Surveillance Swabs

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    So I am trying to find out others policies for surveillance swabs, particularly for MRSA, but any others you might want to chime in about feel free! At my hospital the NICU and PICU do admission VRE/MRSA swabs. The CICU does not. I do not understand this policy. I have asked my units practice council and no one can give me a really good idea why other than they used to do admission swabs but then did away with it. They have suggested I contact the hospitals ID person which I have done but I am awaiting a response. Right now we simply swab on a random day each month. Makes NO sense! So if little Johnny was admitted on December 1st and is still there on swab day December 29th and he turns up positive there is no way to know if he acquired that in the hospital or if he came in with it from home. I feel like this is a big Jcaho and insurance issue since we can't prove it was not hospital acquired, we are not responsible for it.

    I can recall being admitted to an ICU last year and I was swabbed, and when I worked in an adult CICU as a tech we swabbed all admits too...remember that dearly as that was the "lucky" techs job

    Thoughts? Comments? Your policy?
    Last edit by umcRN on Dec 18, '12
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  3. 9 Comments so far...

  4. 0
    Our ICU and ER policy is to swab everyone that is admitted for MRSA.
  5. 0
    We don't screen every patient on admission. Our guidelines state that anyone who has been hospitalized or institutionalized for more than 24-48 hours within the last 6 months is to be swabbed. As well, any patient who is known to have been positive in the past is to be screened on admission. When we have a patient known to be positive on the unit, we swab every patient on the unit once a week. In order to have isolation d/c'd they have to have three consecutive negatives with the first negative swabbed at least 48 hours after all antimicrobials have been d/c'd.

    Statistically speaking, children are more susceptible to community-associated MRSA than they are to health care-associated MRSA, particularly children under 2 years.
  6. 0
    We swab all PICU admissions on arrival and on discharge from the unit if they stayed in ICU for longer than 48 hours.
  7. 0
    We swab upon admission so that we know if the baby was exposed before getting to us. We do it to track hospital acquired vs community acquired .
  8. 0
    It's all very standardized surveillance criteria: the unit selection, frequency of testing, determining if the MDRO was CA or HA, etc. Maybe an ICP can chime in on this thread. Doing that surveillance, among other uses, allows the ICP to identify problematic trends and promptly intervene, and it allows the hospital to look at areas for quality improvement. You could consider moving this over to infection control.
  9. 0
    Thanks for all the replies!
    It's interesting. I heard back from my hospitals ID people who apparently conducted a study in 2008 between our units. Now it seems they didn't include NICU but did it between CICU and PICU.
    Now at the time of the study we had a 10 bed CICU and a 20ish something bed PICU. We now have a 26 bed cicu and a 40 bed picu. At the time of the study, for every 100 admissions there were 6 pos picu pts and 2 pos cicu pts (MRSA). They concluded that because of the younger age of cicu pts and that there were less chronics and frequent flyers in cicu they we only needed to do once a month testing while picu does on admission.
    I have not emailed them back yet but I do have a few arguments for that. First its been a few years and our units have changed. We do transplants now and have quite a few frequent flyers, we have also developed quite the chronic population that bounce back and forth from us to the rehab facility that takes them. Also I feel as though age shouldn't matter because as community acquired all you need are positive parents who pass it to the kiddos and in the area we live in we have seen some scary MRSA sepsis pts (all ecmos come to my unit and we've had several community acquired mrsa sepsis ecmo kiddos).

    Jan you say statistically younger children under two are more at risk, do you know of any articles supporting this, since yes most of our patients are under two, though last week we had several elementary school and high school kiddos, which is unusual, we usually don't have to listen to call bells going all day!
  10. 0
    Quote from umcRN
    Thanks for all the replies!
    Jan you say statistically younger children under two are more at risk, do you know of any articles supporting this, since yes most of our patients are under two, though last week we had several elementary school and high school kiddos, which is unusual, we usually don't have to listen to call bells going all day!
    I haven't heard of this either. The only disease I know of to which that specific age category (<2) is more susceptible is strep pneumo. CA-MRSA is associated with athletic facilities, prisons, dorms, child care, LTCFs, & other congregate settings; Age may be tied to it in that a weakened immune system would make someone more susceptible to invasive and non-invasive forms of it, and the young & old have weaker immune systems. This excerpt from the APIC website lists risk factors for both CA & HA-MRSA:
    MRSA Risk Factors
    General risk factors for MRSA acquisition from hospital and from community settings, are well documented in the
    literature (see reference list at end of this section) ..Known risk factors include but are not limited to:
    previous hospital admission in the previous year with at least one underlying chronic illness
    admission to a nursing home in the previous year
    previous receipt of antibiotics during an admission
    diagnosis of skin or soft-tissue infection at admission
    HIV infection
    injection drug use
    previous MRSA infection or colonization
    hemodialysis
    others as defined by the MRSA risk assessment (increasing age, work with animals, incarceration, etc) http://apic.org/Resource_/Eliminatio...guide-2010.pdf
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    The data I used isn't new, from 2006. It was published in the Canadian Journal of Infectious Diseases Medical Microbiology. (Can J Infect Dis Med Microbiol 2006;17(Suppl C):4C‐24C.) I took the information from the Alberta Health Services MRSA Guidelines 2007. http://www.health.alberta.ca/documen...lines-2007.pdf
  12. 0
    We swab nasopharynx on admission and again every 30 days for every patient.
    In a previous hospital we swabbed nose, throat and collected a stool sample for every patient.


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