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The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California.

  • Author(s): McKinnell, James A;
  • Singh, Raveena D;
  • Miller, Loren G;
  • Kleinman, Ken;
  • Gussin, Gabrielle;
  • He, Jiayi;
  • Saavedra, Raheeb;
  • Dutciuc, Tabitha D;
  • Estevez, Marlene;
  • Chang, Justin;
  • Heim, Lauren;
  • Yamaguchi, Stacey;
  • Custodio, Harold;
  • Gohil, Shruti K;
  • Park, Steven;
  • Tam, Steven;
  • Robinson, Philip A;
  • Tjoa, Thomas;
  • Nguyen, Jenny;
  • Evans, Kaye D;
  • Bittencourt, Cassiana E;
  • Lee, Bruce Y;
  • Mueller, Leslie E;
  • Bartsch, Sarah M;
  • Jernigan, John A;
  • Slayton, Rachel B;
  • Stone, Nimalie D;
  • Zahn, Matthew;
  • Mor, Vincent;
  • McConeghy, Kevin;
  • Baier, Rosa R;
  • Janssen, Lynn;
  • O'Donnell, Kathleen;
  • Weinstein, Robert A;
  • Hayden, Mary K;
  • Coady, Micaela H;
  • Bhattarai, Megha;
  • Peterson, Ellena M;
  • Huang, Susan S
  • et al.


Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NHs), and long-term acute care facilities (LTACs) via patient transfers. The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based on their high degree of patient sharing. We report baseline MDRO prevalence in 21 NHs/LTACs.


A random sample of 50 adults for 21 NHs/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase-producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, skin (axilla/groin), and peri-rectal swabs. Facility and resident characteristics associated with MDRO carriage were assessed using multivariable models clustering by person and facility.


Prevalence of MDROs was 65% in NHs and 80% in LTACs. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). CRE prevalence was higher in facilities that manage ventilated LTAC patients and NH residents (8% vs <1%, P < .001). MDRO status was known for 18% of NH residents and 49% of LTAC patients. MDRO-colonized adults commonly harbored additional MDROs (54% MDRO+ NH residents and 62% MDRO+ LTACs patients). History of MRSA (odds ratio [OR] = 1.7; confidence interval [CI]: 1.2, 2.4; P = .004), VRE (OR = 2.1; CI: 1.2, 3.8; P = .01), ESBL (OR = 1.6; CI: 1.1, 2.3; P = .03), and diabetes (OR = 1.3; CI: 1.0, 1.7; P = .03) were associated with any MDRO carriage.


The majority of NH residents and LTAC patients harbor MDROs. MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.

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