Times Up! Manually Working to Remove Patients from Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus faecium (VRE) Isolation Precautions

Abstract

BackgroundIn 2007 PA Act 52 identified the need to screen and isolate for MRSA in patients who were deemed a high-risk admission in order to prevent the spread of MRSA. High risk at UPMC PUH was determined to be patients who were arriving from an outside facility and patients who were being transferred to an intensive care unit. In 2002 VRE screening began in high-risk patients based on the fact that 80% of our Enterococcus faecium was resistant and there was an increase of VRE infections by 42%. After years of gathering data and isolating patients the decision was made to increase the screening of MRSA and VRE to all patients upon admission then weekly and at discharge. With increased surveillance the isolation density averaged around 15% for MRSA and 25% for VRE. As our facility had a decrease in beds due to renovations and still has semi-private rooms the isolation burden, though low was impacting patient flow. The objective was to ensure that the correct patient population remained in isolation while those who were no longer colonized could be removed.MethodsRemoval Criteria:VREMRSA>2 months since last positive>2 months since last positive>7 days since effective antibiotics>7 days since effective antibiotics3 negative stool or peri-rectal cultures at least 7 days apart3 negative nares cultures at least 24 hours apartTime Period: December 5, 2016 – May 12, 2017Manual review: (i) Gather all patients on a daily basis who have MRSA, VRE or a combo of both; (ii) eliminate all patients whose positive test is less than 2 months ago; (iii) evaluate to see if patient has been on antibiotics effective against MRSA/VRE for the past 7 days; (iv) Review for any prior negative swabs; (v) Call the unit and request swabs along with an email to the unit director; (vi) Follow up daily until patient is cleared.Results(i) 1707 = positive > 2 months ago; (ii) 1516 = eligible based on Antibiotics; (iii) §113= Cleared based on 3 negative swabs; (iv) 1382 Patients were discharged prior to receiving 3 negative swabs.Conclusion(i) 7% of patients were able to have isolation discontinued. (ii) Manual method is not as effective as electronic as many patients were discharged before swabs were obtained; (iii) Ideal circumstances is obtaining swabs on patients while they are not inpatients.Disclosures All authors: No reported disclosures.