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Evaluation of Care Interactions Between Healthcare Personnel and Residents in Nursing Homes Across the United States

Published online by Cambridge University Press:  02 November 2020

Nai-Chung Chang
Affiliation:
University of Utah, VA Salt Lake City Health Care System
Karim Khader
Affiliation:
University of Utah, VA Salt Lake City Health Care System
Molly Leecaster
Affiliation:
VA Salt Lake City Health Care System, University of Utah School of Medicine
Lindsay Visnovsky
Affiliation:
University of Utah, VA Salt Lake City Health Care System
Scott Fridkin
Affiliation:
Emory Healthcare and Emory University
Morgan Katz
Affiliation:
Johns Hopkins University
Philip Polgreen
Affiliation:
University of Iowa
Mary-Claire Roghmann
Affiliation:
University of Maryland School of Medicine VA Salt Lake City Health Care System
Candace Haroldsen
Affiliation:
VA Salt Lake City Health Care System, University of Utah School of Medicine
Diane Mulvey
Affiliation:
VA Salt Lake City Health Care System, University of Utah School of Medicine
Kristina Stratford
Affiliation:
VA Salt Lake City Health Care System, University of Utah School of Medicine
Lauren Dempsey
Affiliation:
Emory University
William Dube
Affiliation:
Emory University School of Medicine
Ghinwa Dumyati
Affiliation:
University of Rochester
Linda Frank
Affiliation:
California Emerging Infections Program
Deborah Godine
Affiliation:
California Emerging Infections Program
Siyeh Gretzinger
Affiliation:
Emory University
Trupti Hatwar
Affiliation:
New York Emerging Infections Program and University of Rochester Medical Center
Marion Kainer
Affiliation:
Tennessee Emerging Infections Program
Joseph Kellogg
Affiliation:
Emory University
Sarah Kuchman
Affiliation:
New York-Rochester Emerging Infections Program, University of Rochester Medical Center
Laura LaLonde
Affiliation:
Oregon Health Authority, Portland, OR
Giancarlo Licitra
Affiliation:
Emory University
Ruth Lynfield
Affiliation:
Minnesota Emerging Infections Program
J.P. Mahoehney
Affiliation:
Minnesota Emerging Infections Program
Joelle Nadle
Affiliation:
California Emerging Infections Program
Sujan Reddy
Affiliation:
Tennessee Emerging Infections Program
Nicola Thompson
Affiliation:
Centers for Disease Control and Prevention
Rebecca Tsay
Affiliation:
New York-Rochester Emerging Infections Program
Lucy Wilson
Affiliation:
Maryland Emerging Infections Program
Alexia Zhang
Affiliation:
Oregon Health Authority
Matthew Samore
Affiliation:
VA Salt Lake City Health Care System, University of Utah School of Medicine
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Abstract

Background: Certain nursing home (NH) resident care tasks have a higher risk for multidrug-resistant organisms (MDRO) transfer to healthcare personnel (HCP), which can result in transmission to residents if HCPs fail to perform recommended infection prevention practices. However, data on HCP-resident interactions are limited and do not account for intrafacility practice variation. Understanding differences in interactions, by HCP role and unit, is important for informing MDRO prevention strategies in NHs. Methods: In 2019, we conducted serial intercept interviews; each HCP was interviewed 6–7 times for the duration of a unit’s dayshift at 20 NHs in 7 states. The next day, staff on a second unit within the facility were interviewed during the dayshift. HCP on 38 units were interviewed to identify healthcare personnel (HCP)–resident care patterns. All unit staff were eligible for interviews, including certified nursing assistants (CNAs), nurses, physical or occupational therapists, physicians, midlevel practitioners, and respiratory therapists. HCP were asked to list which residents they had cared for (within resident rooms or common areas) since the prior interview. Respondents selected from 14 care tasks. We classified units into 1 of 4 types: long-term, mixed, short stay or rehabilitation, or ventilator or skilled nursing. Interactions were classified based on the risk of HCP contamination after task performance. We compared proportions of interactions associated with each HCP role and performed clustered linear regression to determine the effect of unit type and HCP role on the number of unique task types performed per interaction. Results: Intercept-interviews described 7,050 interactions and 13,843 care tasks. Except in ventilator or skilled nursing units, CNAs have the greatest proportion of care interactions (interfacility range, 50%–60%) (Fig. 1). In ventilator and skilled nursing units, interactions are evenly shared between CNAs and nurses (43% and 47%, respectively). On average, CNAs in ventilator and skilled nursing units perform the most unique task types (2.5 task types per interaction, Fig. 2) compared to other unit types (P < .05). Compared to CNAs, most other HCP types had significantly fewer task types (0.6–1.4 task types per interaction, P < .001). Across all facilities, 45.6% of interactions included tasks that were higher-risk for HCP contamination (eg, transferring, wound and device care, Fig. 3). Conclusions: Focusing infection prevention education efforts on CNAs may be most efficient for preventing MDRO transmission within NH because CNAs have the most HCP–resident interactions and complete more tasks per visit. Studies of HCP-resident interactions are critical to improving understanding of transmission mechanisms as well as target MDRO prevention interventions.

Funding: Centers for Disease Control and Prevention (grant no. U01CK000555-01-00)

Disclosures: Scott Fridkin, consulting fee, vaccine industry (spouse)

Type
Oral Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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