Policies and Practices for Multidrug Resistant Organisms (MDRO) in a National Sample of NHSN Hospitals Monika Pogorzelska, MPH Elaine Larson, RN, PhD, FAAN, CIC Patricia W. Stone, PhD, FAAN Columbia University School of Nursing This study is generously funded by the National Institute of Nursing Research (R01NR010107) Background • Identification of MDRO infections in high risk populations is an important component of infection control (IC) programs • Published recommendations on use of contact precautions and surveillance cultures are not consistent • Paucity of national data on extent of implementation of MDRO policies and practices in intensive care units (ICUs) Objectives • To determine the range of MDRO policies and practices employed by infection preventionists in ICUs • To investigate whether screening for select MDRO varied with certain hospital and IC department characteristics Methods: Enrollment • As part of a larger study, a survey was sent to select National Healthcare Safety Network (NHSN) hospitals • Facility administrators from NHSN hospitals were invited to participate in the P-NICE survey if: • Hospital conducts NHSN HAI surveillance in an adult Medical, Medical/Surgical, or Surgical ICU in 2007 • ICU has a minimum of 500 device days • 441 hospitals were eligible Survey Development • On-line survey developed based on the seminal SENIC study in which staffing of infection control programs and intensity of surveillance, prevention and control activities were measured in 1970’s (Haley et al.) Methods: Survey Data • Hospital Characteristics • Teaching status • Bedsize • Geographic region • Infection Control Department Characteristics • Infection control staffing • Years in NHSN • Infection preventionist (IP) certification • State mandatory reporting of infections • Use of electronic surveillance system • ICU Characteristics • Type (medical, medical/surgical, surgical) Methods: Survey Data • Extent of implementation of policies and practices to reduce MDRO rates: •Screening ALL patients for MDROs upon ICU admission •Screening patients for MDROs periodically after ICU admission •Implementing presumptive isolation/contact precautions pending an MDRO screen •Implementing contact precautions for patients with MDRO positive cultures •Cohorting patients colonized with MDROs in the same room •For each ICU, the following was asked for each policy: • Written policy was in place, if yes • Was it monitored, if yes • Proportion of time correctly implemented • Routine screening for MRSA, VRE, C. difficile and MDRGNRs Methods: Data Analysis • Descriptive statistics of hospitals and infection control departments • Descriptive statistics of MDRO policies and practices • Logistic Regressions to see if hospital and infection control department characteristics predicted screening for select MDROs (MRSA, VRE. C. difficile, MDRGNRs) Results: Hospital Characteristics Region N % Northeast 109 44 South 66 26 Midwest 40 16 West 35 14 • 250 Hospitals (57% Response rate) provided data on 414 ICUs Sample (N = 250) N NHSN (N = 621) % N % Bed size ≤ 200 50 2 273 44 201-500 146 58 250 40 501-1000 49 20 96 16 > 1000 5 2 2 0.3 163 65 321 52 Teaching Results: Infection Control Department Characteristics n % 189 76 Yes 63 25 No 183 73 4 2 Mandatory Reporting (State) Electronic Surveillance System Missing Median IP Staffing per bed Median % IP Certified Hospital Epidemiologist Full-time 15 6 Part-time 105 42 1 IP Per 167 beds 50% Length in NHSN/NNIS (years) <1 33 13 1-3 78 31 <3 134 54 5 2 Missing Results: Implementation of policies ICUs Reporting Correct Implementation of Policies All of the Time N % Contact precautions for patients with positive cultures for MDROs 219 83 Screen All patients for MDROs upon ICU admission 94 72 Presumptive isolation/contact precautions pending an MDRO screen 44 62 Screen periodically after ICU admission 42 48 Cohort patients colonized with MDROs in the same room 41 47 Results: MDRO Routine screening practices in ICUs (n = 414) • MRSA 242 (58.6%) • VRE 89 (21.6%) • C. difficile 44 (10.7%) • MDRGNRs 48 (11.6%) • Other 28 (6.8%) Results: Significant Predictors of Screening for MRSA Hospital Characteristics OR p-value Mandatory Reporting 2.37 0.001 Teaching 1.67 0.020 Northeast 1.92 0.031 0.91 0.026 Region (as compared to the West) Beds Results: Significant Predictors of Screening for VRE and C. difficile VRE C. difficile Hospital Characteristics OR p-value OR p-value Total Hours of IC Staffing 1.03 0.034 0.99 0.014 Presence of Hospital Epidemiologist 1.97 0.010 2.10 0.044 Region (as compared to the West) Northeast 0.44 0.011 0.58 0.153 South 0.54 0.065 0.24 0.004 Midwest 0.12 0.001 0.13 0.009 Discussion • Extent of implementation of MDRO policies and practices varies in this select group of NHSN hospitals • Screening for specific MDROs is associated with certain hospital and IC department characteristics Future Plans • Other Analyses Based on Survey Results • Multivariate analyses • Examine association between different policies and practices for Multidrug Resistant Organisms and MDRO HAI Rates Thank You! 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