Survey of Dallas-Fort Worth (DFW) Hospital Practices for Multidrug Resistant Gram Negative Bacilli (MDR-GNB) Surveillance

Abstract

BACKGROUND/OBJECTIVES: Increasing incidence of MDR-GNB has made it imperative that hospitals implement measures to prevent its spread. Guidelines put forth by the Society for Healthcare Epidemiology of America (SHEA) and the CDC Healthcare Infection Control Practices Advisory Committee ( draft ) emphasize routine systematic monitoring for multidrug resistant organisms (MDROs), and intensified control measures to include active surveillance cultures (ASC) and empiric contact precautions for at-risk patients at time of admission, once novel MDROs emerge. It is not known how frequently these recommendations are implemented. METHODS: Given reports of isolation of a novel strain of multidrug resistant P. aeroginosa (MDR-PA) from multiple hospitals in DFW, we surveyed Infection Control practitioners (ICPs) to assess compliance with the recommendations for ASC. A survey was initially distributed to ICPs attending the Association of Professionals in Infection Control-DFW chapter meeting and followed by an e-mail reminder. RESULTS: Of the 26 hospital ICPs that responded, only 45% incorporated routine MDR-GNB surveillance as part of their infection control program. About two-thirds reported isolating MDR-PA with a frequency >10 per month. Although 71% of the respondents had previously cultured MDR-PA in patients transferred from other health care facilities (HCF) with two-thirds of the cultures obtained on admission, only 25% had a policy for ASC. Eighty-six percent had no formal mechanism of receiving MDR notification from the transferring HCF. CONCLUSIONS: There is significant discordance between national recommendations and actual practice in the monitoring and prevention of MDROs in the DFW hospitals responding to our survey. While the role of ASC is being widely debated, transmission of MDROs via patients transferred between HCFs continues. A measure as simple as formal MDRO notification on institutional transfer can go a long way in decreasing transmission of these epidemiologically significant organisms, and reducing the financial burden of ASC for the receiving HCF.