Creation of a statewide prevention collaborative regarding
multidrug-resistant organisms (MDRO).
Katherine Henry1, Kerri Thom2, David Blythe1, Anthony Harris2, Patricia Lawson1,
Brenda Roup1, Margaret Pass3, Elizabeth Fuss4, Lisa Maragakis5, Byron Pugh1, Lucy Wilson1
2011 CSTE Annual
Conference
Pittsburgh, PA
June 12-16, 2011
1Maryland
Department of Health and Mental Hygiene, 2University of Maryland School of Medicine,
3St. Agnes Hospital, 4Carroll Hospital Center, 5Johns Hopkins School of Medicine
BACKGROUND
METHODS
RESULTS
CONCLUSIONS
In 2009, the Maryland Department of Health & Mental
Hygiene formed a multidisciplinary advisory group of
healthcare partners to address surveillance and
prevention of multidrug-resistant organisms (MDROs),
initially focusing on multidrug-resistant Acinetobacter
baumannii (MDR-Ab). MDR-Ab is a rapidly emerging
pathogen in a variety of healthcare settings, and is an
important patient safety concern. Several acute care
hospitals and other healthcare facilities in Maryland
identified MDR-Ab as a problem and expressed a desire to
address surveillance and infection control concerns in a
collaborative fashion.
A diverse, experienced group of healthcare
professionals
including
epidemiologists,
physicians, laboratorians, infection preventionists
(IPs), and representatives from state agencies,
acute care hospitals, and long term care facilities
(LTCF) were convened to establish the Maryland
MDRO/MDR-Acinetobacter
Prevention
Collaborative. By consensus, the members
determined as its first priority the establishment
of baseline MDR-Ab prevalence among
mechanically ventilated patients, via a statewide
Acinetobacter
Prevalence
Survey.
The
Collaborative regularly met throughout the year
to establish priorities and design a survey
protocol.
Concurrently,
the
Collaborative
prepared and disseminated a questionnaire to
assess MDRO surveillance and prevention
practices in these facilities.
The Acinetobacter Prevalence Survey was conducted
in August 2010, in which sputum and peri-anal
samples were collected from mechanically ventilated
patients. 30/46 (65%) acute care and 10/12 (83%)
LTCF participated in the prevalence survey. Overall,
34% of patients surveyed were positive for A.
baumannii. Of those testing positive, 54% were MDRAb. In acute care hospitals and LTCF, A. baumannii
was isolated in 16% and 63% of patients, respectively.
Facility-specific results were provided to participating
facilities, and aggregate survey results were shared
with acute care hospitals. All 46 acute care hospitals
and all 12 LTCF with ventilator beds completed the
infection control questionnaire (100% participation).
Questionnaire results highlighted disparities in
facilities’ MDRO screening policies via active
surveillance cultures. In addition, 100% of facilities
reported communicating a patient’s MDRO status on
transfer to another facility, while 84% of facilities
reported receiving information on a patient’s MDRO
status upon transfer from another facility. Facilities
reported ease in execution of the survey and
questionnaire, with no major obstacles encountered.
• The combined expertise of Collaborative members and
the statewide participation of both acute care and LTCF
contributed to the success of this project.
• Invaluable connections were strengthened between
state public health and acute and LTCF infection
preventionists.
• This project demonstrates that collaborative efforts may
serve to direct state priorities in MDRO surveillance,
prevention, and control among acute and LTCF settings.
Agencies/Institutions Represented in the
MDRO/MDR-Acinetobacter Prevention
Collaborative
State
Agencies
•Maryland Dept of Health & Mental Hygiene
Academic
Institutions
•University of Maryland School of Medicine
•Maryland Health Care Commission
•Johns Hopkins School of Medicine
•Johns Hopkins Bayview Hospital
Community •St. Agnes Hospital
Hospitals
•Carroll Hospital Center
Long Term
Care
Table 1. Number (percent) of mechanically ventilated
patients positive for Acinetobacter baumannii and
multidrug-resistant A. baumannii by facility type,
results from the Acinetobacter Prevalence Survey
+ A. baumannii
+ MDR-Ab*
121/358 (34%)
87/358 (24%)
36/222 (16%)
20/222 (9%)
85/136 (63%)
67/136 (49%)
•Lorien Health Systems
TOTAL
Acute Care
patients
LTCF
patients
Table 2. Number (percent) of facilities screening for
MDROs by facility type and organism, results from
Infection Control Questionnaire
Acute Care
LTCF
Hospitals
IMPLICATIONS
• Based on the high prevalence rates seen among the
survey population, the Collaborative is exploring areas
for improved infection control of MDR-Ab, including
respiratory personnel and equipment.
• Collaborative efforts continue to address MDRO
prevention efforts, and results from the Acinetobacter
Prevalence Survey can serve as baseline data in order to
evaluate future interventions.
• A survey to assess the value of the Acinetobacter
Prevalence Survey among IPs is currently under way.
Figure 1. Facility participation in Acinetobacter Prevalence
Survey by region
TOTAL
MRSA
44 (98%)
5 (42%) 49 (86%)
VRE
6 (13%)
5 (42%) 11 (19%)
Eastern Shore – 2/6 (33%)
*MDR-Ab = organisms susceptible to 2 or fewer classes of
antimicrobial agents excluding tigecycline and polymixin B
MDR-Ab
6 (13%)
2 (17%) 8 (14%)
Central MD – 25/31 (81%)
National Capital – 6/12 (50%)
Southern MD – 3/3 (100%)
November 2009
January 2010
March 2010
April - May 2010
June - July 2010
Implementation
planning, further
facility recruitment
Facility conference
calls to review
protocol, supplies
ordered & shipped
July 26 –
Aug 6 2010
October 2010
Survey
Days
Results finalized
and shared with
facilities
January 2011
April 2011
Western MD – 4/5 (80%)
TIMELINE
MDRO/MDRAcinetobacter Prevention
Collaborative is formed
Collaborative
decides to do a
prevalence
survey
Protocol developed
and initial facility
recruitment begins
Collaborative
begins discussing
“next steps”
PFGE results
finalized and shared
with facilities
Contact Information:
Katie Henry-Richards
KRichards@dhmh.state.md.us