transmission was found. Microbiology laboratories, acute care facilities, and long-term care facilities reported lacking carbapenemase testing capability, reliable interfacility communication, and CRE awareness, respectively. Survey findings informed the creation of the Oregon CRE Toolkit, a state-specific CRE guide booklet.Conclusions.A regional epidemiology surveillance and response network has been implemented in Oregon in advance of widespread CRE transmission. Prospective surveillance will determine whether this collaborative approach will be successful at forestalling the emergence of this important healthcare-associated pathogen.

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