Should Surveillance Cultures be Done on All New Admissions?

Question: Since HAIs are going to be a reportable for all states fairly soon in the future, is it prudent for healthcare facilities to do surveillance cultures on all new admits to identify colonized patients? LC, Atlanta


Answer: Individual states have looked at laws concerning mandatory reporting of healthcare-associated infections (HAIs). For instance, in my own state, South Carolina, a law was recently passed which included the following for mandatory reporting:  surgical site infections, ventilator-associated pneumonias, central line-related bloodstream infections, and "other" additional categories of hospital associated rates as required by our health department from time to time. As you can see, nothing is mentioned regarding antibiotic resistant organisms, although this could be a focus in the future. If healthcare facilities are performing screening cultures of some or all newly admitted patients, the purpose is to identify the reservoir, or those who are infected or colonized with resistant organisms such as MRSA and VRE, and to isolate the patients accordingly to prevent transmission of these organisms. The facility may actually find that the cultures prove the patient was colonized on admission and therefore could not be counted as hospital (or healthcare)-associated infection for this facility. Also, due to the fact that colonization is merely the presence of an organism in the absence of symptoms or deep tissue invasion, this would not be counted as infection (presence and invasion of the organism) in this instance.