Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-26T09:07:08.476Z Has data issue: false hasContentIssue false
  • English
  • Français

Multidrug-Resistant Organisms Detected More Than 48 Hours After Hospital Admission Are Not Necessarily Hospital-Acquired

Published online by Cambridge University Press:  17 October 2016

Stefan Erb ,
Reno Frei ,
Marc Dangel  and
Andreas F. Widmer
Stefan Erb
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
Reno Frei
Affiliation:
Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
Marc Dangel
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
Andreas F. Widmer*
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
*
Address correspondence to Prof. Andreas F. Widmer, MD, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

Infections and colonization with multidrug-resistant organisms (MDROs) identified >48 hours after hospital admission are considered healthcare-acquired according to the definition of the Centers for Disease Control and Prevention (CDC). Some may originate from delayed diagnosis rather than true acquisition in the hospital, potentially diluting the impact of infection control programs. In addition, such infections are not necessarily reimbursed in a healthcare system based on the diagnosis-related groups (DRGs).

OBJECTIVE

The goal of the study was to estimate the preventable proportion of healthcare-acquired infections in a tertiary care hospital in Switzerland by analyzing patients colonized or infected with MDROs.

METHODS

All hospitalized patients with healthcare-acquired MDRO infection or colonization (HAMIC) or according to the CDC definition (CDC-HAMIC) were prospectively assessed from 2002 to 2011 to determine whether there was evidence for nosocomial transmission. We utilized an additional work-up with epidemiological, microbiological, and molecular typing data to determine the true preventable proportion of HAMICs.

RESULTS

Overall, 1,190 cases with infection or colonization with MDROs were analyzed; 274 (23.0%) were classified as CDC-HAMICs. Only 51.8% of CDC-HAMICs had confirmed evidence of hospital-acquisition and were considered preventable. Specifically, 57% of MRSA infections, 83.3% of VRE infections, 43.9% of ESBL infections, and 74.1% of non-ESBL MDRO infections were preventable HAMICs.

CONCLUSIONS

The CDC definition overestimates the preventable proportion of HAMICs with MDROs by more than 50%. Relying only on the CDC definition of HAMICs may lead to inaccurate measurement of the impact of infection control interventions and to inadequate reimbursement under the DRG system.

Infect. Control Hosp. Epidemiol. 2016;1–6

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 18 - 23
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Enthoven, AC. Reforming Medicare by reforming incentives. N Engl J Med 2011;364:e44.Google Scholar
2. Jha, AK, Joynt, KE, Orav, EJ, Epstein, AM. The long-term effect of premier pay for performance on patient outcomes. N Engl J Med 2012;366:1606–1615.Google Scholar
3. Rosenthal, MB. Nonpayment for performance? Medicare’s new reimbursement rule. N Engl J Med 2007;357:1573–1575.Google Scholar
4. Wenzel, RP. Nosocomial infections, diagnosis-related groups, and study on the efficacy of nosocomial infection control. Economic implications for hospitals under the prospective payment system. Am J Med 1985;78:3–7.Google Scholar
5. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
6. Identifying Healthcare-Associated Infections (HAI) for NHSN Surveillance. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/2PSC_IdentifyingHAIs_NHSNcurrent.pdf. Published January 2016. Accessed September 13, 2016.Google Scholar
7. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
8. Fluckiger, U, Widmer, AF. Epidemiology of methicillin-resistant Staphylococcus aureus . Chemotherapy 1999;45:121–134.Google Scholar
9. Widmer, A, Frei, R. The impact of infection control (IC) on MRSA: the need for a standardized classification. Presented at: 35th Annual IDSA Meeting; 1997; San Francisco, CA.Google Scholar
10. Multidrug-Resistant Organism and Clostridium difficile Infection (MDRO/CDI) Module. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf. Published April 2013. Accessed September 13, 2016.Google Scholar
11. Pfaller, M, Hollis, R, Sader, H, et al. Chromosomal restriction fragment analysis by pulsed-field gel electrophoresis. In: Clinical Microbiology Procedures Handbook. Washington; 1992. 10.5.c.1–10.5.c.12.Google Scholar
12. Stranden, A, Frei, R, Widmer, AF. Molecular typing of methicillin-resistant Staphylococcus aureus: Can PCR replace pulsed-field gel electrophoresis? J Clin Microbiol 2003;41:3181–3186.Google Scholar
13. Lambert, ML, Silversmit, G, Savey, A, et al. Preventable proportion of severe infections acquired in intensive care units: case-mix adjusted estimations from patient-based surveillance data. Infect Control Hosp Epidemiol 2014;35:494–501.Google Scholar
14. Fenner, L, Widmer, AF, Dangel, M, Frei, R. Distribution of spa types among meticillin-resistant Staphylococcus aureus isolates during a 6-year period at a low-prevalence university hospital. J Med Microbiol 2008;57:612–616.Google Scholar
15. Mertz, D, Frei, R, Periat, N, et al. Eradication of an epidemic methicillin-resistant Staphylococcus aureus (MRSA) from a geriatric university hospital: evidence from a 10-year follow-up. Eur J Clin Microbiol Infect Dis 2010;29:987–993.CrossRefGoogle Scholar
16. Buehlmann, M, Frei, R, Fenner, L, Dangel, M, Fluckiger, U, Widmer, AF. Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol 2008;29:510–516.Google Scholar
17. Buehlmann, M, Bruderer, T, Frei, R, Widmer, AF. Effectiveness of a new decolonisation regimen for eradication of extended-spectrum beta-lactamase-producing Enterobacteriaceae. J Hosp Infect 2011;77:113–117.Google Scholar
18. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, Health Care Infection Control Practices Advisory C. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65–S164.Google Scholar
19. Pittet, D, Allegranzi, B, Storr, J, Donaldson, L. ‘Clean Care is Safer Care’: the Global Patient Safety Challenge 2005–2006. Int J Infect Dis 2006;10:419–424.Google Scholar
20. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.Google Scholar
21. Kmietowicz, Z. Hospital infection rates in England out of control. BMJ 2000;320:534.Google Scholar
22. Orsi, GB, Di Stefano, L, Noah, N. Hospital-acquired, laboratory-confirmed bloodstream infection: increased hospital stay and direct costs. Infect Control Hosp Epidemiol 2002;23:190–197.Google Scholar
23. Harbarth, S, Sax, H, Gastmeier, P. The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect 2003;54:258–266; quiz 321.Google Scholar
24. Haley, RW, Morgan, WM, Culver, DH, et al. Update from the SENIC project. Hospital infection control: recent progress and opportunities under prospective payment. Am J Infect Control 1985;13:97–108.Google Scholar
25. Vegni, FE, Panceri, ML, Biffi, M, Banfi, E, Porretta, AD, Privitera, G. Three scenarios of clinical claim reimbursement for nosocomial infection: the good, the bad, and the ugly. J Hosp Infect 2004;56:150–155.Google Scholar