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Commonsense medical precautions ignored

Wide discrepancy in surveillance and control of infections in ICUs

New York, NY, USA (October 15, 2012) – Screening practices for multidrug-resistant organisms (MDROs) in intensive care units (ICUs) vary widely from hospital to hospital, according to a new study by researchers at Columbia University School of Nursing and published in the October 2012 issue of the American Journal of Infection Control.

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.

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

The authors declare no financial or other conflicts of interest.

Columbia University School of Nursing is part of the Columbia University Medical Center, which also includes the College of Physicians & Surgeons, the Mailman School of Public Health, and the College of Dental Medicine. With close to 100 full-time faculty and 600 students, the School of Nursing is dedicated to educating the next generation of nurse leaders in education, research, and clinical care. The School has pioneered advanced practice nursing curricula and continues to define the role of nursing and nursing research through its PhD program which prepares nurse scientists, and its Doctor of Nursing Practice (DNP), the first clinical practice doctorate in the nation. Among the clinical practice areas shaped by the School’s research are the reduction of infectious disease and the use of health care informatics to improve health and health care. For more information, please visit: www.nursing.columbia.edu.

Columbia University Medical Center, 15.10.2012 (tB).