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Invited Commentary |

Revisiting Standard Precautions to Reduce Antimicrobial Resistance in Nursing Homes

Nimalie D. Stone, MD, MS1
[+] Author Affiliations
1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Intern Med. 2015;175(5):723-724. doi:10.1001/jamainternmed.2015.137.
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The need to address transmission of multidrug-resistant organisms (MDROs) has never been more critical for nursing homes. Nursing home care is increasing in complexity as growing proportions of residents are entering homes directly from acute care hospitals. The post–acute care population experiences health care exposures such as invasive medical devices, wounds, and antibiotic use that are well-established risk factors for MDRO acquisition, colonization, and infection. In this issue of JAMA Internal Medicine, Mody and colleagues1 describe a new approach to reduce MDRO prevalence and incidence of infections in nursing homes through a multifaceted, targeted infection prevention (TIP) intervention. The TIP intervention incorporates an extensive educational curriculum for nursing staff, active surveillance for MDRO colonization and infections, and the preemptive use of gown and gloves during daily care of all residents with indwelling medical devices (eg, urinary catheters, feeding tubes). Using cluster randomization at the facility level, implementation of the TIP intervention resulted in a 23% reduction in MDRO prevalence among residents with indwelling devices in 6 intervention homes compared with 6 usual care homes. In addition, residents in the intervention homes had a significantly lower risk of methicillin-resistant Staphylococcus aureus acquisition (hazard ratio, 0.78; P = .01) and fewer clinically diagnosed catheter-associated urinary tract infections (hazard ratio, 0.54; P = .04).

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