Is Isolation Effective as a Precaution to Prevent MDRO Infection in Nursing Homes?

Infections are the leading cause of morbidity and mortality in nursing homes with 3.8 million healthcare-associated infections (HAIs) occurring annually, contributing to nearly 400,000 deaths and as much as $2 billion in hospitalization costs. Among these infections are various multidrug-resistant organism (MDRO) infections, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) infections.  Consequently, nursing homes are required to implement effective infection prevention practices to control the incidence of MDROs, including isolation precautions which can require residents to be confined to a private room, and requires a gown and gloves to be used by anyone entering an ill patient’s room. However, the guidelines were based on data primarily collected in acute care settings and thus may not apply to residential community settings such as nursing homes.

This knowledge gap is currently being bridged by Catherine Crawford Cohen, a PhD student at Columbia School of Nursing, who just received a $5,000 award at this year’s Eastern Nursing Research Society (ENRS) Conference for her dissertation proposal, “Multidrug-resistant Organism Infection and Isolation Precautions in Nursing Homes.”  Her study will be the first to evaluate isolation practices and MDRO infection risks in nursing homes nationwide.

Cohen’s research aims to identify characteristics that may predict the probability of MDRO infections, the likelihood that isolation precautions will be used to combat infections and, ultimately, the relationship between isolation use and the spread of MDRO infections in nursing homes.

“I was surprised how little information exists on infection control in nursing homes,” Cohen said. “I was also surprised how little nursing homes have been studied, how few resources most nursing homes have available to them, and how the lack of resources and good data affects infection control practices..”

The award is presented annually to a doctoral candidate enrolled in a nursing program that recognizes a research doctoral degree requiring a dissertation. Review criteria for the award include the significance of the research to nursing science, the innovativeness of proposed research methods, and the likelihood that the study may launch an important program of research. Applicants must present their findings at an at ENRS or Council conference within three years of receiving the award.

Cohen’s research analyzes very large data sets collected from 96% of the nursing homes in the U.S. during 2011-2013.  These data, which includes detailed information on some 1.5 million people, focuses strictly on nursing homes and does not include data on individuals in acute care or other shorter-term settings.  Since Cohen’s study employs large national datasets, the findings could potentially provide more detailed information than previous investigations. So far, her research has discovered a variety of procedures and decision-making processes among nursing homes nationwide. 

Isolation in nursing homes is handled many ways, from placing infected individuals in an isolation room to allowing them varying degrees of movement among other residents.  Isolation works against the basic socialization behaviors that most nursing homes try to encourage among their residents, and can also have psychological effects.  One challenge of isolation is balancing the safety of the greater nursing home population with the risks of putting an elderly individual into isolation. 

Consequently, nursing homes try to adapt and tailor their isolation practices, but they have few studies for determining the effectiveness of these procedures. Cohen’s research using a larger database will allow her to more broadly determine the effectiveness of isolation precautions in order to inform decisions regarding interventions and best practices in nursing homes.

 “Currently, we do not have the evidence we need to understand how and even if isolation should be implemented to prevent infections,” Cohen says.  “This study will evaluate how isolation precautions affect MDRO infections. I believe this will also be the first study to assess MDRO predictors in nursing home populations nationwide.”

ENRS 2015

AWARD RECIPIENTS

2015 ENRS/ Council for the Advancement of Nursing Science Dissertation Award: Catherine Cohen

First place, peer reviewed PhD poster

Cardiovascular Risk Among HIV-infected and Uninfected Postmenopausal Women: Preliminary Findings

Yamnia Cortes, Nancy Reame, Michael Yin

First place, peer reviewed PhD poster

The Impact of Nurses in School-based Childhood Obesity Initiatives: A Systematic Review

Krista Schroeder, Jasmine Travers, Arlene Smaldone

Second place, early PhD poster

Generational Differences in Mental Health and Internalized Transphobia among Transgender Women

Katherine Jackman, Curtis Dolezal, New York State Psychiatric Institute; Walter Bockting

Faculty/Student Papers and Posters

Paper Session A3: Long-Term Care

Barriers to Infection Prevention and Control among Nursing Home CNAs: A Qualitative Study

Jasmine Travers, Carolyn Herzig, Columbia University; Eileen Carter, Catherine Cohen, Ragnhildur Bjarnadottir, Patricia Semeraro, Monika Pogorzelska, Thomas Jefferson University; Patricia Stone

