To screen or not to screen?

Abstract

Introduction
Screening for carbapenem resistant organisms (CROs) enables early isolation and prevention of transmission in inpatient healthcare settings. In 2013, the UK Department of Health detailed a national approach to screening for CROs. Implementation of this policy has been variable and the growing numbers of patients who meet screening criteria likely exceeds capacity for isolation.
Method
We undertook a point prevalence study across two London hospitals to ascertain the frequency of per-policy screening. We assessed the screening of acutely admitted patients in March 2019 at hospital 1 and July 2019 at Hospital 2. We then modelled variations in screening approaches to optimise risk assessments in the context of isolation room availability.
Results
A total of 199 patients (112 patients at hospital 1 and 87 patients at hospital 2) were included in the analysis. Overall, 27/112 (24%) and 32/87 (37%) met the criteria for CRO screening according to current guidelines. Of these, 0/27 (0%) of patients at hospital 1 and 5/32 (16%) at hospital 2 had a CRO screen performed [p=0.06]. Across both hospitals, the principal risk factors for CRO carriage included: admission to a UK hospital in a high risk area (63/199;32%); admission to a non-UK hospital (3/199/;2%) and previous CRO carriage (1/199;0.5%) albeit with some variation between sites
Conclusion
Six years after the roll out of the national toolkit, CRO screening is still variable. Reworking of the risk stratification is needed, and we suggest technological approaches with electronic healthcare records may enable more robust screening strategies