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Evaluation of Care Interactions Between Healthcare Personnel and Residents in Nursing Homes Across the United States
- Nai-Chung Chang, Karim Khader, Molly Leecaster, Lindsay Visnovsky, Scott Fridkin, Morgan Katz, Philip Polgreen, Mary-Claire Roghmann, Candace Haroldsen, Diane Mulvey, Kristina Stratford, Lauren Dempsey, William Dube, Ghinwa Dumyati, Linda Frank, Deborah Godine, Siyeh Gretzinger, Trupti Hatwar, Marion Kainer, Joseph Kellogg, Sarah Kuchman, Laura LaLonde, Giancarlo Licitra, Ruth Lynfield, J.P. Mahoehney, Joelle Nadle, Sujan Reddy, Nicola Thompson, Rebecca Tsay, Lucy Wilson, Alexia Zhang, Matthew Samore
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s36-s38
- Print publication:
- October 2020
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- Article
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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)
Contributors
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- By Sofya Abazyan, Saskia S. Arndt, Jonathon C. Arnold, Sandra Beeské, Odd-Geir Berge, Valerie J. Bolivar, David Borchelt, Marie-Françoise Chesselet, Yoon H. Cho, Angelo Contarino, John C. Crabbe, Wim E. Crusio, Bianca De Filippis, Mara Dierssen, Stephanie C. Dulawa, Emily C. Eastwood, Haim Einat, Raul R. Gainetdinov, David Gordon, Guy Griebel, F. Scott Hall, John H. Harkness, Christopher Janus, Zhengping Jia, Nirit Kara, Tim Karl, Martien J. H. Kas, Federica Klaus, Robert Lalonde, Glenda Lassi, Giovanni Laviola, Iddo Magen, Stephen C. Maxson, Douglas Ashley Monks, Rebecca E. Nordquist, Lucy R. Osborne, Tamara J. Phillips, Alisdair R. Philp, Marina R. Picciotto, Susanna Pietropaolo, Mikhail V. Pletnikov, Christopher R. Pryce, James L. Resnick, Laura Ricceri, Frans Sluyter, Emily Y. Smith, Ichiro Sora, Tatyana D. Sotnikova, Rebecca C. Steiner, Ortrud K. Steinlein, Catherine Strazielle, Enejda Subashi, Ashlyn Swift-Gallant, Aki Takahashi, Kevin Talbot, Stewart Thompson, Valter Tucci, F. Josef van der Staay, Gertjan van Dijk, Nancy S. Woehrle
- Edited by Susanna Pietropaolo, Centre National de la Recherche Scientifique (CNRS), Paris, Frans Sluyter, University of Portsmouth, Wim E. Crusio, Centre National de la Recherche Scientifique (CNRS), Paris
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- Book:
- Behavioral Genetics of the Mouse
- Published online:
- 05 October 2014
- Print publication:
- 25 September 2014, pp ix-xii
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List of contributors
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- By Nazia M. Alam, Enrico Alleva, Hiroyuki Arakawa, Robert H. Benno, Fred G. Biddle, D. Caroline Blanchard, Robert J. Blanchard, Richard J. Bodnar, John D. Boughter, Igor Branchi, Richard E. Brown, Abel Bult-Ito, Jonathan M. Cachat, Peter R. Canavello, Francesca Cirulli, Giovanni Colacicco, John C. Crabbe, Jacqueline N. Crawley, Wim E. Crusio, Sietse F. de Boer, Ekrem Dere, Brenda A. Eales, Robert T. Gerlai, Howard K. Gershenfeld, Thomas J. Gould, Martin E. Hahn, Peter C. Hart, Andrew Holmes, Joseph P. Huston, Allan V. Kalueff, Benjamin Kest, Robert Lalonde, Sarah R. Lewis-Levy, Hans-Peter Lipp, Sheree F. Logue, Stephen C. Maxson, Jeffrey S. Mogil, Douglas A. Monks, Dennis L. Murphy, Lee Niel, Timothy P. O’Leary, Susanna Pietropaolo, Peter K.D. Pilz, Claudia F. Plappert, Bernard Possidente, Glen T. Prusky, Laura Ricceri, Heather Schellinck, Herbert Schwegler, Burton Slotnick, Frans Sluyter, Shad B. Smith, Catherine Strazielle, Douglas Wahlsten, Hans Welzl, James F. Willott, David P. Wolfer, Armin Zlomuzica
- Edited by Wim E. Crusio, Université de Bordeaux, Frans Sluyter, Robert T. Gerlai, University of Toronto, Susanna Pietropaolo, Université de Bordeaux
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- Book:
- Behavioral Genetics of the Mouse
- Published online:
- 05 May 2013
- Print publication:
- 25 April 2013, pp ix-xii
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- Export citation