Abstract
As emergence and spread of multi-drug resistant organisms (MDRO) requires a standardized preventive approach, we aimed to evaluate current MDRO admission screening practices in Swiss hospitals and to identify potential barriers impeding their implementation. In early 2018, all Swiss public and private healthcare institutions providing inpatient care were contacted with a 34-item questionnaire to investigate current MDRO admission screening policies. Among 139 respondents representing 180 institutions (response rate, 79%), 83% (149) of institutions implemented MDRO admission screening, while 28% of private and 9% of public institutions did not perform any screening. Targeted high-risk screening included carbapenemase producers, extended-spectrum beta-lactamase producers and methicillin-resistant Staphylococcus aureus at the institutional level for respectively 78% (115), 81% (118) and 98% (145) of screening institutions. Vancomycin-resistant enterococci (44% of institutions), multi-resistant Acinetobacter baumanii (41%) and Pseudomonas aeruginosa (37%) were systematically searched only by a minority of screening institutions. A large diversity of risk factors for targeted screening and some heterogeneity in body sites screened were also observed. Admission-screening practices were mostly impeded by a difficulty to identify high-risk patients (44%) and non-compliance of healthcare workers (35%). Heterogeneous practices and gaps in small and privately-owned institutions, as well as a mismatch between current epidemiologic MDRO trends and screening practices were noticed. These results highlight the need for uniform national MDRO screening standards.
Highlights
Detection of multi-drug resistant organisms (MDRO) carriage upon admission could allow timely implementation of infection control measures and the appropriate selection of empiric antimicrobial therapy [1]
Targeted high-risk screening at the institutional level included carbapenemase-producing Enterobacteriaceae (CPE), Extended-Spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus (MRSA), which were monitored by 78% (n = 115), 81% (n = 118) and 98% (n = 145) of hospitals, respectively (Table 1)
Vancomycin-resistant enterococci (VRE) (44%), multi-resistant Acinetobacter baumanii (41%) and Pseudomonas aeruginosa (37%) were systematically searched only by a minority of institutions with on-admission screening programs, without differences between small and large institutions
Summary
Detection of multi-drug resistant organisms (MDRO) carriage upon admission could allow timely implementation of infection control measures and the appropriate selection of empiric antimicrobial therapy [1]. Few nationwide surveys investigated real-life MDRO screening practices upon admission [2,3,4,5]. In 2010, an unpublished survey conducted in Swiss intensive care units (ICUs) revealed heterogeneous MDRO screening practices. Martischang et al Antimicrobial Resistance and Infection Control (2019) 8:37 hospitals and identified potential barriers impeding their implementation
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