Experiences in MRSA

Presentation Transcript

Successful Implementation of a Hospital Wide Admission Screening Protocol

Cindi Leigh Wigston

Infection Prevention and Control Coordinator/Quality Leader

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)

The IP&C Team circa 2001-2006

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

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

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!)

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

Data Set

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

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%

Meeting Objectives

Identified champions
Nursing management acceptance
Senior management acceptance
MAC acceptance
Education
Unit Challenges
Visibility

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!!!

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

Patient Consequences

Patients in isolation received less direct care
Tests are often postponed/cancelled
Unable to transfer to alternative level of care
“STIGMA”

Hospital Consequences

Multiple bed moves
Blocked beds
Increased LOS
Increased cost

Isolation supplies
Antibiotic therapy
Dialysis Patients (OSMH)

Patient Cost is Immeasurable

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