Top 3 Secrets to Effective Infection Prevention and Control Through Strategic MDRO Surveillance

Sean Brown, CIC, CPHQ, with author

(Photo Courtesy of Carole W. Kamangu, MPH, RN, CIC)

During my recent attendance at the Disease Prevention and Control Summit—America and World AMR [Antimicrobial Resistance] Congress in Philadelphia, held September 5 and 6, 2024, I listened to an insightful presentation on MDRO Surveillance titled Cracking the Code: MDRO surveillance secrets revealed. Sean Brown, CIC, CPHQ, associate director of infection prevention and control at NYC Health + Hospital - Harlem, New York, covered essential aspects of multidrug-resistant organisms MDRO surveillance and provided insights on infection prevention and control (IPC) practices in health care settings.

“Emphasizing the importance of leveraging both existing resources—regardless of their size or cost—and the power of local vulnerability assessments, [in this presentation] we explored how to gauge the prevalence and incidence of communicable diseases,” Brown told me. “Attendees learned to harness collaboration with key stakeholders, including labs, health departments, and fellow infection preventionists. Additionally, we highlight the significance of engaging all 5 senses—sight, smell, feel, taste, and touch—in identifying potential vulnerabilities and implementing targeted interventions. This session equipped participants with practical insights to enhance their MDRO surveillance efforts and improve overall infection control practices.”

His presentation also emphasized the importance of adopting a proactive and comprehensive surveillance strategy for detecting MDRO by implementing the 3-I framework (Identify, Isolate, Inform) for persons under investigation (PUI).

Role of Data in Infection Prevention and Control

(Courtesy of Sean Brown, CIC, CPHQ, associate director of infection prevention and control at NYC Health + Hospital - Harlem, New York Text from the CDC and the World Health Organization)

The Role of Data in Infection Prevention and Control

Several data sources can be utilized for effective surveillance, notably laboratory-generated reports, electronic medical records (EMR), as well as city, state, federal, and global health databases from reliable sources such as the CDC and the World Health Organization (WHO).

Brown emphasized the value of comparing facility data with city and international data to ensure comprehensive surveillance and the performance of “data mining at the highest level.” He highlighted 3 important secrets to performing MDRO surveillance at an optimal level: prioritizing high-risk patients, leveraging technology through electronic medical records (EMR), and incorporating environmental surveillance into IPC operations.

Secret #1: Prioritizing High-Risk Patients

Due to their increased vulnerability and predisposition to infections, prioritizing high-risk patients must be a key component of an effective surveillance strategy. High-risk patients show at least one of the following characteristics:

• Immunocompromised status
• Presence of indwelling devices (eg urinary catheters)
• Need for critical care (eg. in the ICU)
• Abnormal chest X-rays
• New antibiotic therapy
• Recent admission from a long-term care facility
• Presence of open wounds (including burn victims)
• History of an infection, particularly an MDRO within this context

Health care facilities should establish systems that ensure IPC teams are immediately notified upon admission of these high-risk patients.

Secret #2: Leveraging Technology Through the Use of EMR Systems

EMR systems can be powerful tools for IPC surveillance. They allow infection preventionists to access the data most relevant to the situation and understand the big picture. Some ways the power of EMR systems can be maximized and used strategically include:

• Filtering data to analyze the most relevant information needed at the time
• Including both preliminary and final results from laboratory reports to have a comprehensive view of infection trends
• Implementing push notifications to receive alerts promptly
• Tailoring notifications to the specific surveillance needs of your department
• Utilizing exposure surveillance tools to track patient movements within the facility and enhance contact-tracing activities
• Maintaining accurate isolation lists and regularly sharing information with stakeholders on the frontline

Secret #3: Incorporating Environmental Surveillance

Brown highlighted the importance of environmental surveillance in gaining more information regarding the MDRO burden within health care facilities. Some effective methods used in environmental surveillance include:

• Fungal spores cultures
• Environmental surface swabbing
• Air sampling
• Water sampling

These methods can provide more insights into the overall picture and reveal environmental sources of infection beyond the data gathered from clinical specimens.

Key Takeaways for Effective MDRO Surveillance

Brown emphasized several key steps to remain effective while conducting MDRO surveillance:

1. Start data collection early in the admission process to capture early signs of a potential infection.
2. Track all indwelling devices used within your facility.
3. Regularly review antibiograms to stay alert to drug-resistant organisms.
4. Know your facility's disease burden and compare it with CDC data for your specific geographical area.

Why Is This Significant?

The presentation revealed that effective IPC surveillance goes beyond analyzing data from clinical samples. By incorporating environmental surveillance and leveraging diverse data sources, health care facilities can create a more comprehensive and proactive approach to infection prevention. This comprehensive approach to IPC surveillance is significant because it allows health care facilities to:

• Identify potential outbreaks earlier
• Implement targeted interventions more effectively
• Reduce the burden of HAIs
• Promote patient safety and improve patient outcomes

By adopting these strategies, health care facilities can optimize infection prevention and control programs and stay ahead of emerging threats.