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Enhanced barrier precautions to prevent transmission of Staphylococcus aureus and Carbapenem-resistant organisms in nursing home chronic ventilator units

Published online by Cambridge University Press:  22 August 2025

Lyndsay M. O’Hara ,
Michelle Newman ,
Alison D. Lydecker ,
Gwen L. Robinson Open the ORCID record for Gwen L. Robinson [Opens in a new window] ,
Aaron Hong Open the ORCID record for Aaron Hong [Opens in a new window] ,
Christina Boucher ,
Patience Osei ,
Erin K. Molloy ,
J. Kristie Johnson  and
Ayse P. Gurses
...Show all authors
Lyndsay M. O’Hara
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
Michelle Newman
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
Alison D. Lydecker
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
Gwen L. Robinson
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
Aaron Hong
Affiliation:
Department of Computer and Information Science, University of Florida, Gainesville, Florida 32611, USA
Christina Boucher
Affiliation:
Department of Computer and Information Science, University of Florida, Gainesville, Florida 32611, USA
Patience Osei
Affiliation:
Armstrong Institute Center for Health Care Human Factors, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
Erin K. Molloy
Affiliation:
Department of Computer Science, University of Maryland, College Park, Maryland 20742, USA
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
Ayse P. Gurses
Affiliation:
Armstrong Institute Center for Health Care Human Factors, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
Heather Jones
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA
Kara Jacobs Slifka
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA
Mary-Claire Roghmann*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
*
Corresponding author: Mary-Claire Roghmann; Email: mroghmann@som.umaryland.edu
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Abstract

Objective:

Assess the feasibility and effect of Enhanced Barrier Precautions (EBP) on the transmission of Staphylococcus aureus (SA) and carbapenem-resistant organisms (CRO) among residents in nursing home chronic ventilator units (NH-CVU).

Design:

Pre-post interventional study.

Setting:

Two community-based nursing homes with CVUs in Maryland. A total of 56 residents were enrolled in the baseline period and 64 residents were enrolled in the intervention period.

Methods:

During a 3-month baseline and intervention period, residents were swabbed monthly to estimate SA and CRO acquisition. During a 2-month training period, EBP was implemented for residents with chronic wounds, medical devices, or history of multidrug-resistant organism (MDRO) colonization. During the subsequent 3-month intervention period, healthcare personnel (HCP) wore gowns and gloves for high-contact care activities when residents were on EBP. Whole genome sequencing assessed resident-to-resident transmission.

Results:

At baseline, NH-CVU1 used gowns and gloves for all direct contact, while NH-CVU2 used EBP only for residents with a history of MDRO colonization. After training, the proportion of NH-CVU2 residents on EBP increased from 65% in the baseline period to 87% in the intervention period. Glove use was high (93–98%) in both NH-CVUs. Gown use increased from 39% to 77% in NH-CVU1 and from 26% to 72% in NH-CVU2. Resident-to-resident transmission of SA or CRO decreased by 25% in NH-CVU1 (p = 0.60) and by 67% in NH-CVU2 (p = 0.05). CRO transmission decreased by 33% in NH-CVU1 (p = 0.54) and by 83% in NH-CVU2 (p = 0.02).

Conclusions:

EBP is feasible and potentially decreases overall and CRO transmission in nursing home CVUs.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 46 , Issue 9 , September 2025 , pp. 888 - 895
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

The views expressed in this manuscript are those of the authors and not necessarily those of the University of Maryland, Johns Hopkins University, and the University of Florida.

The views expressed are those of the authors and do not necessarily reflect the official policy or position of the U.S. Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services.

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