Targeting high-risk patients can yield infection control benefits

Nurse Leader Insider, June 29, 2007

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Screening every patient who comes through your doors for multidrug-resistant organisms can be a costly and time-consuming endeavor, but a new study on patients from long-term care facilities reinforces the idea that targeting high-risk patients can be an effective infection control strategy.

The study "Active Surveillance Cultures to Detect Multidrug-Resistant Acinetobacter" shows that targeting patients from long-term care facilities for active surveillance and isolation precautions in acute-care hospitals may help control the spread of multidrug-resistant acinetobacter (MDR-ACIN).

Researchers wanted to better define the epidemiology of the organism, says study author Lisa Maragakis, assistant professor of medicine at the Johns Hopkins University School of Medicine. They also wanted to learn where the organism was coming from to discover if patients were acquiring it in the hospital or if they had it when they arrived.

Acinetobacter, a gram-negative bacterium, is an environmental organism found in soil and water, similar to Pseudomonas aeruginosa in that respect, says Maragakis. Because it exists in nature it is able to survive on hospital surfaces, such as sinks, for long periods of time. It can cause bloodstream infections, wound infections, pneumonia, urinary tract infections, or meningitis.

Results point to common factors

Researchers found that the overwhelming majority of patients were coming into the hospital with the organism, rather than acquiring it once they arrived. During the course of the four-month study they tracked 1,100 patients, and 13 had cultures that grew MDR-ACIN. The results are as follows:

  • Five patients with a prior history of MDR-ACIN were included in the study, and four (80%) grew MDR-ACIN again
  • Eight patients were newly identified with MDR-ACIN during the study, four (50%) of those eight were identified by surveillance cultures alone
  • Of the 13 patients with MDR-ACIN, 69% had been in a long-term care facility within the preceding six months, compared to 15% of control patients without MDR-ACIN

"I was kind of surprised that we found that much in such a short period of time," says Maragakis.

Applying the results

The study can be used to guide future practices regarding MDR-ACIN, Maragakis says.

The results also emphasize the importance of inter-facility communication to reduce transmission of these organisms.

Organizations can no longer focus only on what they're doing and need to work in tandem with other facilities. Hospitals should contact facilities when they detect these cases and encourage other facilities to do the same.

"We need to recognize that a core group of patients transfer among hospitals and other healthcare facilities multiple times, and that they are at risk for these organisms and may be harboring them when they arrive. We need to take a coordinated approach," says Maragakis.

Source: Briefings on Infection Control, July 2007, HCPro, Inc.

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