Grant Application

Mohamed Tassin, MD, PhD, UPMC Mercy

Proposed Innovation

The spread of multidrug resistant organisms (MDRO) represents a challenge to patient safety and quality of care. Early detection through surveillance is a cornerstone for infection prevention.

This project — an extension of an earlier project funded by the Beckwith Institute in 2016 — aims to demonstrate that surveillance of patients with a high risk of MDRO colonization (a horizontal approach) is more effective than the current vertical strategy that focuses surveillance on specific pathogens.

Improvements in Action

In the initial stage of the project, a computer-generated screening tool was developed to evaluate newly admitted patients to the Critical Care Unit (CCU) and identify those at high risk for MDRO with at least two of the following risk factors:

  • Readmission within 90 days
  • Presence of a chronic open wound (more than 30 days)
  • Having a tracheostomy
  • Having a chronic indwelling catheter, such as a feeding tube, urinary catheter,  intravenous catheter, or bowel diversion

Data collected in the initial stage of the project indicated that clinically driven surveillance is a more effective method of detecting MDRO. Once an alert is activated, surveillance cultures are taken; those testing positive for MDRO colonization are then targeted for hospital-associated infection prevention measures, including hand hygiene, chlorhexidine bathing, and contact precautions as needed. Tracing MDRO is an essential step for the prevention of outbreaks within the CCU.

Intended Outcomes

During this next stage of the project, researchers intend to conduct additional studies using control patients and those with a longer, seven-day stay in the CCU. They also plan to add clostridium difficile (C. diff.) infection to the screening tool. A detailed analysis will be performed to determine difference in the approaches.

Focusing screening on high-risk patients is expected to result in surveillance efforts that are more precise, while decreasing the burden on the nursing and microbiology lab staff. It is also expected to reduce unnecessary costs. The ultimate goal is to establish a new protocol for MDRO surveillance that will improve infection prevention and enhance patient safety.