516. Screening Nursing Home Residents on Admission for MDROs: Is it worth it?
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Screening nursing home residents (NHR) upon admission can help identify patients colonized with multi-drug resistant organisms (MDRO). This study looks at a screening protocol for all NHR on admission and aims to identify risk factors for colonization with MDROs in this population.
Subjects and Methods: On admission, NHRs were automatically screened for MDROs from the sputum, axilla, rectum, urine and wound, if present. Patients that screened positive for an MDRO were compared with those that screened negative. Univariate and multivariate regression analyses were used to identify risk factors associated with screening positive on admission. Patients with MDROs on previous admissions were flagged on discharge and upon readmission.
Results: Over a 14 month-period, 172 NH patients were screened. 50/172 (29.1%) were found to be colonized with MDROs. Patients who screened positive had a significantly longer hospital stay (p=0.012). There was no difference between the 2 groups with respect to age, gender, presence of comorbidities, dementia, or fecal incontinence. Recent hospitalization (p=0.029), exposure to antibiotics (p=0.005), and being colonized with an MDRO (p<0.001) on previous admission were associated with screening positive. Decubitus ulcer (p<0.001), urinary incontinence (p=0.043) and being bed-bound (p<0.001) were also associated with positive screens. Multivariate logistic regression found that having a prior MDRO identified on a previous admission and being bed bound were associated with screening positive for a resistant organism (p<0.001) on the current admission. The most common organisms isolated were ESBL-Klebsiella and MRSA.
Conclusions: We showed that almost 1/3 of all NH residents admissions screened positive for at least one MDRO. Being bed-bound and having a known previous MDRO were strongly associated with screening positive. Screening high risk NHRs on admission may be an important tool to help decrease nosocomial transmission of MDROs.
Phyllis Andrews, RPA-C, Albert Einstein College of Medicine, Bronx, NY, Christina Coyle, MD, Infection Control, Albert Einstein College of Medicine, Bronx, NY, Dimitrios Farmakiotis, MD, Jacobi Medical Center, Bronx, NY, NY and  D. Farmakiotis, None..
P. Andrews, None..
C. Coyle, None.