Abstract
Infections caused by multidrug-resistant organisms (MDROs) are associated with prolonged hospitalization and higher risk of mortality. Patients arriving in the hospital via the emergency department (ED) are screened for the presence of MDROs in compliance with the screening protocols in order to apply the correct isolation measures. In the Dutch–German border region, local hospitals apply their own screening protocols which are based upon national screening protocols. The contents of the national and local MDRO screening protocols were compared on vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and carbapenemase-producing and carbapenem-resistant Enterobacteriaceae (CPE/CRE). The practicality of the screening protocols was evaluated by performing an audit. As a result, the content of the MDRO screening protocols differed regarding risk factors for MDRO carriage, swab site, personal protective equipment, and isolation measures. The observations and questionnaires showed that the practicality was sufficient; however, the responsibility was not designated clearly and education regarding the screening protocols was deemed inappropriate. The differences between the MDRO screening protocols complicate patient care in the Dutch–German border region. Arrangements have to be made about the responsibility of the MDRO screening, and improvements are necessary concerning education regarding the MDRO screening protocols.
Highlights
The emergency department (ED) provides care to patients with acute illnesses or injuries that require immediate medical care
The multidrug-resistant organisms (MDROs) screening protocols from the WIP, KRINKO, University Medical Center Groningen (UMCG) and UKM were compared to investigate differences and similarities in order to facilitate healthcare professionals involved in cross-border healthcare
Differences were noted regarding previous admissions to national hospitals: the KRINKO and the UMCG advised screening a patient when they were recently admitted to another national hospital, whereas the WIP advised only screening when a patient is transferred from a hospital with an MDRO-outbreak on the ward
Summary
Germany and the Netherlands both advise a risk inventorization for MRSA, but healthcare institutions within the countries sometimes advise differently [10,11,12]. Depending on the MDRO species, different swab sites need to be screened. All this information regarding screening is brought together in MDRO screening protocols. MDRO screening protocols are often created by national healthcare institutions. In the Netherlands, the ‘Working Party on Infection Prevention’ (in Dutch: Werkgroep Infectie Preventie, WIP) and in Germany, the ‘Commission for Hospital Hygiene and Infection Prevention’ (in German: Kommission für Krankenhaushygiene und Infektionsprävention, KRINKO) have provided the content of the national protocols [11,12]. In university hospitals with a large population of immune-compromised patients, screening protocols may be more extensive
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