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MRSA SCREENING: THEORETICAL VS. PRACTICAL

MRSA SCREENING: THEORETICAL VS. PRACTICAL. Nancy Alfieri, March 5, 2008. Why Screen?. PROs: MRSA has increased (in CHR) from 2.2 to 9.4/10,000 patient days since 2003 CMRSA (new cases) is rising as quickly as health-care associated MRSA in the CHR

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MRSA SCREENING: THEORETICAL VS. PRACTICAL

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  1. MRSA SCREENING: • THEORETICAL VS. PRACTICAL Nancy Alfieri, March 5, 2008

  2. Why Screen? • PROs: • MRSA has increased (in CHR) from 2.2 to 9.4/10,000 patient days since 2003 • CMRSA (new cases) is rising as quickly as health-care associated MRSA in the CHR • U.S. data indicates an MRSA infection costs an additional $35,000 (while other nosocomial infections add $14,000 to $15,000) • Patients with unidentified MRSA act as reservoirs for transmission

  3. CONs: • Screening programs are expensive… • $100,000 allows 5,000 persons to be screened(average of 2.5 screens/person) • 3 averted infections = $105,000 • Isolation precautions challenge systems already stretched to capacity

  4. CHR Universal Screening Pilot Project • 3 months, 3 units(orthopedic surgery, palliative/medicine, medical teaching) • Methods: • All patients admitted to these units were screened • Prevalence screens conducted prior to beginning screening and on termination of the pilot • Anatomical sites screened were: • Nasal culture • Z body swab (axilla and torso) • Up to three wounds • Suppression: CHG bath/shower

  5. Results • 89.2% of eligible patients were screened • PREVALENCE SCREEN RESULTS

  6. New Cases Admitted During Pilot

  7. Acquisition of Newly Detected MRSA Positive Cases

  8. The Last Table is Important! Why? • An equal number of cases are hospital-acquired and community-acquired • This means up to 44% of the positive patients would have been “missed” using an admission screening protocol based on previous hospitalization or living in “institutional” settings

  9. What Did We Learn… • For the CHR, traditional admission screening would not capture a large proportion of the MRSA-colonized clients • Medically complex patients with multiple co-morbidities and frequent health care encounters are to be considered “high risk” for MRSA • Some surgical patient populations may be low risk

  10. What did we learn…(cont’d) • “Universal” screening is challenging to units facing significant staffing shortages • Housekeeping workload increases as the burden of patients on isolation increases • Suppression regimes may be an effective way to decrease transmission risk • Streamlining screening processes is key to sustainability

  11. Next Steps… • In the CHR we are proposing expansion of the “universal” screening process and staging implementation • Screening programs require regular analysis for efficiency and effectiveness • Screening combined with interventions to reduce transmission requires further study

  12. GO OUT ON A LIMB…

  13. Recommendations • Go ‘out on a limb’, test your population appropriately • Engage the front-line care providers and measure workload, transmission/ acquisition rates in screening programs • Question, Question, Question….if the screening protocols don’t impact nosocomial acquisition…then what? • Test interventions: • Effective screening specimens • Decolonization • Suppression • Isolation • Environmental controls • Hand hygiene

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