ITS 100 - Reducing Multi-drug Resistant Organism Infection Status Burden in a Pediatric Urologic Patient Population

Background: Negative effects of unnecessary isolation precautions have been well-established in literature. Patients with a multi-drug resistant organism (MRO), an organism non-susceptible to 3 antibiotic classes, have an infection status placed in their electronic medical record for a minimum of six months per policy, and require contact isolation. The Infection Prevention and Control (IP&C) department does not have a system in place to identify and remove these statuses leading to over-isolation of patients. Therefore, a sustainable process of removing infection statuses is necessary and gaps in MRO policy knowledge should be addressed.

Methods: We queried the number of patients consulted by the pediatric urology service from January 2018 to October 2022 and identified those with an infection status to establish a baseline measure. The infection statuses that were entered >6 months prior were reviewed for eligibility to be removed. Patients with a permanent indwelling device that was not re-cultured after an MRO was previously identified at that site or in the blood were considered ineligible for removal. An automated quarterly report and a standard review process were operationalized. Removal rates were calculated for proof of concept. IP&C presented in-person didactic education to urology providers on IP&C principles, transmission-based precautions, and MRO policy.

Results: In our initial (MRO status entered 01/2018-10/2022) and second data query (MRO status entered 11/2022-06/2023), 120/135 (89%) and 74/130 (57%) infection statuses were removed, respectively. In total, we were able to appropriately remove MRO infection statuses from 73% of our pediatric urology patients from whom an MRO was cultured over a 5.5-year period.

Conclusions: Through this investigation, we found many inappropriate infection statuses for urology patients leading to an undue burden of isolation precautions. In response, we are utilizing a standard surveillance process to mitigate this burden. Additionally, our pediatric urology clinicians are better equipped to interpret IP&C recommendations for patients.