Many ICUs don’t screen for C. diff, other MDROs

Screening practices for multidrug-resistant organisms in ICUs vary widely from hospital to hospital, according to a study.

An interdisciplinary research team from the Columbia University School of Nursing collected and analyzed survey responses from infection preventionists at 250 hospitals that participated in the Centers for Disease Control and Prevention’s National Healthcare Safety Network in 2008. The goal was to explore the relationship between hospital and infection control characteristics and the adoption, monitoring and implementation of infection control policies aimed at MDROs.

The researchers found that ICUs participating in the NSHN routinely screened for methicillin-resistant Staphylococcus aureas (59%). However, other potentially deadly MDROs were screened for far less frequently: vancomycin-resistant Enterococcus (22%), gram-negative rods (12%), and C. difficile (11%).

Meanwhile, 40% of ICUs reported a written policy to screen for any MDRO, and less than a third (27%) had a policy for periodic screening following admission. A third reported a policy requiring isolation/contact precautions pending screening, 98% reported requiring contact precautions for culture-positive patients and 42% reported a policy for grouping colonized patients together.

The researchers found that state-mandated reporting, status as a teaching hospital, having 201 to 500 beds and being located in the western United States were characteristics associated with having a policy to screen all admissions for any MDRO. Periodic screening after admission was correlated with mandated reporting, teaching status and use of an electronic surveillance system.

“There is significant variation in adoption of screening and infection control interventions aimed at MDRO and C. difficile in NHSN ICUs, which is congruent with data from other studies and may reflect wide variation in published recommendations or their interpretation,” Monika Pogorzelska, PhD, MPH, the study’s lead author, said in a news release.

“Additionally, with the current increase in mandatory reporting, infection preventionists 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, 2012 president of the Association for Professionals in Infection Control and Epidemiology, said MDRO screening should be based on a facility’s risk assessment rather than driven by legislative mandates that are not evidence based.

“The epidemiology of these organisms can vary from region to region,” Farber said. “APIC recommends that each institution design an HAI prevention program that is effective for their facility and needs.”

The study appears in the October issue of the American Journal of Infection Control, the official publication of APIC. The full study is available at

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