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Experiences in MRSA. Successful Implementation of a Hospital Wide Admission Screening Protocol Cindi Leigh Wigston Infection Prevention and Control Coordinator/Quality Leader Orillia Soldiers’ Memorial Hospital. Orillia Soldiers’ Memorial Hospital. Large Community Hospital

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Experiences in mrsa l.jpg

Experiences in MRSA

Successful Implementation of a Hospital Wide Admission Screening Protocol

Cindi Leigh Wigston

Infection Prevention and Control Coordinator/Quality Leader

Orillia Soldiers’ Memorial Hospital


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Orillia Soldiers’ Memorial Hospital

  • Large Community Hospital

  • 218 in-patient beds

  • Regional Programs

    • Dialysis

    • High Risk Maternal

    • Paeds/NICU

    • SADV

    • CCC/Rehab

    • Psychiatry (Form 1 Facility)



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The OSMH Experience

  • November 2000

    • 3 patients identified on transfer to other facility

    • Review of current policy and procedure

    • Review of lab reports

    • Review of staff practice

    • Point prevalence screen of medical unit (60 beds)

  • December 2000

    • Audit of screening results


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Initial Findings

  • December2000

    • 147 “high risk” admits

    • 19.7% Screened within 24 hours

    • 9.5% Screened within 24-48 hours

    • 38% Screened after 72 hours

    • 32.6% Discharged prior to screening


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Finding the Findings!

  • Daily review of admission list for previous 24 hours

  • Utilizing CIS Patient system to determine risk factors (limitation!)

  • Utilizing laboratory reports (paper copies!)

  • Writing “Infection Prevention and Control Suggests” orders on patient charts (limitation!)


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Next Steps January to March 2001

  • Met with Senior Management

  • Met with Nursing Management

  • Met with IT Staff

  • Built data set

  • Developed and implemented staff education

  • Continued audit of screening compliance



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January to March 2001 Findings

  • 34.1% ‘High Risk’ Admits

    • 21.4% Screened within 24 hours

    • 13.8% Screened within 24-48 hours

    • 30.4% Screened after 72 hours

    • 34.2% Discharged prior to screening


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Now What?

  • Goals

    • Increase staff knowledge regarding MRSA

    • Increase staff awareness of risk of MRSA colonization = INFECTION

    • Increase staff compliance with Additional Precautions

    • Increase staff compliance with Admission Screening of High Risk Patients

    • INTEGRATION OF SCREENING INTO PRACTICE - GOAL 80%


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Meeting Objectives

  • Identified champions

  • Nursing management acceptance

  • Senior management acceptance

  • MAC acceptance

  • Education

  • Unit Challenges

  • Visibility


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Why is Screening Important?

  • Approximately 54% of MRSA cases in hospital were identified through admission screening

    (CJIC 2005;20(1):36-37)

  • Active admission screening protocols are integral to control

    (Lancet Infect Dis. 2005;5(10)653-663)

  • Early Screening = Early Identification = Less Isolation and Bed Movement!!!


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Colonization = Infection?

  • Increased risk of infection in colonized patients

    • “4 fold increase in infection”

      (Safdar, AJM 2008;121(4):310-315)

    • “23% developed infection”

      (Huang, IDSA 2008, July 3)

    • “In 16 of the 28 patients with MRSA bacteraemia and MRSA colonization, the MRSA colonization was identified more than seven days before the bacteraemia”

      (Roghman, Journal Hosp Infect 2007;47(2):98-103


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Patient Consequences

  • Patients in isolation received less direct care

  • Tests are often postponed/cancelled

  • Unable to transfer to alternative level of care

  • “STIGMA”


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Hospital Consequences

  • Multiple bed moves

  • Blocked beds

  • Increased LOS

  • Increased cost

    • Isolation supplies

    • Antibiotic therapy

    • Dialysis Patients (OSMH)

  • Patient Cost is Immeasurable


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And Then Came **Bob** . . .

  • 52 year old dialysis patient

  • Admit post BKA

  • Admission screens negative

  • Day 14 nasal/rectal MRSA positive

  • Unable to discharge home as satellite dialysis unit unable to provide dialysis to MRSA patient

  • Decolonization/abx therapy not effective

  • Remained positive in weekly follow up

  • Repeated infections, repeated surgeries

  • Remained in-patient for 14 months

  • Blood culture positive MRSA - died


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Reviewed and Updated Existing Protocol

  • All patients meeting ‘high risk’ criteria to be screened within 24 hours

    • Previous hospital admission

    • Direct hospital transfer

    • Prior admission to nursing care facility (LTC, group home)

    • Unit contacts of identified positive patients

    • Previously identified positive patients

    • Admission from correctional facility

    • Dialysis patients

    • Patients being transferred to CCC/Rehab

    • Patients being transferred from ICU


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Simplified Process

  • Added screening questions to Nursing History

  • Involved ER in screening activities

  • Entered unit contacts into CIS system

  • Unit helpers ensured that “screening kit” was in each room

  • Daily “ARO Screening Required” email from IP&C team

  • Ongoing education

  • Ongoing compliance audits

  • Changed micro media



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Challenges

  • Staff perception of need

  • Lack of integrated IT

  • Cost

  • Time commitment

  • ‘Spoon feeding’ vs TAKING OWNERSHIP!

  • Integrating into practice


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In Summary

  • Have patience!

  • Assess current status and build from there

  • Set small goals!

  • Celebrate achievement!

  • Provide timely feedback

  • Use “teaching moments”

  • Shift ownership to staff


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Questions?

Cindi Wigston, IP&C Coordinator/Quality Leader

Orillia Soldiers’ Memorial Hospital

[email protected]

705 325-2201 ext 3390


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