High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An "Iceberg Effect".
James A McKinnell, Loren G Miller, Raveena D Singh and 42 others
PMID 32553489WHAT IT FOUND
Half of residents sampled in nursing homes carried a multidrug-resistant organism, and most were not known from records.
High-touch common areas and rooms were often contaminated.
Key findings
01Median MDRO carriage prevalence across the nursing homes was 50% (range 24% to 70%).
02Previously unknown MDRO carriage was identified in 627 residents, and unknown colonization represented a median 45% of residents per home (range 24% to 67%).
03Any MDRO was found on 74% of sampled resident rooms and 93% of sampled common areas.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was limited to 28 nursing homes in Southern California, so prevalence may not match other regions. Sampling was limited to nares and axilla/groin, not throat or rectal swabs, so MDRO detection was likely underestimated. MDRO history was based on nursing home medical records and transfer records, not full multifacility records or prior hospitalization data, so some known carriage may have been missed. It was baseline data for a trial, not a test of infection prevention strategies. Some environmental comparisons, such as CMS star ratings and resident status, were described as hypothesis generating and not confirmed.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that chlorhexidine bathing, nasal decolonization, hand hygiene, or environmental cleaning reduced MDROs. This paper reports baseline prevalence and contamination, not trial outcomes. It did not test which component, if any, works.