Can guidelines for the control of multi-drug-resistant Gram-negative organisms be put into practice? A national survey of guideline compliance and comparison of available guidelines

Abstract

Multi-drug-resistant Gram-negative organisms (MDRGNO) are an emerging global threat, reflected in the increasing incidence of infections in Ireland and elsewhere. The response to this threat has been the development of Infection Prevention and Control (IPC) guidelines. A survey of IPC teams in Ireland was undertaken to assess compliance with national guidelines. To place these survey results in context, IPC guidelines from the Irish Health Protection Surveillance Centre (HPSC) are compared with guidelines from Healthcare Infection Society (HIS), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Centre for Disease Control (CDC). Thirty-three percent of hospitals responded across a range of hospital types. The results highlight the variability in implementation of guidelines across Ireland, as well as the variability between guidelines internationally. Respondents are less than 90% compliant with the majority of MDRGNO screening guidelines. Hospitals have variable access to isolation facilities with an average of 29% single rooms available (range 2.6-100%), resulting in some patients with MDRGNO not being isolated. Broad variability in application of guidance on personal protective equipment was demonstrated. This survey gives an insight into the real-life applicability of HPSC guidelines. Survey results are placed in context with a comparison of five MDRGNO IPC guidelines. Although core tenets of IPC are standard across guidelines, research into which practices are efficient in reducing MDRGNO transmission while being cost-effective would be worthwhile.

Keywords: Infection prevention and control; Multi-drug resistant Gram-negative organisms.