Strategies to reduce multi-drug resistant infections in California hospitals

Background: Infections caused by multi-drug resistant organisms are associated with significant morbidity and mortality in the acute care setting. Early identification and control of MDRO infections remain a major focus in infection control departments; however, little is known about the actual use of different infection control policies in hospitals.

Objective: To describe the use of infection control policies aimed at reducing MDRO in a sample of California hospitals.

Methods: A cross-sectional survey of infection control departments from acute care California hospitals was conducted in the Fall of 2008. Respondents were asked to report on specific policies instituted by their  hospital that focused on MDRO including: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), multi-drug resistant gram negative rods (MDR GNR), Clostridium difficile and other. Descriptive statistics were conducted to examine the presence of policies for active surveillance, patient isolation, and antibiotic restriction directed at these specific MDRO.

Results:

169 hospitals participated for a response rate of 48%.  The mean hospital bedsize in this sample was 223 (SD ± 162). One third of hospitals reported that a surveillance culture (N = 57) was collected at admission; the specific populations cultured included ICU patients (67%), transfers from nursing homes (42%), dialysis patients (30%), all admissions excluding labor & delivery (18%) and readmissions within 30 days (18%). Less than 10% of hospitals reported screening all patients for different MDRO upon admission. The use of targeted screening was reported more frequently with one third (33%) of hospitals reporting targeted screening of ICU patients and transfers from nursing homes for MRSA upon admission. The vast majority of hospitals implemented contact precautions for MRSA (96%), VRE (94%), C. difficile (96%) and MDR GNRs (85%). Presumptive isolation/ contact precautions for patients with pending screens was less frequently implemented; half of the hospitals (52%) reported that this policy was not used for any MDRO. The reported use of cohorting of patients colonized with an MDRO in the same room varied depending on the type of MDRO: 77% and 72% of hospitals reported the use of this policy for MRSA and VRE, respectively. It was less frequently reported for C. difficile (64%) and MDR GNRs (57%).

Conclusions: This study represents a snapshot of the infection control practices aimed at MDRO utilized by California hospitals right before the implementation of mandatory reporting and targeted MRSA screening requirements in the state of California in January 2009. Although most hospitals are involved in activities to decrease MDRO, there is variation in the specific type of activities that are utilized.