Gown and Glove Use to Prevent the Spread of Infection in VA Community Living Cent
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Methicillin-resistant S. aureus (MRSA) infections are a major cause of morbidity and mortality in veterans. MRSA is transmitted through direct or indirect contact in the healthcare setting. In acute care settings, we use Contact Precautions (health care workers [HCW] wear gowns and gloves for all patient contact) for patients colonized with MRSA to prevent transmission to other patients. Current Centers for Disease Control and Prevention (CDC) Isolation Guidelines suggest modifying Contact Precautions in long term care facilities (LTCF), but there is little evidence to guide how to modify them. The goal of this revised proposal is to determine the optimal modifications of Contact Precautions for LTCF in order reduce the risk of MRSA transmission and allow care in a home-like, patient-centered environment consistent the Community Living Centers Cultural Transformation. LTCFs provide multiple levels of care including rehabilitation, skilled nursing and maintenance care. In the PI's current VA Merit award, we demonstrated that MRSA transmission is four-fold higher in rehabilitation care than in other long term care. This suggests that the types of care delivered increase the risk of transmission. MRSA transmission to other residents is difficult to study. Recently we developed a novel surrogate measure of MRSA transmission, detection of MRSA on HCW gown and gloves during HCW-patient interaction. Using this new methodology, we will test two major hypotheses based on expert opinion recommendations from the CDC Isolation Guidelines. 1. Risk of MRSA transmission will vary by type of contact with the resident and each activity will have its own risk of transmission. Some activities such as those involving contact with secretions (e.g. draining wounds, ostomy care) will be of higher risk than others (e.g. vital signs, medication administration). 2. For any given type of contact, resident characteristics increases the risk of transmission (e.g. residents totally dependent upon healthcare personnel for healthcare and activities of daily living or residents whose secretions or drainage cannot be contained). Our aim is to estimate the frequency of and risk factors for MRSA transmission to protective gowns and gloves worn by HCW interacting with 400 MRSA colonized VA long term care residents in a multi-site observational study in VA Community Living Centers from four states and the District of Columbia.
