CONCLUSIONS

1. Creation of a statewide prevention collaborative regarding multidrug-resistant organisms (MDRO). Katherine Henry1, Kerri Thom2, David Blythe1, Anthony Harris2, Patricia Lawson1, Brenda Roup1, Margaret Pass3, Elizabeth Fuss4, Lisa Maragakis5, Byron Pugh1, Lucy Wilson1 1Maryland Department of Health and Mental Hygiene, 2University of Maryland School of Medicine, 3St. Agnes Hospital, 4Carroll Hospital Center, 5Johns Hopkins School of Medicine 2011 CSTE Annual Conference Pittsburgh, PA June 12-16, 2011 RESULTS The Acinetobacter Prevalence Survey was conducted in August 2010, in which sputum and peri-anal samples were collected from mechanically ventilated patients. 30/46 (65%) acute care and 10/12 (83%) LTCF participated in the prevalence survey. Overall, 34% of patients surveyed were positive for A. baumannii. Of those testing positive, 54% were MDR-Ab. In acute care hospitals and LTCF, A. baumannii was isolated in 16% and 63% of patients, respectively. Facility-specific results were provided to participating facilities, and aggregate survey results were shared with acute care hospitals. All 46 acute care hospitals and all 12 LTCF with ventilator beds completed the infection control questionnaire (100% participation). Questionnaire results highlighted disparities in facilities’ MDRO screening policies via active surveillance cultures. In addition, 100% of facilities reported communicating a patient’s MDRO status on transfer to another facility, while 84% of facilities reported receiving information on a patient’s MDRO status upon transfer from another facility. Facilities reported ease in execution of the survey and questionnaire, with no major obstacles encountered. • CONCLUSIONS • The combined expertise of Collaborative members and the statewide participation of both acute care and LTCF contributed to the success of this project. • Invaluable connections were strengthened between state public health and acute and LTCF infection preventionists. • This project demonstrates that collaborative efforts may serve to direct state priorities in MDRO surveillance, prevention, and control among acute and LTCF settings. BACKGROUND In 2009, the Maryland Department of Health & Mental Hygiene formed a multidisciplinary advisory group of healthcare partners to address surveillance and prevention of multidrug-resistant organisms (MDROs), initially focusing on multidrug-resistant Acinetobacter baumannii (MDR-Ab). MDR-Ab is a rapidly emerging pathogen in a variety of healthcare settings, and is an important patient safety concern. Several acute care hospitals and other healthcare facilities in Maryland identified MDR-Ab as a problem and expressed a desire to address surveillance and infection control concerns in a collaborative fashion. METHODS A diverse, experienced group of healthcare professionals including epidemiologists, physicians, laboratorians, infection preventionists (IPs), and representatives from state agencies, acute care hospitals, and long term care facilities (LTCF) were convened to establish the Maryland MDRO/MDR-Acinetobacter Prevention Collaborative. By consensus, the members determined as its first priority the establishment of baseline MDR-Ab prevalence among mechanically ventilated patients, via a statewide Acinetobacter Prevalence Survey. The Collaborative regularly met throughout the year to establish priorities and design a survey protocol. Concurrently, the Collaborative prepared and disseminated a questionnaire to assess MDRO surveillance and prevention practices in these facilities. • IMPLICATIONS • Based on the high prevalence rates seen among the survey population, the Collaborative is exploring areas for improved infection control of MDR-Ab, including respiratory personnel and equipment. • Collaborative efforts continue to address MDRO prevention efforts, and results from the Acinetobacter Prevalence Survey can serve as baseline data in order to evaluate future interventions. • A survey to assess the value of the Acinetobacter Prevalence Survey among IPs is currently under way. Table 1. Number (percent) of mechanically ventilated patients positive for Acinetobacter baumannii and multidrug-resistant A. baumannii by facility type, results from the Acinetobacter Prevalence Survey Figure 1. Facility participation in Acinetobacter Prevalence Survey by region Table 2. Number (percent) of facilities screening for MDROs by facility type and organism, results from Infection Control Questionnaire *MDR-Ab = organisms susceptible to 2 or fewer classes of antimicrobial agents excluding tigecycline and polymixin B July 26 –Aug 6 2010 November 2009 January 2010 March 2010 April - May 2010 June - July 2010 October 2010 April 2011 January 2011 TIMELINE PFGE results finalized and shared with facilities Protocol developed and initial facility recruitment begins Implementation planning, further facility recruitment Facility conference calls to review protocol, supplies ordered & shipped Survey Days Results finalized and shared with facilities Collaborative begins discussing “next steps” MDRO/MDR-Acinetobacter Prevention Collaborative is formed Collaborative decides to do a prevalence survey Contact Information: Katie Henry-Richards KRichards@dhmh.state.md.us