Vets commonly acquire multidrug-resistant infections in community living centers
Key takeaways:
- Transmission of multidrug-resistant organisms is common during out-of-room visits by veterans at VA community living centers.
- Veterans’ hands may shed MDROs such as MRSA and VRE to surfaces.
SEATTLE — Veterans commonly acquire multidrug-resistant organisms during stays in Veterans Health Administration community living centers, researchers found.
According to findings presented at the Society for Healthcare Epidemiology of America Spring Conference, many out-of-room visits result in transmission of multidrug-resistant organisms (MDROs) to and from patient hands and surfaces.
“We know that over 50% to 60% of older adults in nursing homes are colonized with drug-resistant organisms, and we were particularly interested in looking at MDROs of patient hands and describing the overall epidemiology of drug resistant organisms,” Lona Mody, MD, Amanda Sanford Hickey Professor of Internal Medicine at the University of Michigan and VA Ann Arbor Healthcare System, said during a presentation at the conference.
“But then we thought of our Veterans Affairs community living center, which houses older adults for short-stay rehab and wound care or for long-stay and palliative care, etc.,” Mody said. “The previous research done on MDROs on hands was largely focused on health care providers, and rightfully so. We took this further, and we wanted to understand MDRO colonization on our patients.”
To assess rates of MDROs and MDRO transmission, Mody and colleagues recruited newly admitted veterans at three community living centers and cultured their nostrils, groins, hands, and seven surfaces in each of the patient rooms. They also accompanied the veterans on out-of-room visits and cultured their hands and any surfaces they touched. They tested the cultures for MDROs including MRSA, vancomycin-resistant Enterococcus (VRE), and gram-negative bacteria resistant to quinolones, carbapenems and/or ceftazidime.
In total, Mody and colleagues recruited 137 veterans for the study, 97% of whom were receiving post-acute care. They conducted 539 visits to sample patient rooms and accompanied 97 veterans on 266 out-of-room visits for sampling.
Overall, 35% of patients were colonized with an MDRO at enrollment and 58% were colonized on any of their follow-up patient-room visits, with 41% acquiring a new MDRO, the researchers reported.
Testing in patient rooms revealed that toilet seats (21%), curtains (19%) and bedrails (18%) were the most frequently contaminated surfaces.
Transmission during out-of-room visits also was common, occurring in 18% of visits, with 8% of participants acquiring a new MDRO on their hands and 12% of MDRO transmission occurring from hands to a surface.
The researchers found that transmission was most common during visits to dialysis (31%), radiology (25%) and rehabilitation therapy (18%).
“Patient hand contamination remains the most significant predictor of MDRO transmission during [these] visits,” Mody said. “We have to go beyond health care worker hand hygiene to now focus on patient hand hygiene, as well to design simple, efficient programs that will help us reduce MDRO transmissions when they are in offices.”
Collapse
Mody L, et al. Transmission of multi-drug resistant organisms by VA CLC residents: A multisite prospective study. Presented at: Society for Healthcare Epidemiology of America Spring Meeting; April 11-14, 2023; Seattle.