Wide discrepancy in surveillance and control of infections in ICUs

Screening practices for multidrug-resistant organisms (MDROs) in intensive care units (ICUs) vary widely from hospital to hospital, according to a new study by researchers at Columbia University School of Nursing and published in the October 2012 issue of the American Journal of Infection Control.

Researchers found that of the hospitals surveyed, a little more than half (59 percent) routinely screened for methicillin-resistant Staphylococcus aurea, or MRSA. Other potentially deadly MDROs were screened for far less frequently: vancomycin-resistant Enterococcus (22 percent), gram-negative rods (12 percent), and C. difficile (11 percent).

The survey showed that not all hospitals follow a comprehensive screening and surveillance policy for infectious disease in the ICU, including the isolation of at-risk patients both during and after laboratory tests for infection. For example, although almost all of the ICUs (98 percent) reported a policy for contact precautions following a positive culture, less than a third reported a policy requiring isolation/contact precautions pending screening results.

While lead author Monika Pogorzelska-Maziarz, PhD, MPH, advocates hospitals tailoring their response to the types and frequency of infection in their local areas, she thinks that some measures included in her study make good sense from a precaution perspective. "It seems prudent to isolate possibly infected patients admitted into the ICU until lab tests come back giving an 'all clear,'" she says.

The researchers found that a larger infection-control staff and longer infection-control staffing hours were associated with better implementation of policy to isolate culture-positive patients. They also found that ICUs with mandatory reporting and electronic surveillance systems were more likely to have a policy of periodic screening for infection after admission.