Ms. Jaimie Yamada1, Ms. Megan Gritt1, Ms. Denise Delrosario-Kelly1, Ms. Pauline Bass1, A/Prof Andrew Stewardson1, Mr. Philip Rawson-Harris1
1Alfred Health, Melbourne, Australia
Biography:
Jaimie is an Infection Prevention Nurse Consultant at Alfred Health in Melbourne. She holds a Master of Public Health from Monash University, with a key professional interest in MRO transmission. Away from work, she has a great love of animals, including her whippet, Whip.
Abstract:
Background: Preemptive screening and isolation (PSI) of patients with recent exposure to healthcare in other countries is a strategy to avoid transmission of carbapenemase-producing organisms (CPO). In 2023, the Victorian CPO guideline broadened the definition of international healthcare exposure to consider contact with emergency departments (ED) and day procedures (DP) in addition to overnight admission. We audited the impact of this change on CPO case-finding and number of patients requiring PSI.
Method: We performed a prospective audit of patients admitted to Alfred Health, January-June 2024. Exposure to international healthcare within the prior 12 months was detected within the standard nursing admission. The Infection Prevention unit then characterised the nature of this exposure as 'admitted' or 'day' (ED or DP). Screening involved one bilateral axilla swab and one combined bilateral groin/rectal swab in patients categorised as ‘admitted’. A rectal swab was collected for patients categorised as ‘day’ contact.
Results: In total, 59 patients had international healthcare exposure; 68% (40/59) were 'admitted' and 32% (19/59) had 'day' exposure. Among the admitted and day patients, 13% (5/40) and 0% (0/19) were CPO positive, respectively. Among CPO-positive patients, the exposure countries were Vietnam (n=3), India (1) and Fiji (1), and the organisms were Acinetobacter baumannii (ArmA, NDM, OXA-23), Escherichia coli (NDM), Klebsiella aerogenes (OXA-48), Klebsiella pneumoniae (KPC, NDM, OXA-48) and Pseudomonas aeruginosa (KPC).
Conclusion: Inclusion of 'day' exposure into the definition of international healthcare contact resulted in a 32% increase in number of patients requiring PSI, without identifying any additional CPO cases.