Of 441 eligible hospitals, 250 provided data on 413 ICUs (57% response rate). provides demographic data of study hospitals. The majority of respondents (n = 142, 57%) provided data on only 1 ICU, with an additional 74 (30%) providing data on 2 ICUs. Almost half the hospitals were located in the Northeast (44%), and the majority was located in states with mandatory reporting of HAI (76%). Two-fifths reported presence of a part-time hospital epidemiologist (42%), whereas a full-time epidemiologist was present in only 6% of the hospitals. Of the independent variables, only total hours of infection control staffing and number of infection control staff were highly correlated (r = 0.90).
Description of hospitals and intensive care units
Aim 1: Describe adoption of MDRO and C difficile screening and infection control interventions
Study ICUs routinely screened for MRSA (59%), VRE (22%), MDR GNRs (12%), and C difficile (11%). A written policy to screen all admissions for any MDRO was reported for 40% of ICUs, and 27% had a policy for periodic screening following admission (). Of those ICUs that reported the presence of these 2 policies, the majority monitored implementation (80% and 79%, respectively), and correct implementation ≥75% of the time was reported for 96% and 91% of the ICUs, respectively. Approximately one-third reported a policy requiring isolation/contact precautions for patients with pending screens; 98% and 42% reported a policy for contact precautions for culture-positive patients and cohorting of colonized patients, respectively.
Extent to which ICUs have written infection control policies related to MDRO, monitor their implementation, and proportion of time these policies are correctly implemented: N = 413
Aim 2: Examine whether presence, monitoring, and/or implementation of screening and infection control interventions aimed at any MDRO vary with setting characteristics
In bivariate analysis, state mandatory reporting (odds ratio [OR], 2.52; 95% confidence interval [CI]: 1.36-4.66; P = .03), teaching status (OR, 1.80; 95% CI: 1.01-3.21; P = .048), hospital bed size of 201 to 500 beds (OR, 2.73; 95% CI: 1.28-5.79; P = .009), and location in the West (OR, 0.31; 95% CI: 0.12-0.80; P =.015) were associated with a policy to screen all admissions for any MDRO. In the multivariable model, mandatory reporting, teaching status, and location in the West remained significant independent predictors of the presence of this policy ().
Predictors of presence of infection control policies in multivariable analysis
Mandatory reporting (OR, 2.25; 95% CI: 1.09-4.64; P = .028), teaching status (OR, 2.68; 95% CI: 1.36-5.29; P = .004), and use of electronic surveillance systems (OR, 1.95; 95% CI: 1.00-3.82; P = .050) were positively associated with a policy to screen periodically after admission in bivariate analyses. Additionally, ICUs in hospitals with 201 to 500 beds were more likely to report this policy as compared with smaller hospitals (OR, 2.47; 95% CI: 1.03-5.94; P = .043), and ICUs located in the Midwest and West were less likely to report this policy versus the Northeast (OR, 0.20; 95% CI: 0.08-0.53, P = .001 and OR, 0.28; 95% CI: 0.10-0.79, P = .016, respectively). However, the presence of an electronic surveillance system, Midwest location, and hospital size remained the only independent predictors of periodic screening in multivariable regression ().
Mandatory reporting status was negatively associated with having a policy for presumptive isolation/contact precautions pending a screen (OR, 0.47; 95% CI: 0.26-0.85; P = .012) and was the only significant predictor of this policy in bivariate analysis. Although mandatory reporting was significantly associated with a policy to cohort colonized patients in bivariate analysis (OR, 1.91; 95% CI: 1.06-3.42; P = .031), it was not an independent predictor of having this policy after controlling for region and the number of infection control staff.
In bivariate analyses, ICUs in hospitals with a full-time epidemiologist were more likely to monitor compliance with cohorting of colonized patients (OR, 6.65; 95% CI: 1.08-40.96; P = .041) but was not significantly associated with monitoring the implementation of this policy after controlling for state mandatory reporting, region, number of infection control staff, and proportion of IPs certified in infection control (data not shown).
Several setting characteristics predicted correct implementation of infection control policies ≥75% of the time. ICUs in hospitals with a greater proportion of certified IPs were less likely to report correct implementation of policy to screen new admissions (OR, 0.19; 95% CI: 0.05-0.64; P = .008) after controlling for the number of infection control staff and region. In bivariate analyses, higher infection control staffing hours were positively associated with correct implementation of periodic screening (OR, 1.01; 95% CI: 1.00-1.02; P = .004) and the presence of any hospital epidemiologist approached statistical significance (OR, 6.11; 95% CI: 0.86-43.47; P = .070). Higher number of infection control staff, and infection control staffing hours were positive predictors of correct implementation of the policy to isolate culture-positive patients in bivariate analysis (OR, 1.32; 95% CI: 1.01-1.71; P = .042 and OR, 1.01; 95% CI: 1.00-1.01, P = .017, respectively). Lastly, ICUs in the Midwest were significantly less likely to report correct implementation of a policy to cohort colonized patients (OR, 0.03; 95% CI: 0.01-0.40; P = .008). However, we lacked sufficient power to assess these variables in multivariable analysis or to assess the relationship between setting characteristics and contact precautions for patients with pending screens.