Applying SHEA/HIPAC Routine Metrics for Multidrug-Resistant Organisms in a community teaching hospital in Belo Horizonte, Brazil

Background: Monitoring multidrug-resistant organisms (MDROs)  is important to assess the need for and effectiveness of interventions. SHEA/HICPAC proposed 4 routine metrics: MDRO-specific line list for tracking patients; an antibiogram for monitoring susceptibility patterns of isolates recovered from patients; the incidence of hospital-onset MDRO bacteremia and clinical culture results.

Objective: To evaluate the compliance of isolation precautions practices using the tracking patients line list with the results of clinical cultures positive for any MDROs.

Methods: This is an observational study realized in the Risoleta Tolentino Neves Hospital. This is a community teaching hospital that receive patients under urgency medical conditions and victims of trauma. Every day the infection control practioner bring up the culture results to the MDRO-specific line list. Then, turn available the list on line by intranet resource. So, a leader registered nurse from the medical ward implements the isolation precautions to patients with MDRO. The patient has to be identified with a sheet informing the isolation precaution category (HICPAC, 2006) required and transfer to a private room or to a cohort room. The authors visited the wards during two weeks checking the compliance of these recommendations.

Results: 275 evaluations were performed involving 34 patients with gram positive and negative MDROs in the medical ward. The length of stay (mean) of these patients were  12,3 days and 418 patients-day in this period. In 21,1% of the evaluations (58/275) there were an identification sheet on the chart and in 62,5% of the evaluations (172/275) there were identification sheet on bedside. Private room were implemented in only 23,6% (65/275) of the evaluations. Cohort isolation were used in approximately 50,0% (137/275). It is important to mention that in 21,5% (59/275) of the evaluations, the patients were only identified by the sheet on the bedside in the same room with non-MDROs patients.

Conclusions: The tracking patient line list joined online detailed information of the MDRO turned easy and fast the implementation of the isolation precautions in a real time. There was a very low compliance on the chart identification of MDROs patients. But it became little better on bedside. As in 21,5% of the evaluations the MDROs patients were beside non-MDROs patients there is an important risk of the dissemination of these microorganisms. So, others education strategies were performed.