Staphylococcus aureus and Carbapenem-resistant gram-negative Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae in Chronic Ventilator Units in Nursing Homes

Nursing homes are healthcare settings that house a high prevalence of people with pathogen colonization, creating a high risk for resident-to-resident transmission of S. aureus and carbapenem-resistant Gram-negative bacteria including Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter spp. Some nursing homes provide care for residents requiring respiratory support using a mechanical ventilator. Residents who require chronic ventilator support are likely to be colonized with these pathogens because of chronic wounds such as tracheostomies, prior exposure to the healthcare environment and frequent antibiotic use. The objective of this study was to test the feasibility and effect of Enhanced Barrier Precautions as currently recommended by the CDC to prevent Staphylococcus aureus and carbapenem-resistant organism transmission in nursing home residents on a chronic ventilator unit. Gown and glove use was targeted to specific high risk care activities for high risk residents defined as those with known colonization with multi-drug resistant organisms (MDRO) or those with chronic wounds (wounds which require dressing) or medical devices such as urinary catheters, vascular catheters or feeding tubes regardless of MDRO colonization. In order to determine the genetic relatedness of the isolates and infer acquisition and transmission events, we sequenced the genomes of the isolates from residents on the chronic ventilator unit in the nursing homes.