Input on Active Surveillance Cultures from the Community

We asked ICT readers what they do relating to active surveillance cultures. Here are their responses:

“We are a tiny facility in the smallest county with the least population in the least populated state. We have not tested those who come into our facility. For us it would take too long to get the results back. I feel it is a waste of time and it is costly. I have spoken to some infection preventionists and they have indicated the testing has depleted their whole budget. If we treat all folks as if they have an infection and handle their bodily fluids and belongings with kid gloves, then we should be able to prevent infections from traveling. I realize that staff members may think the rules do not apply to them in particular; however, we need to keep trying to get 100 percent compliance with prevention. Maybe we need to think that the bacteria we are trying to kill is only defending its own, and learn to live with it. Declare a truce.” -- Julia Mason, Niobrara County Memorial Hospital in Lusk, Wyo.

“We do not do surveillance cultures on admissions or on high-risk patients. Our rate for 2009 was .5 percent. We do not feel it would be economically feasible for us to do testing at this time. We are a small rural hospital." -- Connie Hyde, RN, CIC, director of preventive health at Mary Lanning Memorial Hospital in Hastings, Neb.

“Texas Children’s Hospital (TCH) does not conduct any routine screening for colonization/infection of MDROs upon admission. This was the only active surveillance culturing that I am aware of for infants admitted to TCH. When we did the screening it was specifically for Serratia marscens and MRSA in babies admitted to the NICU only. We do not monitor acquisition rates for any of our patients except for the indicators we report for specific SSIs in spinal fusions, cardiac surgeries and VP shunts and central line-related bloodstream infections. I have mixed feelings about mandatory screening. I think that each facility should assess its patient population, educate on observing strict standard precautions and evaluate outcomes before knowing what is right for them.” -- Kathy Ware, RN, Texas Children’s Hospital

“We are a 25-bed facility with an attached 40-bed long-term care facility. We do not screen for MDROs in general or any specific ones. The majority of our hospital admissions are Medicare patients. I am not in favor of mandatory screening because of the increased cost to our facility and I don’t see us doing anything different in the way the patient is cared for. We stress to our healthcare workers that standard precautions are still the most important thing that we can do to prevent the spread of any kind of organisms within our facility.” -- Sharon Jordan, MT (ASCP), infection control practitioner at Mitchell County Hospital Health Systems in Beloit, Kan.

“In our 400-bed hospital, we do not do active surveillance culturing. However, our corporation has recently mandated isolation of all patients infected or colonized with an MDRO. We have the means to electronically flag records of patients who test positive for an MDRO for easy identification at next admission. I do not agree with the practice of active surveillance culturing. I feel that it only adds extra work for the staff and cost for the patient. I agree that patients with an active infection should be isolated. I do not agree that isolating patients only colonized with MRSA. I have yet to see any good studies demonstrating that isolating colonized persons is effective at controlling spread of these organisms. Recent studies show that nasal swabs are very inefficient at identifying MRSA. I feel that all this recent hype over MRSA is knee-jerk reaction to a public that needs education. The ‘horses have been out of the barn’ (MRSA) for 60-plus years.” -- Doe Kley, RN, BS, CIC, infection control coordinator at McKay-Dee Hospital Center in Ogden, Utah

“The VA has a nationwide program that has been in effect for several years now. We have several prevention programs that address HAIs following the VA MRSA Prevention Initiative (2007) and CDC guidelines.

1. We do surveillance nares screening on all admissions to our hospital and nursing home. These are done by PCR on the Cepheid GeneXpert within four hours (or less) of admission. This facilitates bed placements and assures that a MRSA carrier is not placed in a room with patients who have any type of lines such as IV, PICC, Foley catheter, etc. This has dramatically cut down on our HAIs.

2. We do surveillance nares cultures on all (MRSA negative) in-hospital transfers between units and discharges from the hospital, to screen for transmission of MRSA.

3. We have a vigorous hand hygiene education program for employees and patients. Each unit has a MRSA champion who acts as a liaison between the patients and infection control.

4. We educate the MRSA carrier on proper hand hygiene, how to keep themselves healthy, proper medication usage (please take the entire prescription not just enough to feel better) and the signs and symptoms to watch for if an infection occurs.

5. We also screen (for MRSA) all pre-op surgical patients and decolonize them before invasive surgeries (following CDC guidelines).

6. Our chief microbiologist works with infection control and pharmacy to produce timely and regionally accurate antibiograms for our clinicians to utilize in prescribing antibiotics.

7. We also track C. diff and VRE, reporting quarterly to the IC board.

All my data is collected and reported to the government IPEC database and compared to previous hospital results, regional and national data as well as our IC board and the board of directors on a quarterly basis. In this day of so many emerging resistant pathogens, I feel it is medically irresponsible not to screen. -- Angela Kellaway, MT/BS, MRSA prevention coordinator at GJVA Medical Center in Grand Junction, Colo.

“We screen: at-risk populations for MRSA, VRE and C. diff; anyone with a history of MDRO is screened on admit; anyone with an open wound of any kind is screened for MRSA, based on our risk assessment. We have seen three times more CA-MRSA than HA-MRSA and using this risk indicator catches that population with CA-MRSA boils, abscess, sports injuries, as well as HA-MRSA diabetic ulcers, pressure sores, etc. I believe most facilities are not using their annual risk assessment to determine their specific population at risk, choosing to just use all nursing home patients as their population as I see in area hospitals close to me. All at-risk patients are isolated until three negative cultures a week or more apart off antibiotics. We monitor and report total MRSA and VRE population rates as well as hospital-acquired rates and break down all MRSA into CA-MRSA or HA-MRSA enabling us to identify our population at risk. I support this effort, as it has lowered our MRSA/VRE acquisition rate and proven beneficial.” -- Beth Puckett, RN, director of infection control at Summit Medical Center in Van Buren, Ark.

“We are currently discussing the topic and need to screen high-risk patients coming from long-term care facilities or other hospitals for MDROs upon admission to our facility. We would be screening for MRSA and/or VRE. We are currently monitoring rates of community-acquired MRSA we are seeing in patients being treated in our ER and clinics, keeping track also of the MRSA and VRE admissions to our facility. In our second quarter infection control meeting 50 percent of the total wounds cultured were MRSA positive. I feel that community MRSA in on the rise. I do not know how I feel about making the reporting mandatory. I am a new infection control nurse and I feel there is already so many things we report." -- Lorraine Hardt, RN, infection control/employee health, Washington County Hospital and Clinics in Washington, Iowa

“We have a MRSA screening protocol which approximately 50 percent of our MDs allow us to use. It is an adapted template from the Medmined library. We look at high-risk patients in crowded conditions, pre total joint surgeries and known carriers. We do a nasal swab and contact precautions and proceed based on the results. It works well for us.” -- Marsha Seppala, RN, Mizell Memorial Hospital in Opp, Ala.