Isolation Precautions Use for Multidrug-Resistant Organism Infection in Nursing Homes

Published in: Journal of the American Geriatrics Society, [Epub January 2017, early view article]. doi:10.1111/jgs.14740

Posted on RAND.org on March 28, 2017

by Catherine C. Cohen, Andrew W. Dick, Patricia Stone

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Research Question

  1. Using the new Minimum Data Set (MDS) 3.0 assessment and items on multidrug-resistant organisms (MDROs), what factors are associated with the use of isolation for residents infected with MDROs in nursing homes?

Objectives

To examine factors associated with isolation precaution use in nursing home (NH) residents with multidrug-resistant organism (MDRO) infection.

Design

Retrospective, cross-sectional analysis.

Setting

Nursing homes with Centers for Medicare and Medicaid Services' certification from October 2010 to December 2013.

Participants

Elderly, long-stay NH residents with positive MDRO infection assessments.

Measurements

Data were obtained from the Minimum Data Set (MDS) 3.0, Certification and Survey Provider Enhanced Reporting, and Area Health Resource File. Multivariable regression with facility fixed effects was conducted.

Results

The sample included 191,816 assessments of residents with MDRO infection, of which isolation use was recorded in 12.8%. Of the NHs reporting MDRO infection in the past year, 31% used isolation at least once among residents with MDRO infection. Resident characteristics positively associated with isolation use included locomotion (23.6%, P < .001) and eating (17.9%, P < .001) support. Isolation use was 14.3% lower in those with MDRO history (P < .001). Residents in NHs that had received an infection control–related citation in the past year had a greater probability of isolation use (3.4%, P = .02); those in NHs that had received a quality-of-care citation had lower probability of isolation use (−3.3%, P = .03).

Conclusion

This is the first study to examine the new MDS 3.0 isolation and MDRO items. Isolation was infrequently used, and the proportion of isolated MDRO infections varied between facilities. Inspection citations were related to isolation use in the following year. Further research is needed to determine whether and when isolation should be used to best decrease risk of MDRO transmission and improve quality of care.

Key Findings

  • Nationwide use of isolation for patients infected with MDROs was 12.8 percent, which seems low considering 20 percent of hospital inpatients are isolated at any time.
  • Residents needing support with locomotion, help with eating, or having an indwelling catheter were more likely to be placed in isolation than other residents.
  • Residents less likely to be placed in isolation included those who had a history of MDRO infections, those who need help with activities of daily living regarding bed mobility, and those prone to wandering.
  • Nursing facilities that had received an infection control citation in the past year were more likely to isolate patients with an MDRO; facilities that received a quality of care citation in the past year, on the other hand, were less likely to isolate residents.
  • Nursing homes appear to be factoring in matters of practicality as well as goals to preserve psychosocial health and functionality when deciding whether to isolate residents.

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