Antimicrobial-resistant organisms (AROs) are endemic in nursing homes (NH) with prevalence rates surpassing those in hospitals. The basic question of interaction between a disabled host, institutional environment, and caregiver contact in ARO acquisition (and transmission) remains unanswered. We hypothesize that specific activities of daily living (ADL) disability patterns in NH residents will predict acquisition risk or new AROs. We will examine whether disability and risk of acquisition are proportional to healthcare worker contact time and contact intensity. Our proposed Specific Aims are:
Aim 1 : Develop and examine a risk-stratification model utilizing resident-, HCW-, and environmental-level factors to identify three categories of NH residents: (1) never acquire an ARO;(2) intermittently acquire an ARO;and (3) newly acquire an ARO and remain persistently colonized. Resident-level factors include incremental levels and specific patterns of ADL impairment, presence of wounds, and use of indwelling devices. HCW factors include contact time and intensity, as well as varying levels of nursing resource utilization. The environment factors include presence of AROs on inanimate objects in resident rooms, common areas, and rehabilitation rooms. We will also establish a """"""""molecular fingerprint"""""""" between the strains of AROs colonizing functionally-impaired residents and those isolated from their environment and the hands of caregivers. Using this risk-stratification model, we will establish the optimal ARO prevention strategy in highest-risk functionally-disabled NH residents.
Aim 2 : Design and evaluate the effectiveness of a multi-component intervention to reduce new acquisition of AROs in the highest-risk functionally-disabled NH residents. This intervention will incorporate resident level, environmental, and caregiver-based strategies. The proposed translational study is innovative and timely because it will develop a risk-stratification model to identify functionally-disabled NH residents who are most likely, if colonized, to transmit AROs;define a molecular """"""""fingerprint"""""""" of resident-caregiver-environment ARO contamination;and design and implement a multi-component comprehensive intervention targeting high-risk functionally-disabled residents. The impact of this research will be an effective, efficient, and infection prevention program for NHs to limit ARO acquisition and more importantly transmission. We expect our results to have widespread application in NHs, enhance residents'quality of life, reduce hospital transfers, reduce healthcare costs and shift the evolving paradigm of infection control and prevention in NHs.

Public Health Relevance

This prospective clinical and molecular epidemiologic study will define the role of functional disability, healthcare worker contact and environmental contamination in acquisition and transmission of antibiotic resistant organisms in nursing home setting. The widespread impact of this research will be in designing an effective, efficient, and targeted infection control program for functionally disabled older adults. We expect our results to shift the evolving paradigm of infection control and prevention in nursing homes.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
1R01AG041780-01A1
Application #
8498737
Study Section
Aging Systems and Geriatrics Study Section (ASG)
Program Officer
Salive, Marcel
Project Start
2013-06-15
Project End
2018-05-31
Budget Start
2013-06-15
Budget End
2014-05-31
Support Year
1
Fiscal Year
2013
Total Cost
$369,252
Indirect Cost
$131,791
Name
University of Michigan Ann Arbor
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
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Cassone, Marco; Mody, Lona (2015) Colonization with Multi-Drug Resistant Organisms in Nursing Homes: Scope, Importance, and Management. Curr Geriatr Rep 4:87-95
Mody, Lona; Gibson, Kristen E; Horcher, Amanda et al. (2015) Prevalence of and risk factors for multidrug-resistant Acinetobacter baumannii colonization among high-risk nursing home residents. Infect Control Hosp Epidemiol 36:1155-62
Mody, Lona (2015) Editorial commentary: Preventing aspiration pneumonia in high-risk nursing home residents: role of chlorhexidine-based oral care questioned again. Clin Infect Dis 60:858-9

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