Perceptions of the Role of Nursing Home MDS Coordinators

Ragnhildur Bjarnadottir, Patricia Semeraro, Carolyn Herzig, Monika Pogorzelska-Maziarz, Thomas Jefferson University; Eileen Carter, Catherine Cohen, Jasmine Travers, Patricia Stone

Paper Session A5: Child and Family Health

Personal Best Hemoglobin F, A Potential Biomarker for Hydroxyurea Adherence in Youth with Sickle Cell Disease

Arlene Smaldone, Deepa Manwani, Albert Einstein Medical Center; Nancy S. Green

MS Posters

A Systematic Review: IUD Continuation Rates in Women Aged 25 Years and Younger

Kaitlin Wagner, Marjorie Salas, Sowsina Gola

DNP Posters

A Systematic Review: The Perioperative Use of Methadone in Adult Surgical Patients and its Role in Postoperative Pain Management

Jennifer Cepak, Nicole Lee, Erin Swepston, Melissa Tam

Poster Session I Meet the Researchers

Feasibility Testing of a Health Information Exchange Infographic to Inform Consent Procedures at an HIV Clinic

S. Raquel Ramos, Suzanne Bakken

Mental Health Disorders in the Home Care Elders: An Integrative Review

Jinjiao Wang, Joan Kearney, Jingjing Shang

Scale-up Considerations of an mHealth Intervention to Support Patients With Active Tuberculosis

Sarah Iribarren

The Prevalence of Mental Health Disorders and Risk Factors in the U.S. Home Care Elders: Exploratory Analysis

Jinjiao Wang, Jingjing Shang, Haomiao Jia, Joan Kearney

Paper Session B2: HIV

HIV Knowledge and Sexual Risk Behaviors among Older Latinas

Yamnia Cortes, Erida Castro, Tawandra Rowell-Cunsolo

Understanding Young Adults’ Use the HIV Home Test Kit

Rebecca Schnall, RitaMarie John

Symposium Session C6: Creating a Culture of Health in the Caribbean Basin through Nursing Research

Clinical Nursing and Midwifery Research in African Countries: A Scoping Review

Carolyn Sun

Health Information Needs of HIV Positive Adults in La Romana, Dominican Republic

Samantha Stonbraker, Elaine Larson

Poster Session II Meet the Researchers

Political Skill and Relevance to Nursing: An Integrative Review

Wanda Montalvo

Food Insecurity: A Concept Analysis

Krista Schroeder, Arlene Smaldone

How Useful is a Single Day-time Measure of Salivary Cortisol as a Stress Biomarker in a Community-based Study of Mental Health Symptoms in Older Hispanic Women?

Nancy Reame, Sunmoo Yoon, Niurka Suero-Tejeda, Serge Cremers, Suzanne Bakken

Paper Session D2: Nursing Organizational Climate and Workforce Issues

Nurse Practitioner Practice Environments in Primary Care Organizations are Important: Implications for Primary Care Workforce Capacity

Lusine Poghosyan, Jianfang Liu

Organizational Climate Assessment of Nurse Practitioners and Physician Assistants and the Association with Perceived Team Membership

Jennifer Derkazarian, Lahey Hospital & Medical Center; Alex Hoyt, MGH Institute of Health Professions; Lisa Colombo, Lahey Hospital &  Medical Center; Lusine Poghosyan

Paper Session D4: Cardiac Disorders: Patient and Family Experiences

Exercise Promotes Behavioral Alertness in Heart Failure

Ruth Masterson Creber, Columbia University; Victoria M. Pak, University of Pennsylvania; Miranda Varrasse, University of Pennsylvania; Barbara Riegel, University of Pennsylvania

Paper Session D5: Cognitive Status in the Elderly

Pain Assessment Tools for Individuals with Dementia: A Meta-review

Dawn Dowding, Valentina Lichtner, University of Leeds, UK; Philip Esterhuizen, University of Leeds, UK; S. José Closs, University of Leeds; Andrew Long, University of Leeds; Anne Corbett, Kings College London; Michelle Briggs, Leeds Beckett University

Symposium Session D6: Creating a Culture of Health in Africa and Asia through Nursing and Interdisciplinary Research

Establishing a Program of Global Initiatives for Nursing Education

Elaine Larson, Jennifer Dohrn, Kristine Kulage

Poster Session III Meet the Researchers

Cultural Factors Associated With Quality of Life: An Integrative Review

Jennel Osborne, Arlene Smaldone

Maternal Childhood Maltreatment, Maternal Obesity, and Infant Birth Weight: Associations with Maternal Stress, Social Support and Mental Health

Patricia Semeraro, Catherine Monk, Joan Kearney