We approached 17 community-based NHs in southeast Michigan that had expressed a preliminary interest in participating in our research program (Figure ). Thirteen agreed to have initial conversations with us, of which 12 agreed to participate and remained in our study for 3 years from May 2010 to April 2013. This study was approved by the institutional review board at the University of Michigan. The full study protocol can be found in the trial protocol in Supplement 1. All Medicare-certified and Medicaid-certified NHs have an infection control program.26 Similar to most US NHs, all study sites had an on-site infection preventionist, most of whom served in this role part-time and had additional responsibilities (eTable 1 in Supplement 2). All NHs had access to laboratory and radiology services.27 (link) 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 (Table 1 ). The control group NHs continued to practice according to their own infection prevention policies.
Written informed consent to collect surveillance samples and resident-specific data was obtained from each resident or his or her durable power of attorney. Inclusion criteria were (1) any short-stay or long-stay resident with an indwelling urinary catheter, a feeding tube (nasogastric or percutaneous endoscopic gastrostomy tube), or both for more than 72 hours and (2) informed consent. Residents receiving end-of-life care were excluded. Study personnel (B.L., S.E.M., J.F., and E.K.) obtained data on participant characteristics, age, sex, functional status,28 (link) comorbidity,29 (link) and facility-level predictors, such as the quality ratings.30 The Centers for Medicare & Medicaid Services created the 5-star quality rating system to help consumers, their families, and caregivers compare NHs. This rating incorporates health inspections, staffing, and quality measures. While the field staff (B.L., S.E.M., J.F., and E.K.) were aware of the intervention assignment, one of us (K.S.) processing microbiology cultures was blinded.
Written informed consent to collect surveillance samples and resident-specific data was obtained from each resident or his or her durable power of attorney. Inclusion criteria were (1) any short-stay or long-stay resident with an indwelling urinary catheter, a feeding tube (nasogastric or percutaneous endoscopic gastrostomy tube), or both for more than 72 hours and (2) informed consent. Residents receiving end-of-life care were excluded. Study personnel (B.L., S.E.M., J.F., and E.K.) obtained data on participant characteristics, age, sex, functional status,28 (link) comorbidity,29 (link) and facility-level predictors, such as the quality ratings.30 The Centers for Medicare & Medicaid Services created the 5-star quality rating system to help consumers, their families, and caregivers compare NHs. This rating incorporates health inspections, staffing, and quality measures. While the field staff (B.L., S.E.M., J.F., and E.K.) were aware of the intervention assignment, one of us (K.S.) processing microbiology cultures was blinded.
