Institutional and Patient Level Predictors of Multi-Drug Resistant Healthcare-Associated Infections

Abstract

Institutional and Patient Level Predictors of Multi-Drug Resistant Healthcare-Associated Infections Monika Pogorzelska Healthcare-associated infections (HAI) caused by multi-drug resistant organisms (MDRO) are an important patient safety concern resulting in a substantial financial and clinical burden. This dissertation aims to contribute to the evidence base on institutional and patient level factors that predict multi-drug resistant infections in the hospital setting. In the first chapter, I review the evidence base on patient-level risk factors for methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI), system-level factors associated with implementation of infection control policies and MDRO rates, and the current knowledge on the use of infection control policies on the national level. In the second chapter, I use data from a national cross-sectional study to describe the range of MDRO screening and infection control policies in U.S. hospitals and identify predictors of their presence and implementation. In the third chapter, using data from a cross-sectional study of California hospitals, I assess the association between the presence and implementation of infection control policies for MDRO infections and rates of BSI caused by MRSA or vancomycin-resistant Enterococcus and infections caused by Clostridium difficile. Next, I identify risk factors for healthcare-associated MRSA BSI in a nested case control study using two sets of controls. In the last chapter, I conclude by summarizing the findings of these three studies.