Applying Metrics for MDROs in the Real-World Setting is Challenging

E. Yoko Furuya, MD, MS, of the Division of Infectious Diseases at Columbia University College of Physicians and Surgeons in New York, and colleagues, sought to test in the real-world environment the recommendations for measuring infection with multidrug-resistant organisms (MDROs) issued by the Society for Healthcare Epidemiology of America (SHEA) and the Centers for Disease Control and Prevention (CDC)s Healthcare Infection Control Practices Advisory Committee (HICPAC).

Using data from three hospital settings within a healthcare network, the researchers applied the SHEA/HICPAC recommendations to measure methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization. They obtained data from the hospitals electronic surveillance system, supplemented by manual medical record review as well as tested different definitions for nosocomial incidence, the effect of excluding patients not at risk from the denominator for hospital-onset incidence, and the appropriate time period to use when including or excluding patients with a prior history of MRSA infection or colonization from nosocomial rates.

Furuya, et al. report that there was no statistically significant difference between using 72 hours or three calendar days as the cutoff to define hospital-onset incidence. They add that excluding patients not at risk from the denominator when calculating hospital-onset incidence led to statistically significant increases in rates. They note, "When excluding patients with a prior history of MRSA infection or colonization from nosocomial incidence rates, rates were similar regardless of whether we looked at 1, 2, or 3 years worth of prior data." The researchers conclude that the SHEA/HICPAC MDRO metrics are useful but can be challenging to implement. Their research was published in Infection Control & Hospital Epidemiology.

Reference: Furuya EY, Elaine Larson E, Landers T, Jia H, Ross B and Behta M. Challenges of Applying the SHEA/HICPAC Metrics for Multidrug-Resistant Organisms to a Real-World Setting. Infection Control & Hospital Epidemiology. Vol. 32, No. 4, April 2011.