Program Schedule

309
Clinical, Psycho-social and Cost Impacts of Performing Active Surveillance to Discontinue MRSA Contact Isolation for Patients Admitted to Medical-surgical Units

Session: Poster Abstract Session: MRSA and VRE
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • MRSA_IDweek2014poster.pdf (2.6 MB)
  • Background: Many healthcare facilities automatically initiate contact isolation whenever known methicillin-resistant Staphylococcus aureus-colonized (MRSA+) patients are readmitted, but duration of colonization with MRSA varies.  Facilities often lack systemic methods to ensure appropriately timed MRSA screening to discontinue isolation when no longer needed, resulting in continued contact isolation for remote MRSA infections.

    Methods: We conducted a process improvement project on 7 medical-surgical units of a 913-bed community-based academic hospital.  The project goal was to facilitate MRSA screening of known MRSA+ patients who were readmitted, if their last MRSA+ culture had occurred ≥ 1 year previously, via improved communication between Infection Prevention and nursing and physician staff and flagging of MRSA+ patients eligible for active surveillance.  Clearance from isolation required 2 negative nasal MRSA cultures using ChromAgar media. We then conducted a mixed methods, retrospective evaluation of the project to evaluate: (1) percentage of eligible patients screened and cleared; (2) psycho-social evaluation of impact of isolation via a survey of a convenience sample of 32 MRSA+ patients; and (3) cost of the screening program vs. cost burden of unnecessary isolation.

    Results: During Feb 2013-March 2014, 269 patients were eligible for MRSA screening, of whom 48 (18%) were unable to complete screening due to discharge or antibiotic use.  Of the 221 completing screening, 130 (81%) were found to be no longer colonized. Of 32 patients surveyed, 13 (41%) reported that isolation had affected their hospital stay, and 9 (28%) reported emotional distress resulting from their isolation. Total cost savings of the program were estimated at $101,230/year across the 7 study units.  To date, 3 (2%) previously cleared patients have been readmitted with subsequent cultures growing MRSA, requiring re-isolation.

    Conclusion: Eighty percent of patients with history of MRSA ≥1 year previously no longer were MRSA-colonized.  Our findings suggest that an active surveillance program targeting patients with a distant history of MRSA has the potential to improve patient experience as well as reduce costs.

    Michelle Power, BSMT (ASCP)1, Jennifer Goldsack, MChem, MA, MS1, Cynthia Taylor, RN, MS, BSN1, Christine Deritter, BSN, RN-BC1, Amy Spencer, MSN, RN-BC1, Ryan Kirk2, Sofia Kim, MD1 and Marci Drees, MD, MS, FACP1,3, (1)Christiana Care Health System, Newark, DE, (2)University of Delaware, Newark, DE, (3)Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA

    Disclosures:

    M. Power, None

    J. Goldsack, None

    C. Taylor, None

    C. Deritter, None

    A. Spencer, None

    R. Kirk, None

    S. Kim, None

    M. Drees, None

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