Constructing clinical indicators for multiresistant organisms. Where do we begin?

Abstract

Multidrug-resistant organisms (MROs) are a significant and growing concern in many healthcare facilities. Resistant organisms can be rapidly transmitted, have limited antimicrobial treatment options, are capable of significant morbidity and mortality, and are associated with longer hospital stays and greater overall costs. Clinical indicators can be used to identify environments that may benefit from closer monitoring. Specific indicators for Southern Health, the largest metropolitan health service in Victoria, were constructed using the methodology developed by the Australian Infection Control Association. Organisms monitored were methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Gram-negative bacilli (Pseudomonas spp., Acinetobacter spp., Serratia marcescens) and Clostridium difficile. Rate-based graphs were constructed to provide a display of changes to the prevalence of MROs. Denominator data (occupied bed days) were easily obtained from the health services clinical information system. Continuous monitoring using clinical indicators allows the infection control team to identify areas that may benefit from enhanced unit activity and allows a framework to be constructed for the ongoing development of quality indicators in infection control. Suitable statistical charts that provide 95% confidence intervals and flag MRO levels requiring action are currently under investigation.