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    Development and Validation of a Clinical Prediction Rule to Predict Transmission of Methicillin-Resistant Staphylococcus aureus in Nursing Homes

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    Author
    Jackson, S.S.
    Lydecker, A.D.
    Magder, Laurence S.
    Date
    2019
    Journal
    American journal of epidemiology
    Publisher
    Oxford University Press
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://dx.doi.org/10.1093/aje/kwy220
    Abstract
    The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among nursing home residents is high. Health-care workers (HCWs) often serve as a vector in MRSA transmission. The ability to identify residents who are likely to transmit MRSA to HCWs' hands and clothing during clinical care is important so that infection control measures, such as Contact Precautions, can be employed. Using data on demographic and clinical characteristics collected from residents of community nursing homes in Maryland and Michigan between 2012 and 2014, we developed a clinical prediction rule predicting the probability of MRSA transmission to HCWs' gowns. We externally validated this model in a cohort of Department of Veterans Affairs nursing home residents from 7 states between 2012 and 2016. The prediction model, which included sex, race, resident dependency on HCWs for care, the presence of any medical device, diabetes mellitus, and chronic skin breakdown, showed good performance (C statistic = 0.70; sensitivity = 76%, specificity = 49%) in the development set. The decision curve analysis indicated that this model has greater clinical utility than use of a nares surveillance culture for MRSA colonization, which is current clinical practice for placing hospital inpatients on Contact Precautions. The prediction rule demonstrated less utility in the validation cohort, suggesting that a separate rule should be developed for residents of Veterans Affairs nursing homes.
    Keyword
    decision curve analysis
    external validation
    prediction rule
    Decision Support Techniques
    Infectious Disease Transmission, Patient-to-Professional--prevention & control
    Methicillan-Resistant Staphylococcus aureus
    Nursing Homes
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85059495608&doi=10.1093%2faje%2fkwy220&partnerID=40&md5=ea344b4574fc524189e60fd4194e80bb; http://hdl.handle.net/10713/8569
    ae974a485f413a2113503eed53cd6c53
    10.1093/aje/kwy220
    Scopus Count
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    UMB Open Access Articles 2019

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