QAPI 143 - Modifying Multi-drug Resistant Organism Admission Screening to Improve Policy Compliance

Background: Multidrug-resistant organisms (MDROs) represent a significant problem in healthcare because they can cause infections which are difficult to treat and are associated with increased morbidity, longer length of stay, higher [risk or rate of] mortality and increased healthcare costs. Screening patients for MDROs on hospital admission is an important control measure to reduce MDRO transmission and burden in healthcare.

Methods: A Plan-Do-Study-Act design was used to improve MDRO screening program at an inpatient rehabilitation facility between May 2023 to November 2023. Patients were identified for targeted screening if any of the following risk criteria were present on admission: 1) presence of a central line, indwelling urinary catheter, ventilator or tracheostomy; 2) presence of a stage III or greater pressure injury (including unstageable); 3) admission to transplant or oncology medical service. Patients meeting criteria were screened for colonization with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and Candida auris. Facility admissions were reviewed by the Infection Preventionist to assess the need for MDRO screening, if screening orders were placed, and results of each test ordered. Non-compliance with MDRO screening policy was addressed as soon as it was identified.

Results: During the study period, 628 patients of 1829 admissions met criteria for MDRO screening. 416 patients met criteria due to presence of a device; 148 had a qualifying pressure injury on admission; 215 were admitted to a transplant/oncology medical service. 141 patients had multiple risk criteria. Overall compliance with MDRO screening was 94%. Cumulative incidence of MRSA, VRE and C. auris was 4%, 16% and 4%, respectively.

Conclusions: Standardizing criteria for MDRO screening along with consistent review and prompt discrepancy resolution resulted in an approximately 30% increase in program compliance. Robust compliance with MDRO admission screening ensures prompt implementation of isolation precautions for at-risk patients to prevent transmission of MDROs between patients.