CSMC Initiates Pilot to Expand Routine Admission Screening Cultures Protocol

Cedars-Sinai's Hospital Acquired Infections (HAI) Task Force begins rolling out a new MEC-approved program next week that will allow nurses to order admission screening cultures per protocol for MDRO (multi-drug-resistant organisms) in those patients identified as high risk.

Previously, routine admission screening cultures were only ordered for ICU admissions. Pediatrics also has had a screening process in place for all NICU and PICU transfers from other facilities.

Starting as a pilot program on 4SE, 4SW, 6SW and 7NE, patients will be assessed on admission for any of the following MDRO risk criteria:

• admission from a skilled nursing facility or other hospital;
• known history of MDRO;
• presence of a ventilator or tracheostomy;
• presence of a draining wound

It is estimated that approximately 7 percent of non-ICU admissions meet these MDRO risk criteria.

Per protocol, the nurse will place a high-risk patient preemptively on Modified Contact Precautions and may obtain the appropriate swabs for screening cultures. Physicians may be contacted to approve the culture orders in advance of being entered into PCX by nursing staff. The need for continued Modified Contact Precautions would depend on the culture results and the specific MDRO history.

If successful, the pilot program will be phased in housewide over the course of several months.

"Our goal is to reduce preventable hospital acquired infections to zero at Cedars-Sinai," said Rekha Murthy, M.D., director of Hospital Epidemiology. "It's important that we have protocols in place to help us identify high-risk MDRO patients and place them on appropriate precautions upon admission. These screening cultures are currently being done for ICU admissions, where these efforts have been helpful in reducing nosocomial transmission of MDR Acinetobacter. By extending these successful strategies to all patients ultimately, we anticipate further reduction of nosocomial infections of these very resistant organisms."

New state and federal regulations are also being implemented which will require public reporting by healthcare facilities of hospital acquired infections. Effective July 1, 2008, all California hospitals are required to report all MRSA (methicillin-resistant Staphylococcus aureus) bloodstream infections identified in hospital inpatients to the California Department of Public Health. In addition, beginning Oct. 1, 2008, the Centers for Medicare & Medicaid Services will not reimburse hospitals for selected infections acquired during hospitalization. These include catheter-associated urinary track infections, central line infections and mediastinitis after cardiac surgery.

"This pilot program is one of several new initiatives being introduced at Cedars-Sinai, based on the work and recommendations of the HAI multidisciplinary teams," said Michael Langberg, M.D., senior vice president of Medical Affairs and Chief Medical Officer. "We can expect further announcements about other initiatives as we continue to implement procedures as part of our drive to eliminate hospital-acquired infections."