Rapid Identification of Hospitalized Patients at High Risk for MRSA Carriage
- R Scott Evansa,b,
- Carrie Jane Wallacea,
- James F Lloyda,
- Caroline W Taylorc,
- Rouett H Abouzelofc,
- Sharon Sumnerc,
- Kyle V Johnsona,
- Amyanne Wuthrichd,
- Stephan Harbarthe,
- Matthew H Samoreb,d,f
- aDepartment of Medical Informatics, LDS Hospital, Intermountain Healthcare, Salt Lake City, UT
- bDepartment of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT
- cDivision of Infection Control, Intermountain Healthcare, Salt Lake City, UT
- dDivision of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
- eDepartment of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
- fVA Health Care System, Salt Lake City, Utah
- Correspondence: R. Scott Evans, M.S., Ph.D., FACMI, Department of Medical Informatics, LDS Hospital, 8th Avenue and C Street, Salt Lake City, Utah (e-mail: <ldsevans{at}ihc.com>)
- Received 14 January 2008
- Accepted 10 April 2008
Abstract
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.
Footnotes
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Funding for this study was provided by Grant 1 U01 CI000334-01 from the Center for Disease Control and Prevention. We also thank Becton Dickinson for providing the PCR kits used to test for MRSA carriage.
