Assessment of Compliance with Admission Screening for Vancomycin Resistant Enterococci (VRE) and Methicillin Resistant Staphylococcus aureus (MRSA) Colonization

BACKGROUND/OBJECTIVES: In Canada, most acute care facilities have established programs for routine screening of newly admitted patients for VRE and MRSA colonization. Rates of compliance with these screening programs are not well studied, and yet the success of such programs is contingent on how well they are accepted by clinical staff and patients. This study evaluates compliance with existing admission screening criteria for VRE and MRSA colonization at a 1300-bed health care organization and identifies factors associated with compliance. METHODS: Compliance with existing admission screening criteria were assessed among patients admitted to acute care from January 1, 2004 to December 1, 2005 who were eligible for VRE or MRSA screening. Patients eligible for screening were not already known to be positive for the organism of interest and had to meet at least one of the following criteria: History of previous hospitalization or long term care residence; self report of MRSA or VRE; on hemodialysis; or history of injecting drug use (IDU). Eligible patients were identified using electronic alerts for MRSA, VRE and hemodialysis, and through analysis of previous hospitalizations. Data that identified IDUs were not available. Factors independently associated with admission screening compliance were identified through logistic regression. RESULTS: Of 39,866 in-patients admitted over the 23-month period, at least 6464 (16%) were eligible for VRE screening, and of those eligible, 1476 (22.7%) were screened; a slightly higher percentage was obtained for MRSA (1317/4943, or 26.6%). Screening for VRE among eligible admissions doubled over time (15.6% from January to September 2004; 30.3% from February to November 2005) and was 3 times higher at the community hospital than at the tertiary care hospital (51.8% versus 16.0%). Independent factors associated with compliance for VRE screening were: admission to the community hospital; recent admission (February to November 2005); being a direct transfer from another healthcare facility; and admission through the ER. Results for MRSA admission screening showed similar trends. CONCLUSIONS: Overall compliance with admission screening criteria was low. Factors associated with compliance were more strongly related to the organizational structure than with the patientʹs underlying risk. Initiatives that encourage compliance such as automated risk assessment may be necessary for a successful admission screening program.