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Comparison of surveillance and clinical cultures to measure the impact of infection control interventions on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in the hospital

Published online by Cambridge University Press:  03 January 2020

Surbhi Leekha
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Lyndsay M. O’Hara
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Alyssa Sbarra
Affiliation:
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
Shanshan Li
Affiliation:
Mass Mutual Financial Group, New York, New York
Anthony D. Harris
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Corresponding
E-mail address:

Abstract

Objective:

To evaluate whether clinical cultures are an appropriate surrogate for surveillance cultures to measure the effect of interventions on the incidence of MRSA and VRE in the hospital.

Design:

Cross-sectional and quasi-experimental, retrospective analysis

Setting and population:

Convenience sample of patients admitted between January 1, 2002, and June 31, 2011, to the medical intensive care unit (MICU) and surgical intensive care unit (SICU) of an acute-care hospital in the United States.

Interventions:

Asynchronously in the MICU and SICU, we introduced (1) universal glove and gown use, (2) bundled intervention to prevent central-line–associated bloodstream infection, and (3) daily chlorhexidine gluconate bathing.

Results:

We observed a statistically significant correlation between surveillance and clinical culture-based incidence rates of MRSA in the MICU (0.32; P < .001) and the SICU (0.37; P < .001) but not for VRE in either the MICU (0.16, P = .11) or the SICU (0.15; P = .12). For VRE, but not for MRSA, incidence density rates based on surveillance cultures were 2- to 4-fold higher than for clinical cultures. When evaluating the impacts of the interventions, different effect estimates were noted for universal glove and gown use on MRSA acquisition in MICU, and for VRE acquisition in both the MICU and the SICU based on surveillance versus clinical cultures.

Conclusions:

For multidrug-resistant organism acquisition, surveillance cultures should be used when feasible because clinical cultures may not be an appropriate surrogate. Clinical or surveillance-based end points for infection control interventions should reflect the conceptual model from colonization to infection and where an intervention might have an effect, rather than considering them interchangeable.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

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Comparison of surveillance and clinical cultures to measure the impact of infection control interventions on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in the hospital
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