Abstract
The primary aim of this brief and exploratory study was to examine the ability of two Infection Control Practitioners in a medium size community hospital to effectively predict the MRSA colonization status of patients on admission compared to a standard MRSA screen in real time using only their clinical judgment and review of selected hospital documents. Sensitivity and specificity results for the clinical prediction of MRSA were 0.88 (95% CI, 0.64â0.96) and 0.79 (95% CI, 0.70â0.85), respectively. The positive predictive value and negative predictive value were 0.39 (95% CI, 0.25â0.55) and 0.97 (95% CI, 0.91â0.99), respectively. The overall accuracy of the ICPs ruling in or ruling out MRSA nares colonization was 80%. These results suggest that ICPs were able to rule out MRSA colonization with a high degree of confidence and accuracy. However, confirmation of MRSA colonization based on clinical judgment was less sensitive.
Highlights
The current methicillin-resistant Staphylococcus aureus (MRSA) public health crisis has led to a number of recommendations to reduce the rate of MRSA colonization and transmission in hospital settings including active surveillance cultures of patients[1,2,3]
The primary aim of this brief and exploratory study was to examine the ability of two Infection Control Practitioners (ICPs) in a medium size community hospital to effectively predict the MRSA colonization status of patients on admission compared to a standard MRSA screen in real time using only their clinical judgment and review of selected hospital documents
Because infection control activities and responsibilities dictated that MRSA screen results be made available to ICPs during the study timeframe, one of the inherent limitations of the study was the effect that knowledge of previous results had on subsequent predictions
Summary
The current methicillin-resistant Staphylococcus aureus (MRSA) public health crisis has led to a number of recommendations to reduce the rate of MRSA colonization and transmission in hospital settings including active surveillance cultures of patients[1,2,3]. Infection Control Practitioners (ICPs) and infectious disease specialists often rely on clinical judgment and suspicion in ruling out MRSA colonized patients while confirmatory laboratory tests are pending. The accuracy of such clinical judgments and predictions has not been assessed. The primary aim of this brief and exploratory study was to examine the ability of two ICPs in a medium size community hospital to effectively predict the MRSA colonization status of patients on admission compared to a standard MRSA screen in real time using only their clinical judgment and review of selected hospital documents. Massachusetts were cultured for MRSA nares colonization on admission during December 2006. Culture swabs were taken from the anterior nares of patients and sent immediately to the microbiology laboratory for processing
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