Impact of a Collaboration-Focused Intervention to Prevent Healthcare-Associated Infections Before and During the Coronavirus Disease 2019 Pandemic.

Abstract

BACKGROUND Nursing home (NH) residents are susceptible to healthcare-associated infections (HAIs). Alignment among NHs, hospitals, and health departments is critical for effective implementation of infection prevention efforts. We tested a collaborative model that engaged hospitals and NHs to reduce infections among NH residents. METHODS We recruited 92 NHs and 15 hospitals over four 12-month cohorts (2018-2022). The intervention focused on HAI prevention; practices to reduce infection transmission; and effective communication among hospitals, NHs, and state health departments. NHs submitted data on urinary tract infection, catheter-associated urinary tract infection, Clostridioides difficile infection, methicillin-resistant Staphylococcus aureus infection, catheter use, and urine cultures. Changes in outcomes before and during the coronavirus disease 2019 (COVID-19) pandemic were assessed using multilevel negative binomial regression. RESULTS A total of 63 NHs (68%) partnered with 18 hospitals and submitted 2 or more months of outcome data. Forty NHs participated before COVID-19 (contributing to 1 364 492 resident-days, 56 258 device-days), and 23 NHs participated during COVID-19 (566 142 resident-days, 29 568 device-days). While reductions in the incidence of urine cultures (incidence rate ratio [IRR], 0.37; P < .001) and total composite infections (IRR, 0.68; P = .03) were observed before COVID-19, these reductions were not sustained during the pandemic. CONCLUSIONS Prior to COVID-19 pandemic, collaboration between NHs and referring regional hospitals with engagement from state health departments led to reductions in NH urine cultures and total infections. Although the pandemic significantly impacted our study, we demonstrate the importance of regional networks in promoting infection prevention in NHs.