Rapid Identification of Hospitalized Patients at High Risk for MRSA Carriage

Patients who are asymptomatic carriers of methicillin-resistant Staphylococcus aureus (MRSA) are major reservoirs for transmission of MRSA to other patients. Medical personnel are usually not aware when these high-risk patients are hospitalized. We developed and tested an enterprise-wide electronic...

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Bibliographic Details
Published in:Journal of the American Medical Informatics Association : JAMIA 2008-07, Vol.15 (4), p.506-512
Main Authors: Evans, R. Scott, Wallace, Carrie Jane, Lloyd, James F., Taylor, Caroline W., Abouzelof, Rouett H., Sumner, Sharon, Johnson, Kyle V., Wuthrich, Amyanne, Harbarth, Stephan, Samore, Matthew H.
Format: Article
Language:English
Subjects:
Algorithms
Application of Information Technology
Carrier State - diagnosis
Cross Infection - prevention & control
Decision Support Systems, Clinical
Disease Reservoirs
Disease Transmission, Infectious - prevention & control
Hospitalization
Humans
Infection Control - methods
Medical Records Systems, Computerized
Methicillin Resistance
Nose - microbiology
Population Surveillance - methods
Reminder Systems
Risk
Staphylococcal Infections - diagnosis
Staphylococcus aureus
Staphylococcus aureus - isolation & purification
Time Factors
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Summary:Patients who are asymptomatic carriers of methicillin-resistant Staphylococcus aureus (MRSA) are major reservoirs for transmission of MRSA to other patients. Medical personnel are usually not aware when these high-risk patients are hospitalized. We developed and tested an enterprise-wide electronic surveillance system to identify patients at high risk for MRSA carriage at hospital admission and during hospitalization. During a two-month study, nasal swabs from 153 high-risk patients were tested for MRSA carriage using polymerase chain reaction (PCR) of which 31 (20.3%) were positive compared to 12 of 293 (4.1%, p < 0.001) low-risk patients. The mean interval from admission to availability of PCR test results was 19.2 hours. Computer alerts for patients at high-risk of MRSA carriage were found to be reliable, timely and offer the potential to replace testing all patients. Previous MRSA colonization was the best predictor but other risk factors were needed to increase the sensitivity of the algorithm.
ISSN:1067-5027
1527-974X
DOI:10.1197/jamia.M2721