Patient Movement and Impact on Multidrug-Resistant Organism (MDRO) Transmission

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Multidrug-resistant organisms (MDROs) are endemic in both acute care and nursing homes (NHs). However, predictors for new MDRO acquisition in older adults and transmission to healthcare professionals (HCPs) and the environment, particularly outside of patient rooms, remain unclear. This is relevant in today’s contemporary healthcare systems with patient movement outside the rooms for medical diagnostics and treatment- such as rehabilitation including physical and occupational therapy, procedures such as biopsies, services such as dialysis, infusion clinics and recreational activities- presenting a tremendous potential for transmission of organisms With this project and a focus on high-risk NH Veterans, our aims are to first characterize the changing epidemiology of MDROs at 3 VA NHs with the explicit goal of developing a ‘Patient Movement Index’ depicting the role of out-of-room visits for medical appointments and recreation in MDRO transmission across the institution. Using molecular and genomic methods, we will develop an understanding of the impact of MDRO transmission, predominant strains circulating in the NHs and other patient use areas. Using an ‘Intervention Mapping Framework’ we will next develop and pilot an integrated multi-modal intervention involving Veterans, their families, HCP as well as leadership to reduce transmission and infections. We anticipate this intervention to include: 1) Veterans’ and caregivers’ hand hygiene and infection prevention education; 2) provider education on MDRO prevention strategies and environmental cleaning; and 3) leadership involvement including infection prevention team, VA NH leadership, and managers of common use areas frequented by our participants. Patterns of patient movements outside their rooms as well as the molecular and genomic data obtained in Specific Aim 1 will be critical in informing our intervention. Our proposed translational study is innovative and timely as we plan to develop a new index that will characterize the amount of time Veterans spend outside their immediate environment in a colonized state and define a “fingerprint” of Veteran-caregiver-environment contamination. These studies will open a new line of inquiry allowing us to design future projects in order to characterize patient movement and transmission in other service areas such as hospitals and specialized units. We expect our results to have widespread application within and outside the VA, enhance Veterans’ quality of life by improving their hygiene practices and preventing infections, and help understand MDRO transmission within an evolving healthcare system. Our multidisciplinary team with expertise in aging, epidemiology including molecular epidemiology, microbiology, infectious diseases, health outcomes, nursing and patient oriented research is uniquely positioned to achieve our goals and advance the field.