Wide discrepancy in surveillance and control of infections in ICUs

Researchers found that of the hospitals surveyed, a little more than half (59 percent) routinely screened for methicillin-resistant Staphylococcus aurea, or MRSA. Other potentially deadly MDROs were screened for far less frequently: vancomycin-resistant Enterococcus (22 percent), gram-negative rods (12 percent), and C. difficile (11 percent).

The survey showed that not all hospitals follow a comprehensive screening and surveillance policy for infectious disease in the ICU, including the isolation of at-risk patients both during and after laboratory tests for infection. For example, although almost all of the ICUs (98 percent) reported a policy for contact precautions following a positive culture, less than a third reported a policy requiring isolation/contact precautions pending screening results.

While lead author Monika Pogorzelska-Maziarz, PhD, MPH, advocates hospitals tailoring their response to the types and frequency of infection in their local areas, she thinks that some measures included in her study make good sense from a precaution perspective. "It seems prudent to isolate possibly infected patients admitted into the ICU until lab tests come back giving an 'all clear,'" she says.

The researchers found that a larger infection-control staff and longer infection-control staffing hours were associated with better implementation of policy to isolate culture-positive patients. They also found that ICUs with mandatory reporting and electronic surveillance systems were more likely to have a policy of periodic screening for infection after admission.

The research was supported by National Institute of Nursing Research grant RO1NR010107.