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Katelyn Klein Madison, WI No Financial Disclosures

Improving Methicillin-Resistant Staphylococcus aureus infection control strategies: Identifying high-risk surgical patients for pre-emptive contact isolation. Katelyn Klein Madison, WI No Financial Disclosures. Consequences of MRSA. Klein et al. Emerg Infect Dis 2007; 13(12): 1840-6

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Katelyn Klein Madison, WI No Financial Disclosures

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  1. Improving Methicillin-Resistant Staphylococcus aureus infection control strategies: Identifying high-risk surgical patients for pre-emptive contact isolation Katelyn Klein Madison, WI No Financial Disclosures

  2. Consequences of MRSA Klein et al. Emerg Infect Dis 2007; 13(12): 1840-6 Klevens et al. JAMA 2007; 298(15): 1763-71 National Nosocomial Infections Surveillance System. Am J Infect Control 2001;29:404-421.

  3. Introduction • VA performs MRSA screening on all admitted patients • Patient admitted to room before test turn around • Single vs. double occupancy rooms • MRSA(+) results after admission can create need for room changes and cleaning • Burden of time, resources, patient dissatisfaction • Opportunity for disease transmission

  4. Project Goal • Create and validate a prediction model that identifies high-risk MRSA patients. • Patients can then be preferentially targeted for single room assignment and contact precautions. • Improved bed utilization • Decrease MRSA transmission

  5. Methods • Retrospective case-control study • June 2009 to May 2010 • Surgical patient admissions • 181 study subjects • 60 randomly selected MRSA(+) cases • 121 randomly selected MRSA(-) controls • Data collection from electronic medical records • 28 variables analyzed

  6. Results Table 1: Risk factors for MRSA Colonization Statistically significant at p<0.2

  7. Results Table 2: Statistically significant risk-factors for MRSA Colonization • 10 variables statistically significant (p<0.2) • 3 associated with reduced odds of being MRSA colonized • Remaining 7 variables tested for potential inclusion in prediction model

  8. Results 2 Stage Prediction Model 2 Question model Sensitivity: 46/60= 77% Specificity: 114/112= 94% 14 114

  9. Results 3 Stage Prediction Model 2 Question model Sensitivity: 46/60= 77% Specificity: 114/112= 94% 3 Question model Sensitivity: 53/60= 88% Specificity: 68/121= 56%

  10. Discussion • Recommend a 2 stage prediction model to identify high-risk MRSA colonization • PPV= 54%, NPV=98% • Fast and simple to use • Results consistent with previous research Patient received for admission Previous history of MRSA Single room admission and contact precautions YES OR Non- ambulatory YES NO Standard admission Solh El et al. ClinInfect Dis 2004;39(4):474–480 Patel et al. Infect Control Hosp Epidemiol 2008;29(6):503-9

  11. Limitations • Generalizability • Model validity outside facility’s surgical population? • Accuracy of antibiotic use data • Pre-admit medication use was inconsistently documented in EMR • Potential placement on drugs effective against S. aureus

  12. Conclusions • Future goals • Validate model in other hospital units • Integrate model into daily admission process hospital- wide • Evaluate • Continue surveillance of MRSA to observe potential hospital MRSA transmission trends • Feedback from hospital staff on admission processes

  13. Katelyn KleinMeriter Hospital202 S Park StreetMadison, WI 53715kklein@meriter.com608-417-5692 Christopher Crnich, MD, MS University of Wisconsin School of Medicine and Public Health Linda McKinley, RN, MPH, CIC Wm. S. Middleton Memorial VA Hospital

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