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633 Maryland Statewide Survey of MDRO Infection Prevention Practices

Sunday, April 3, 2011: 3:45 PM
Coronado A (Hilton Anatole)
Katherine Henry, MPH , Maryland Department of Health & Mental Hygiene, Baltimore, MD
Lucy Wilson, MD, ScM , Maryland Department of Health & Mental Hygiene, Baltimore, MD
Anthony D. Harris , University of Maryland, Baltimore, MD
Brenda Roup, PhD, RN, CIC , Maryland Department of Health & Mental Hygiene, Baltimore, MD
Patricia Lawson, RN, MS, MPH, CIC , Maryland Department of Health & Mental Hygiene, Baltimore, MD
Margaret A. Pass, RN , St. Agnes Hospital, Baltimore, MD
Elizabeth Fuss, RN, MS, CIC , Carroll Hospital Center, Westminster, MD
Lisa Maragakis, MD , Johns Hopkins University, Baltimore, MD
David Blythe, MD, MPH , Maryland Department of Health & Mental Hygiene, Baltimore, MD
Kerri A. Thom, MD, MS , University of Maryland, Baltimore, MD
Background: Multi-drug resistant Acinetobacter baumannii (MDR-Ab) is an emerging pathogen of increasing importance in the healthcare setting. In general, isolation and screening practices on a statewide level are not known.

Objective: To understand Maryland acute and long-term care facilities’ (LTCF) MDRO screening and isolation practices, and to understand survey results in the context of Maryland’s MDR-Ab prevalence.

Methods: The Maryland MDRO/MDR-Ab Prevention Collaborative prepared a questionnaire to assess screening, isolation, and inter-facility transfer communication practices regarding MDROs, including MDR-Ab. In Maryland, 100% of acute care hospitals (45) and LTCF housing mechanical ventilator beds (12) were included. Concurrently, MDR-Ab prevalence was assessed based on surveillance cultures from 30 acute care and 10 LTCF. Sputum and peri-anal samples were collected among mechanically ventilated patients. Results and methods from this prevalence survey are discussed in further detail in a concurrent SHEA presentation.

Results: Overall, 18% of mechanically ventilated patients surveyed had MDR-Ab. While 98% of acute care and 42% of LTCF report the use of active surveillance cultures (ASC) for methicillin-resistant Staphylococcus aureus (MRSA), only 6/45 acute care and 2/12 LTCF perform ASC for MDR-Ab. Using presence of Ab at either site as the gold standard, the MDR-Ab prevalence survey demonstrated a sensitivity of Ab sputum cultures at 80% and sensitivity of peri-anal swabs at 63%. In general, facilities reported MDR-Ab ASC site as sputum (50%), skin (25%), and 38% tested other patient sites:  respiratory tract (not including sputum), peri-anal/stool, and/or wounds. 44/45 acute care and 10/12 LTCF reported routine contact isolation precautions for MDR-Ab. 100% of facilities reported communicating a transfer patient’s MDRO status upon discharge, however, only 82% of acute care and 92% of LTCF reported receiving communication about a patient’s MDRO status upon transfer/admission from another facility.

Conclusions: Overall prevalence of MDR-Ab among mechanically ventilated patients was higher than expected. While most facilities isolate known MDR-Ab cases, few facilities perform ASC. Given Maryland’s high MDR-Ab prevalence, enhanced ASC for MDR-Ab may steer facilities towards increased contact isolation and potential reductions of MDR-Ab transmission. Additionally, sputum culture appears to be the most sensitive active surveillance site for detecting MDR-Ab among ventilated patients. Regarding inter-facility transfers, although 100% of facilities note reporting MDRO status on discharge, not all facilities report receiving this data when receiving transfers. A standardized statewide transfer document/protocol may enhance communication of MDRO status and facilitate prevention efforts.