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Isolation and Identification of Waterborne Antibiotic-Resistant Bacteria and Molecular Characterization of their Antibiotic Resistance Genes
Published on: March 3, 2023
Regional infection control assessment of antibiotic resistance knowledge and practice
Stephanie R Black1, Kingsley N Weaver1, Robert A Weinstein2
11Communicable Disease Program,Chicago Department of Public Health,Chicago,Illinois.
Objective:
Multidrug-resistant organisms (MDROs) are an increasing burden among healthcare facilities. We assessed facility-level perceived importance of and responses to various MDROs.
Design:
A pilot survey to assess staffing, knowledge, and the perceived importance of and response to various multidrug resistant organisms (MDROs)
Setting:
Acute care and long-term healthcare facilities
Methods:
In 2012, a survey was distributed to infection preventionists at ~300 healthcare facilities. Pathogens assessed were Clostridium difficile, carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, multidrug-resistant (defined as bacterial resistance to ≥3 antibiotic classes) Pseudomonas, and extended-spectrum β-lactamase-producing Escherichia coli.
Results:
A total of 74 unique facilities responded, including 44 skilled nursing facilities (SNFs) and 30 acute care facilities (ACFs). While ACFs consistently isolated patients with active infections or colonization due to these MDROs, SNFs had more variable responses. SNFs had more multi-occupancy rooms and reported less specialized training in infection control and prevention than did ACFs. Of all facilities with multi-occupancy rooms, 86% employed a cohorting practice for patients, compared with 50% of those without multi-occupancy rooms; 20% of ACFs and 7% of SNFs cohorted staff while caring for patients with the same MDRO. MRSA and C. difficile were identified as important pathogens in ACFs and SNFs, while CRE importance was unknown or was considered important in <50% of SNFs.
Conclusion:
We identified stark differences in human resources, knowledge, policy, and practice between ACFs and SNFs. For regional control of emerging MDROs like CRE, there is an opportunity for public health officials to provide targeted education and interventions. Education campaigns must account for differences in audience resources and baseline knowledge.
Insights
Healthcare facilities show varied responses to multidrug-resistant organisms (MDROs). Acute care facilities (ACFs) consistently isolate patients, while skilled nursing facilities (SNFs) have less specialized training and variable practices for MDRO control.
Area of Science:
- Healthcare-associated infections
- Infectious disease epidemiology
- Public health
Background:
- Multidrug-resistant organisms (MDROs) pose a significant and growing threat in healthcare settings.
- Understanding facility-level perceptions and responses to MDROs is crucial for effective control strategies.
Purpose of the Study:
- To assess the perceived importance of and facility-level responses to various MDROs.
- To compare infection prevention and control practices between acute care facilities (ACFs) and skilled nursing facilities (SNFs).
Main Methods:
- A pilot survey was distributed to infection preventionists in approximately 300 healthcare facilities in 2012.
- The survey assessed staffing, knowledge, and perceived importance and response to specific MDROs including Clostridium difficile, carbapenem-resistant Enterobacteriaceae (CRE), and methicillin-resistant Staphylococcus aureus (MRSA).
- Respondents included 74 unique facilities: 44 SNFs and 30 ACFs.
Main Results:
- ACFs consistently isolated patients with MDROs, whereas SNFs exhibited more variable responses.
- SNFs reported more multi-occupancy rooms and less specialized infection control training compared to ACFs.
- While MRSA and C. difficile were recognized as important in both settings, CRE recognition varied, particularly in SNFs.
Conclusions:
- Significant disparities exist in resources, knowledge, policies, and practices between ACFs and SNFs regarding MDRO management.
- Targeted education and interventions by public health officials are needed for regional control of emerging MDROs like CRE.
- Future educational initiatives must consider the varying resources and knowledge levels of different healthcare facility types.
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