Point Prevalence Survey in a Long Term Care Facility, 2016 Nicole Hearon, MPH Healthcare Associated Infections Epidemiologist Infectious Disease Epidemiology Indiana State Department of Health

What is a Point Prevalence Survey? A point prevalence survey (PPS) is a tool to assess a facility’s current baseline of a given organism(s). A PPS can vary based on the following: Healthcare setting (e.g., acute care, long term care) Ward/unit type Patient census Organism of concern Limiting factors: Patient participation Facility financial constraints Laboratory capacity

Case Study Starting in 2012, a LTCF began screening of tracheal aspirates on any newly admitted/readmitted resident. The LTCF contacted the LHD in 2016 to report four trach residents who tested positive for Acinetobacter baumannii as a result of admission surveillance cultures. The LHD contacted ISDH and an investigation was initiated. After reviewing medical records, 13 residents were identified as having previous MDRO infections within the last year: Acinetobacter baumanii Pseudomonas aeruginosa Klebsiella pneumoniae

Case Study (cont’d) ISDH consulted with CDC and the decision was made to conduct a PPS. Facility staff collected tracheal aspirates, sputum, and rectal swabs on all residents currently residing in facility. Total of 41 residents; 82 specimens Tracheal aspirates (23) and sputum (18) Rectal swabs (41) Testing was split between local hospital laboratory and ISDH.

Case Study (cont’d) A total of 23 patients tested positive for MDROs, and several tested positive for multiple organisms. Acinetobacter (+): 8-rectal; 4-sputum Klebsiella (+): 8-rectal; 2-sputum Pseudomonas (+): 8-rectal; 4-sputum Patients: Acinetobacter and Klebsiella (+): 2 Acinetobacter and Pseudomonas (+): 2 Klebsiella and Pseudomonas (+): 2 A total of 34 isolates from 23 patients sent to CDC for PFGE 12 Acinetobacter, 10 Klebsiella, 12 Pseudomonas

Case Study (cont’d) PFGE results: Acinetobacter transmission occurred within facility Two clusters – one contained four isolates and the other contained two isolates Klebsiella transmission occurred within facility Two clusters – each contained two indistinguishable members Pseudomonas was imported into facility One cluster of two indistinguishable isolates; both of these originated from the same patient More consistent with importation into the facility rather than transmission of a single strain

Acinetobacter baumannii Klebsiella pneumoniae Pseudomonas aeruginosa

CDC Tiers of Contact Precautions for LTCF Standard precautions – PPE use when blood and body fluid exposure are anticipated Targeted or enhanced precautions – PPE use for morning/evening care as well as other high risk care activities (e.g., wound care, device care) Recommended for lower acuity post-acute care units

CDC Tiers of Contact Precautions for LTCF Transmission-based precautions – PPE use for every resident interaction as soon as a healthcare worker enters the room Recommended for high risk post-acute care units Transmission-based precautions plus in-room isolation – PPE use for every resident interaction and restricting resident movement and participation in group events in the facility generally reserved for individuals with active signs/symptoms with contagious organisms (e.g., Norovirus infection)

Resources http://cid.oxfordjournals.org/content/52/5/654.full.pdf?cited-by=yes&legid=cid;52/5/654 https://www.lsqin.org/event/webinar-cre-strategies/

Nicole Hearon 317-234-2805 (office) Questions? Nicole Hearon 317-234-2805 (office) nhearon@isdh.in.gov