title: Isolation Precautions Use for Multidrug-Resistant Organism Infection in Nursing Homes.
abstract: OBJECTIVE
  To examine factors associated with isolation precaution use in nursing home (NH) residents with multidrug-resistant organism (MDRO) infection.
  
  
  METHODS
  Retrospective, cross-sectional analysis.
  
  
  METHODS
  Nursing homes with Centers for Medicare and Medicaid Services' certification from October 2010 to December 2013.
  
  
  METHODS
  Elderly, long-stay NH residents with positive MDRO infection assessments.
  
  
  METHODS
  Data were obtained from the Minimum Data Set (MDS) 3.0, Certification and Survey Provider Enhanced Reporting, and Area Health Resource File. Multivariable regression with facility fixed effects was conducted.
  
  
  RESULTS
  The sample included 191,816 assessments of residents with MDRO infection, of which isolation use was recorded in 12.8%. Of the NHs reporting MDRO infection in the past year, 31% used isolation at least once among residents with MDRO infection. Resident characteristics positively associated with isolation use included locomotion (23.6%, P < .001) and eating (17.9%, P < .001) support. Isolation use was 14.3% lower in those with MDRO history (P < .001). Residents in NHs that had received an infection control-related citation in the past year had a greater probability of isolation use (3.4%, P = .02); those in NHs that had received a quality-of-care citation had lower probability of isolation use (-3.3%, P = .03).
  
  
  CONCLUSIONS
  This is the first study to examine the new MDS 3.0 isolation and MDRO items. Isolation was infrequently used, and the proportion of isolated MDRO infections varied between facilities. Inspection citations were related to isolation use in the following year. Further research is needed to determine whether and when isolation should be used to best decrease risk of MDRO transmission and improve quality of care.
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York City, New York.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Cohen
authors.affiliation: The RAND Corporation, Boston, Massachusetts.
authors.forename: Andrew
authors.initials: A
authors.lastname: Dick
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York City, New York.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
mesh_terms: D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000494:pharmacology; D002408:Catheters, Indwelling; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D066264:Datasets as Topic; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D009735:Nursing Homes; D009740:Nursing Staff / Q000600:supply & distribution; D010043:Outcome and Process Assessment, Health Care; D010356:Patient Isolation / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D016635:Universal Precautions
chemical_list: D000890:Anti-Infective Agents
keywords: Minimum Data Set; infection control; isolation precautions; large data analysis; nursing homes