Selecting a Strategy to Stop HAI
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Separate from its MRSA surveillance program, NorthShore also tests all ICU patients once a month for gram-negative bacterial strains that are highly resistant to antibiotics, such as E. coli, Klebsiella, and especially Acinetobacter "so we can take extra special precautions to reduce the spread of these organisms."
"This comes from learning lessons from other places that were not proactive in looking for these bacteria and were caught unaware with very high rates of infection in ICUs," Robicsek says. The most dramatic example is in New York state with KPC genes in Carbapenem-resistant Klebsiella. "These are resistant to virtually all antibiotics we have available, and many ICUs on the East Coast have a high prevalence of these KPC organisms."
Robicsek acknowledges that NorthShore is trying to develop a more cost-effective process that minimizes false positives, which have, in the past, amounted to 1.5% to 2%, or about 1,000 patients a year. "Patients with false positive results are unnecessarily isolated and treated, a situation that's not ideal for those patients."
What NorthShore has come up with is an algorithm in the electronic medical record that identifies patients who are at high risk of developing MRSA infection. It's a clinical decision-support tool programmed to signal a threshold that would indicate a test is warranted. "With this, we would instead test only 50% of our patients but would capture nearly all patients with MRSA.
"I suspect that as more hospital systems develop more mature EMR systems, they'll move to something similar as well."
Virginia Commonwealth is the testing holdout. Edmond says that over the past seven years, since the hospital instituted aggressive hand hygiene and other changes but avoided taking patients' nasal swabs, "overall infections in the ICU went down 85%, bloodstream infections dropped 84%, ventilator-associated pneumonia dropped 95%, MRSA infections dropped 89%, and Clostridium difficile infections are down by 54%."
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