Improving Infection Control in Nursing Homes: Enhanced Barrier Precautions and MDRO Colonization

Background Nursing home residents have a high prevalence of multidrug-resistant organism (MDRO) colonization. CDC guidance recommends enhanced barrier precautions (EBP) for residents with novel or targeted MDROs and residents with indwelling medical devices or wounds, regardless of MDRO status. The guidance permits facilities to apply EBP to residents colonized with additional MDROs, as appropriate. Methods This study reports on prospective admission surveillance cultures collected during a trial evaluating EBP in 4 Maryland nursing homes. Our objective was to assess effectiveness of EBP indications for identifying residents with MDRO colonization. We collected clinical characteristics and surveillance cultures from the anterior nares and inguinal skin to estimate MDRO colonization prevalence. Results Among 580 mostly short-stay residents, 31% had one or more EBP indication; 21% had a MDRO history; 13%, a medical device; and 9%, a chronic wound. Surveillance cultures detected MDRO colonization in 21% of residents. Only 1 resident had carbapenemase-producing Gram-negative bacilli; no residents had Candidozyma auris . Only 25% of residents with MDRO history were culture-positive, and 25% of MDRO-colonized by culture residents had a MDRO history. Conclusions MDRO history was the most common indication for EBP among short-stay residents. Novel or targeted MDROs were rare and most with MDRO history were not MDRO culture-positive. MDRO history poorly identified current MDRO-culture positive residents and may not be an effective EBP indication. ClinicalTrials.gov study number NCT03319368