MRSA screening now law for New Jersey hospitals

ICPs meeting with state to develop definitions

Infection control professionals in New Jersey are hoping a series of upcoming meetings with state officials will clarify exactly what is required under a recently passed law codifying active surveillance cultures [ASC] for methicillin-resistant Staphylococcus aureus (MRSA). Several other states are moving forward quickly on similar legislation, as MRSA laws threaten to sweep the country in much the same way infection rate disclosure laws did.

At the moment it [calls for ASC for MRSA] in the high risk areas of the hospitals, such as critical care units, and eventually it is to be put house wide," says Carol A. Ward, RN, CIC, legislative representative for the Southern New Jersey chapter of the Association for Professionals in Infection Control and Epidemiology. "As far as I know, we will give them monthly numbers of hospital-acquired MRSA for all patients coming into the hospital. It's going to have an impact on infection control for monitoring this and also for the laboratory because they are going to possibly need additional micro staff."

Among the questions in the wake of the law are which screening test should be used, as they may vary in accuracy and costs. Likewise, uniform definitions are needed so every hospital uses the same criteria in reporting. "We have let the department of health know that we want definitions," says Ward, an ICP at Virtua-Memorial Hospital in Westhampton, NJ. "We want to know exactly what they want so we can all be doing the same thing." Such issues were to be addressed in a meeting that was slated between the New Jersey Department of Health and members of APIC, other infectious disease groups and the state hospital association. Another critical issue is funding or reimbursement for implementing the ASC programs. "In the bill, there was nothing for funding, and that was something that we did request," Ward says. "It will be an increase in hospital expenses, not just for the microbiology departments, but once you identify the patient as having MRSA, you have to place them in isolation. So that is additional costs for personal protective equipment, and isolation [rooms]. There is the issue of private rooms or cohorting, so each hospital will have to have policies and procedures in place."

Provisions in the New Jersey law include the following summary:

Within one month after the effective date of this act, all general hospitals licensed by the Department of Health and Senior Services shall implement an infection prevention program in their intensive care unit or units, as applicable, and if the hospital has no intensive care unit, then in another high-risk unit such as a surgical unit, or other unit where there is significant risk of facility-acquired infections. Ultimately, the hospital shall expand the infection prevention program to all areas of the hospital, with the exception of an inpatient psychiatric unit, if applicable. The expansion of the infection prevention program shall be completed as quickly as feasible, taking into account the hospital's patient population, physical plant, and other facility-specific circumstances.

In addition to any other best practices and effective strategies, the hospital shall incorporate the following strategies:

1) identification and isolation of both colonized and infected patients by screening patients upon admission in order to break the chain of transmission;

2) contact precautions for patients found to be MRSA-positive, as "contact precautions" is defined by the Centers for Disease Control and Prevention;

3) patient cultures for MRSA upon discharge or transfer from the unit where the infection prevention program has been implemented, and flagging of patients who are readmitted to the hospital;

4) strict adherence to hygiene guidelines;

5) a written infections prevention and control policy with input from frontline caregivers; and

6) a worker education requirement regarding modes of transmission of MRSA, use of protective equipment, disinfection policies and procedures, and other preventive measures.