Indwelling devices such as urinary catheters and feeding tubes are often used in nursing homes (NHs). Inadequate care of residents with these devices contributes to high rates of multidrug-resistant organisms (MDROs) and device-related infections in NHs.
The Targeted Infection Prevention (TIP) study was a cluster randomized multi-modal interventional trial to reduce the prevalence of MDROs and incident indwelling device-related infections in NH residents with urinary catheters and feeding tubes (Mody et al. JAMA Internal Medicine 2015;175(5):714-723). The TIP intervention was implemented in 6 nursing homes, while 6 control nursing homes continued to practice according to their own infection prevention policies. The TIP intervention included the following: (1) preemptive barrier precautions; (2) active surveillance for MDROs and infections with data feedback; and (3) NH staff education on key infection prevention practices and hand hygiene promotion.
The multi-modal TIP intervention reduced the overall MDRO prevalence density, new methicillin-resistant Staphylococcus aureus acquisitions, and clinically-defined catheter-associated urinary tract infection rates in NH residents with indwelling devices in the intervention group compared to the control group. However, there were no differences in the rates of new vancomycin-resistant enterococci or resistant gram-negative bacilli acquisitions, or in new feeding tube-associated pneumonias or skin and soft-tissue infections between the two groups. Mean infection prevention knowledge scores were higher for the intervention group compared to the control group after an interactive educational program. Hand hygiene and gown use was also higher in the intervention group, although glove use did not differ.
This toolkit and implementation guide provides details about each intervention component used in the TIP study. Educational materials on infection prevention topics such as hand hygiene or indwelling urinary catheter care were designed for nurses and nurse aides and include: presentation slides, pre/post-tests, and interactive activity instructions. In addition, tools such as hand hygiene monitoring forms and infection definition pocket guides are provided.
• This toolkit has been designed to aid infection preventionists, nurses, and physicians working in post-acute and long- term care facilities in developing their own infection prevention programs to reduce MDROs and infections.
• Educational materials are easy to implement and customize for each facilities needs