Intensive Care Units have different screening methods for multidrug-resistant organisms (MDROs), as stated by a recent study published in the American Journal of Infection Control and conducted by the P-NICE interdisciplinary team of researchers from the Columbia University School of Nursing.

For their study, the experts examined data from survey answers from the infection preventionists (IPs) from 250 different hospitals involved in Centers for Disease Control and Prevention’s National Healthcare Safety Network in 2008. The team set out to see the relationship between hospital and infection control characteristics and the adoption, monitoring, and implementation of infection control policies aimed at MDROs.

According to their findings, researchers discovered that 59% of NHSN ICUs regularly preformed screenings for methicillin-resistant Staphylococcus aureas, but other extremely dangerous MDROs were not screened nearly enough, with C. difficile at 11%, gram-negative rods at 12%, and Enterococcus at 22%.

Of the ICUs involved in the study, 40% said they had written guidelines which made it mandatory that MDRO was screened for, and only 27% had policies in place for regular screenings after being admitted.

In an online communique, the authors wrote, “One-third reported a policy requiring isolation/contact precautions pending screening, 98 percent reported requiring contact precautions for culture-positive patients, and 42 percent reported a policy for grouping colonized patients together.” Factors linked to having policies regarding screening all admissions for any MDRO were:

  • if the hospital was a teaching hospital
  • if the hospital contained anywhere from 201-500 beds
  • if the hospital was located in the western United States

It was also discovered through the study that screening after patients were admitted was directly linked to teaching status, use of an electronic surveillance system, and mandated reporting.

Monika Pogorzelska, PhD, MPH, the study’s lead author, commented:

“There is significant variation in adoption of screening and infection control interventions aimed at MDRO and C. difficle in NHSN ICUs, which is congruent with data from other studies and may reflect wide variation in published recommendations or their interpretation.

Additionally, with the current increase in mandatory reporting, IPs may be focusing on fulfilling mandates rather than implementing policies based on their experience and hospital needs. Further research is needed to provide additional insight on effective strategies and how best to promote compliance.”

Michelle Farber, RN, CIC the APIC 2012 President concluded: “Rather than being driven by legislative mandates that are not evidence based, MDRO screening should be based on a facility’s risk assessment, as the epidemiology of these organisms can vary from region to region. APIC recommends that each institution designs an HAI prevention program that is effective for their facility and needs.”

Written by Christine Kearney