503. Lack of Impact of Multi-drug Resistant Organism Screening and Isolation on Hospital Acquired Infections
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Multi-drug resistant organisms (MDROs);MRSA, VRE and ESBL gram negatives, are major causes of hospital acquired infections (HAIs). Spread of MDROs is a major problem in hospitals. Active surveillance (AS) has not been proven to decrease transmission or HAIs. Pennsylvania Act 52 mandates hospital screening for MDROs. This study describes the risk of MDRO colonization on HAI development and the cost of maintaining a year long AS program at our hospital.
Methods: Targeted MDRO AS, began in the first quarter of 2008: long term care/chronic tracheostomy, Cystic Fibrosis, Sickle Cell Disease, Oncology, NICU, CCU, > 3 admits/yr and >30 day length of stay (LOS). Nasal, skin and rectal swabs for MRSA, VRE and ESBL culture by standard microbiological methods were performed on targeted populations and linked with isolation. MDRO AS compliance was monitored. We identified MDRO HAIs and matched screens with infected patients. We performed a retrospective cost analysis of the AS program.
Results: 97% of targeted patients were reviewed for compliance. Hospital wide compliance was 89%. Compliance was best in Q 3 and 4 of 2008. 91% of screens performed were negative. Patients screened because their LOS > 30 days had only 5% of screens positive (4/87). None of these 4 patients developed an HAI. MDRO HAI rate was 0.6, 0.5, 0.6 per 1000 patient days from 2006-2008 respectively. Isolating Q3 and 4 from 2007-2008 also showed no improvement in MDRO HAI rate. MRSA was most common positive screen, but in Q3 and Q4 MRSA HAIs were screen positive in only 21%. Risk for developing an MDRO HAI if screen positive was 2%, 5%, 11% for MRSA,VRE and ESBL respectively. Total estimated cost for AS program was $104,896 (45% PPE, 45% microbiology and 10% IC costs).
Conclusions: There is no direct evidence that screening/isolation affected the MDRO HAI rate. HAIs due to MRSA were not predictable by our AS program. The overall risk of MDRO HAI development in colonized patients is low. Risk of transmission from colonized non-infected patients is unknown. AS programs can be costly.
Jane M. Gould, MD1, Patricia Hennessey, MSN2, Andrea Kiernan, AAS2, Tamara Stein, MD2, Sheila Wood, PhD3 and  J. M. Gould, None..
P. Hennessey, None..
A. Kiernan, None..
T. E. Stein, None..
S. J. Wood, None., (1)St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, (2)St. Christopher's Hospital for Children, Philadelphia, PA, (3)St. Christopher's Hospital for Children, Phildelphia, PA