CONCLUSIONS

1
Creation of a statewide prevention collaborative
regarding multidrug-resistant organisms
(MDRO). Katherine Henry1, Kerri Thom2, David
Blythe1, Anthony Harris2, Patricia
Lawson1, Brenda Roup1, Margaret Pass3, Elizabeth
Fuss4, Lisa Maragakis5, Byron Pugh1, Lucy
Wilson1 1Maryland Department of Health and Mental
Hygiene, 2University of Maryland School of
Medicine, 3St. Agnes Hospital, 4Carroll Hospital
Center, 5Johns Hopkins School of Medicine
2011 CSTE Annual Conference Pittsburgh, PA June
12-16, 2011

• CONCLUSIONS
• The combined expertise of Collaborative members
  and the statewide participation of both acute
  care and LTCF contributed to the success of this
  project.
• Invaluable connections were strengthened between
  state public health and acute and LTCF infection
  preventionists.
• This project demonstrates that collaborative
  efforts may serve to direct state priorities in
  MDRO surveillance, prevention, and control among
  acute and LTCF settings.

BACKGROUND In 2009, the Maryland Department of
Health Mental Hygiene formed a
multidisciplinary advisory group of healthcare
partners to address surveillance and prevention
of multidrug-resistant organisms (MDROs),
initially focusing on multidrug-resistant
Acinetobacter baumannii (MDR-Ab). MDR-Ab is a
rapidly emerging pathogen in a variety of
healthcare settings, and is an important patient
safety concern. Several acute care hospitals and
other healthcare facilities in Maryland
identified MDR-Ab as a problem and expressed a
desire to address surveillance and infection
control concerns in a collaborative fashion.
METHODS A diverse, experienced group of
healthcare professionals including
epidemiologists, physicians, laboratorians,
infection preventionists (IPs), and
representatives from state agencies, acute care
hospitals, and long term care facilities (LTCF)
were convened to establish the Maryland
MDRO/MDR-Acinetobacter Prevention Collaborative.
By consensus, the members determined as its first
priority the establishment of baseline MDR-Ab
prevalence among mechanically ventilated
patients, via a statewide Acinetobacter
Prevalence Survey. The Collaborative regularly
met throughout the year to establish priorities
and design a survey protocol. Concurrently, the
Collaborative prepared and disseminated a
questionnaire to assess MDRO surveillance and
prevention practices in these facilities.
RESULTS The Acinetobacter Prevalence Survey was
conducted in August 2010, in which sputum and
peri-anal samples were collected from
mechanically ventilated patients. 30/46 (65)
acute care and 10/12 (83) LTCF participated in
the prevalence survey. Overall, 34 of patients
surveyed were positive for A. baumannii. Of those
testing positive, 54 were MDR-Ab. In acute care
hospitals and LTCF, A. baumannii was isolated in
16 and 63 of patients, respectively.
Facility-specific results were provided to
participating facilities, and aggregate survey
results were shared with acute care hospitals.
All 46 acute care hospitals and all 12 LTCF with
ventilator beds completed the infection control
questionnaire (100 participation). Questionnaire
results highlighted disparities in facilities
MDRO screening policies via active surveillance
cultures. In addition, 100 of facilities
reported communicating a patients MDRO status
on transfer to another facility, while 84 of
facilities reported receiving information on a
patients MDRO status upon transfer from another
facility. Facilities reported ease in execution
of the survey and questionnaire, with no major
obstacles encountered.

• IMPLICATIONS
• Based on the high prevalence rates seen among
  the survey population, the Collaborative is
  exploring areas for improved infection control of
  MDR-Ab, including respiratory personnel and
  equipment.
• Collaborative efforts continue to address MDRO
  prevention efforts, and results from the
  Acinetobacter Prevalence Survey can serve as
  baseline data in order to evaluate future
  interventions.
• A survey to assess the value of the
  Acinetobacter Prevalence Survey among IPs is
  currently under way.

Agencies/Institutions Represented in the MDRO/MDR-Acinetobacter Prevention Collaborative Agencies/Institutions Represented in the MDRO/MDR-Acinetobacter Prevention Collaborative
State Agencies Maryland Dept of Health Mental Hygiene
State Agencies Maryland Health Care Commission
Academic Institutions University of Maryland School of Medicine
Academic Institutions Johns Hopkins School of Medicine Johns Hopkins Bayview Hospital
Community Hospitals St. Agnes Hospital
Community Hospitals Carroll Hospital Center
Long Term Care Lorien Health Systems
Table 1. Number (percent) of mechanically
ventilated patients positive for Acinetobacter
baumannii and multidrug-resistant A. baumannii by
facility type, results from the Acinetobacter
Prevalence Survey
Figure 1. Facility participation in Acinetobacter
Prevalence Survey by region
A. baumannii MDR-Ab
TOTAL 121/358 (34) 87/358 (24)
Acute Care patients 36/222 (16) 20/222 (9)
LTCF patients 85/136 (63) 67/136 (49)
Table 2. Number (percent) of facilities screening
for MDROs by facility type and organism, results
from Infection Control Questionnaire
Acute Care Hospitals LTCF TOTAL
MRSA 44 (98) 5 (42) 49 (86)
VRE 6 (13) 5 (42) 11 (19)
MDR-Ab 6 (13) 2 (17) 8 (14)
MDR-Ab organisms susceptible to 2 or fewer
classes of antimicrobial agents excluding
tigecycline and polymixin B
July 26 Aug 6 2010
November 2009
January 2010
March 2010
April - May 2010
June - July 2010
October 2010
April 2011
January 2011
TIMELINE
PFGE results finalized and shared with facilities
MDRO/MDR-Acinetobacter Prevention Collaborative
is formed
Collaborative decides to do a prevalence survey
Protocol developed and initial facility
recruitment begins
Implementation planning, further facility
recruitment
Facility conference calls to review protocol,
supplies ordered shipped
Survey Days
Results finalized and shared with facilities
Collaborative begins discussing next steps
Contact Information Katie Henry-Richards KRichard
s_at_dhmh.state.md.us