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Improving Efficiency in Active Surveillance for Methicillin-Resistant Staphylococcus aureus or Vancomycin-Resistant Enterococcus at Hospital Admission

Published online by Cambridge University Press:  02 January 2015

Daniel J. Morgan ,
Hannah R. Day ,
Jon P Furuno ,
Atlisa Young ,
J. Kristie Johnson ,
Douglas D. Bradham  and
Eli N. Perencevich
Daniel J. Morgan*
Affiliation:
Veterans Affairs Maryland Healthcare System, Baltimore, Maryland Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
Hannah R. Day
Affiliation:
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
Jon P Furuno
Affiliation:
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
Atlisa Young
Affiliation:
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
Douglas D. Bradham
Affiliation:
Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas–Wichita, Wichita, Kansas Robert J Dole Veterans Affairs Medical Center, Wichita, Kansas
Eli N. Perencevich
Affiliation:
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland Divisions of General Internal Medicine and Infectious Diseases, University of Iowa Carver College of Medicine, Wichita, Kansas Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
*
685 West Baltimore Street, MSTF 334, Baltimore, MD 21201, (dmorgan@epi.umaryland.edu)
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Abstract

Objective.

Mandatory active surveillance culturing of all patients admitted to Veterans Affairs (VA) hospitals carries substantial economic costs. Clinical prediction rules have been used elsewhere to identify patients at high risk of colonization with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE). We aimed to derive and evaluate the clinical efficacy of prediction rules for MRSA and VRE colonization in a VA hospital.

Design and Setting.

Prospective cohort of adult inpatients admitted to the medical and surgical wards of a 119-bed tertiary care VA hospital.

Methods.

Within 48 hours after admission, patients gave consent, completed a 44-item risk factor questionnaire, and provided nasal culture samples for MRSA testing. A subset provided perirectal culture samples for VRE testing.

Results.

Of 598 patients enrolled from August 30, 2007, through October 30, 2009, 585 provided nares samples and 239 provided perirectal samples. The prevalence of MRSA was 10.4% (61 of 585) (15.0% in patients with and 5.6% in patients without electronic medical record (EMR)-documented antibiotic use during the past year; P < .01). The prevalence of VRE was 6.3% (15 of 239) (11.3% in patients with and 0.9% in patients without EMR-documented antibiotic use; P < .01 ). The use of EMR-documented antibiotic use during the past year as the predictive rule for screening identified 242.8 (84%) of 290.6 subsequent days of exposure to MRSA and 60.0 (98%) of 61.0 subsequent days of exposure to VRE, respectively. EMR documentation of antibiotic use during the past year identified 301 (51%) of 585 patients as high-risk patients for whom additional testing with active surveillance culturing would be appropriate.

Conclusions.

EMR documentation of antibiotic use during the year prior to admission identifies most MRSA and nearly all VRE transmission risk with surveillance culture sampling of only 51% of patients. This approach has substantial cost savings compared with the practice of universal active surveillance.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 12 , December 2010 , pp. 1230 - 1235
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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