659 Infection Control Practices for Multi-Drug Resistant Organisms in 10 Hospitals

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Sorabh Dhar, MD , Detroit Medical Center,Wayne State University, Detroit, MI
Dror Marchaim, MD , Detroit Medical Center,Wayne State University, Detroit, MI
Teena Chopra, MD , Detroit Medical Center,Wayne State University, Detroit, MI
Ryan Tansek, BS , Detroit Medical Center,Wayne State University, Detroit, MI
Elaine Flanagan, MSA, CIC , Detroit Medical Center,Wayne State University, Detroit, MI
Thomas R. Talbot, MD, MPH , Vanderbilt University, Nashville, TN
Laura Johnson, MD , Henry Ford Health System, Detroit, MI
Jerry Zuckerman, MD , Albert Einstein Med Ctr, Philadelphia, PA
Bartholomew R. Bono , Albert Einstein Med Ctr, Philadelphia, PA
Emily K. Shuman, MD , University of Michigan, Ann Arbor, MI
Jose Poblete, MD , Summa Health Systems, Akron, OH
Grace Kim, MD , Sparrow Hospital, Michigan State University, Lansing, MI
Rama Thyagarajan, MD , Oakwood Health Care System, Dearborn, MI
Carrie A. Herzke, MD , Johns Hopkins Medical Institute, Baltimore, MD
Trish Perl, MD, MSc , The Johns Hopkins Hospital, Baltimore, MD
Keith S. Kaye, MD, MPH , Detroit Medical Center,Wayne State University, Detroit, MI

Background: Increases in the incidence of infections caused by multi-drug resistance organisms (MDROs) have resulted in detailed recommendations from several national organizations on preventing transmission in the hospital. With the increasing frequency of MDROs, limited infection control resources, and difficulties in achieving compliance from healthcare workers, institutions struggle to define optimal isolation goals.

Objective: Our objective was to survey different hospitals to assess contact isolation practices and for trends in practice relevant to newly identified MDROs (i.e. carbapenem-resistant enterobacteriaceae (CRE), carbapenem-resistant and susceptible Acinetobacter baumannii (CRABs/CSABs)) and more traditional pathogens ( i.e. extended spectrum beta lactamase (ESBL) producers, methicillin resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE)).

Methods: 10 institutions were surveyed from 5 states in the US in the spring/summer 2009. Questions were asked regarding definitions of contact isolation, isolation practices for 6 types of resistant bacterial pathogens (MRSA, CRE, CRABs, CSABs, ESBL, VRE) on acute care floors and intensive care units (ICUs), active surveillance practices, and routine use of dedicated equipment.

Results: Most sites defined “contact isolation” as use of gowns and gloves (n=6) (Table).  Dedicated equipment was used at the majority of the sites (n=9). The average number of selected pathogens for which contact isolation was performed on the regular patient floors was 3.6 (median 4.0, range 2-6) and in the intensive care unit was 3.9 (median 4.5, range 2-6). Contact precautions were performed for a variety of different pathogens.  All sites implemented contact precautions routinely for CRE, 7 for MRSA and only 5 for ESBLs and VRE. Four sites utilized contact precautions based on criteria related to the “infectivity” of an anatomic site (i.e. contained vs. noncontained site). Active surveillance for at least 1 MDRO was performed at 8 sites and 3 of these sites presumptively isolated patients while surveillance tests were pending. 

Conclusions: Practices to control the spread of MDROs are an important component of hospital infection control programs.  Much variability exists regarding which MDROs to target and what types of infection control practice are used by hospital infection control programs.