Measuring Infections with Multidrug Resistant Organisms: An Analysis from the Real World

Multidrug-resistant organisms (MDROs) are a growing problem. The Society for Healthcare Epidemiology of America (SHEA) and the Centers for Disease Control and Prevention’s (CDC’s) Healthcare Infection Control Practices Advisory Committee (HICPAC) published recommendations providing guidance and standardization on how to measure infection with MDROs. These include a variety of incidence and prevalence measures, as well as items such as antibiograms and line listings. 

An important question arises: how can this be implemented in the real world?

Dr. Maryam Behta, Barbara Ross, RN, both former colleagues of mine from New York City, and their collaborators, published this interesting study in ICHE assessing the challenges of applying the SHEA/CDC metrics for MDROs.

Importantly, the investigators discovered no statistically significant difference between using 72 hours or 3 calendar days as the cutoff to define hospital-onset incidence. Excluding patients not at risk (patients hospitalized for <72 hours)  from the denominator when calculating hospital-onset incidence led to statistically significant increases in rates. When excluding patients with a prior history of MRSA infection or colonization from nosocomial incidence rates, rates were similar. 

Most importantly, however, was the detailed description on data collection for each of the MDRO metrics.  Most of the metrics require some degree of electronic data extraction, a problem for hospitals without electronic medical records. Also, many of the metrics require manual review, a problem for infection prevention programs already functioning at capacity. And this is for only one pathogen, MRSA.  

If one were to fully implement the SHEA/CDC metrics for MDROs, how many full time infection preventionists would be required? Real world application is a financial and logistical challenge.

This leads me, again, to the issue of an opportunity cost. Although I work for one of the largest infection prevention programs in the country, to take on additional initiatives would require that we drop a component of our current program. Owing to a limited budgets and manpower, we choose to vigorously perform a horizontal, non-pathogen based infection prevention platform that increases implementation of infection prevention best practices and reduces all infections, by all pathogens. 

This perspective has been shared before.