Reducing the Threat of Nosocomial Antibiotic-Resistant Organism Infections in Long-Term Acute Care through Proactive Screening

ISSUE: There is no nationally recognized threshold for a “good” nosocomial antibiotic-resistant organism (ARO) rate in long-term acute-care hospitals. Senior leadership wanted to know if we were doing all we could to minimize the threat of AROs within our organization. The Medical Staff and Board of Directors turned to Infection Control to investigate ways to decrease the risk of nosocomial AROs. PROJECT: Based on a review of medical literature, identification and isolation are the most effective means of decreasing nosocomial ARO infections. Because patients requiring long-term acute care are at higher risk for colonization with AROs, a proposal for screening newly admitted patients was presented and approved by the Medical Executive Committee. In June 2002, the hospital began screening every patient not previously identified with oxycillin-resistant Staphylococcus aureus (ORSA) or vancomycin-resistant Enterrococcus (VRE) for ORSA and VRE. Those patients testing positive for either (or both) ARO were placed in contact isolation. RESULTS: At the end of 12 months, the nosocomial ORSA rate fell 55.9% and the nosocomial VRE rate fell 48.4% (July 2001–June 2002 compared to July 2002–June 2003). Although the hospital incurred a cost of $136,223 for this program, approximately $700,872 in ARO–related costs were prevented. Based on estimates from the Society for Healthcare Epidemiology of America, Inc. (SHEA), this represents a net savings of $564,649 for July 2002–June 2003. LESSONS LEARNED: Identification and isolation is the best method for reducing nosocomial ARO infection. Administrative and medical staff support is imperative for a program of this magnitude to be successful.