Infection Control Policies on Multidrug-Resistant Gram-Negative Bacilli in Illinois Hospitals

Background: CDC Isolation Guidelines (2007) cite local, state, regional, or national recommendations as sources to consult in determining which multidrug-resistant organisms should cause an infected patient to be placed on contact precautions.  Little is known about criteria used by hospital infection control (IC) programs to implement contact precautions for patients infected with gram-negative bacilli such as Klebsiella spp. and Acinetobacter spp.

Objective: (1) Summarize IC program characteristics in Illinois hospitals (acute care), (2) describe contact precautions policies for various gram-negative bacilli and (3) identify facility characteristics that are associated with certain types of policies.

Methods: We sent an online questionnaire to all hospital IC programs in Illinois.  Topics of survey questions included facility and IC program characteristics, and policies regarding specific organisms.  A certified infection preventionist (IP) was defined as a person certified in IC (CIC).  The Wilcoxon test was used to compare means of non-normally distributed populations.

Results: Questionnaires were completed by 83% (175/212) of hospitals.  Forty two percent of hospitals had at least one certified IP and 64% had a physician in the role of hospital epidemiologist.   At 59% of facilities, Acinetobacter spp. triggered contact precautions only when resistant; Pseudomonas spp. triggered contact precautions only when resistant at 69% of facilities, and Klebsiella spp., 64%.  The definition of resistance for each organism varied among facilities.  Patients infected with extended spectrum beta-lactamase producing bacteria were not always placed on contact precautions at 35% of responding facilities.  Hospitals with at least one certified IP had more gram-negative bacilli specifically addressed in regards to contact precautions in their IC policies than facilities without at least one certified IP (mean 2.48 vs. 1.40, Wilcoxon Two-Sample Test Statistic = 6560, p<0.001).  Respondents from hospitals with at least one certified IP answered “don’t know” to fewer questions about their facilities’ policies on contact precautions than those from facilities without at least one certified IP (mean 0.33 vs. 2.11, Wilcoxon Two-Sample Test Statistic = 4471.5, p<0.001).

Conclusions: Although most hospitals in Illinois address specific organisms or resistance patterns in their IC policies for gram negative bacilli, criteria for contact precautions vary and knowledge of contact precautions policies was incomplete at some hospitals.  Having at least one certified IP was associated with more specific policies regarding which antibiotic resistant organisms warranted contact precautions, and more knowledge of the facilities’ IC policies.  Additional public health guidance regarding resistance patterns necessitating contact precautions, as cited in the CDC guidelines, is warranted.