Managing Infection Prevention and Control for Multidrug-Resistant Organism Patients in Ebeye Hospital

Ebeye Hospital is a 60-bed acute care and district hospital in the Republic of the Marshall Islands (RMI). In October 2022, the hospital's Infection Prevention and Control (IPC) Program initiated health care-associated infection and antimicrobial resistance surveillance, along with efforts to promote appropriate antimicrobial use. New National IPC Guidelines call for the institution of appropriate infection control measures (based on the organism identified and site of infection) and adjustment, when needed, of patients' antibiotic regimen within 24 hours of release of multidrug-resistant organism culture results. A descriptive cohort study was conducted on hospital inpatients who tested positive for multidrug-resistant organisms, using program data from October 25, 2022, to December 31, 2023. Each case (n=58) was reviewed to assess: a) the timeliness of initiating infection control measures, and b) the timeliness and appropriateness of antibiotic selection, as guided by the RMI National Antimicrobial Guidelines. Multidrug-resistant organism cases involved a variety of organisms and occurred across all clinical wards. Of these, 35 cases (60%) met IPC standards. The primary reasons for not meeting IPC standards were lack of isolation rooms (n=10, 44%) and failure to meet the IPC initiation criterion per the working definition (n=13, 56%). Only 8 cases (14%) adhered to antibiotic usage guidelines. The most common reasons for non-adherence were prolonged antibiotic duration (n=19, 38%) and shorter-than-recommended duration (n=16, 32%). Management of a substantial proportion of multidrug-resistant cases at Ebeye Hospital failed to meet IPC standards. These findings highlight several areas for improvement.