Attachment 4 - Requested changes

Major added/deleted questions for modified Methicillin-Resistant Staphylococcus aureus (MRSA) Infection Control Practices Survey

Please note: There are two proposed versions of the survey (ABCs and Illinois). They differ only in the introduction, the numbering of questions (up to question 18), and the Illinois version does not include the second question which asks about the state in which the facility resides. In addition to the questions included here, there are some changes in the wording of questions.

Deleted Questions (based on old survey numbering):

--Question 19:

Which precautions are included in these isolation precautions? (check all that apply)

 Place patient in private room or cohort patients with MRSA when private rooms are not available

 Gown worn by all prior to entering the room

 Gowns worn prior to entering the room in some situations, describe __________

 Gloves worn by all prior to entering room

 Gloves worn prior to entering the room in some situations, describe __________

 Masks worn by all prior to entering the room

 Masks worn prior to entering the room in some situations, describe __________

 Removal of personal protective equipment (gowns, gloves, etc) prior to exciting the room

 Sign outside the room describing the isolation precautions that are in use

 Hand hygiene upon exiting the room (either before or after leaving room)

--Question 22a:

22a. Which MRSA infected or colonized patients are put in isolation precautions in addition to standard precautions? (check one)

 All MRSA infected or colonized patients are put in isolation precautions

 Only MRSA infected patients are put in isolation precautions

 Only MRSA colonized patients are put in isolation precautions

 Selected MRSA colonized or infected patients are put in isolation precautions, please describe _______________________________

--Question 23:

“Describe” options removed

--Question 27:

Which precautions are included in these isolation precautions? (check all that apply)

 Place patient in private room or cohort patients with MRSA when private rooms are not available

 Gown worn by all prior to entering the room

 Gowns worn prior to entering the room in some situations, describe __________

 Gloves worn by all prior to entering room

 Gloves worn prior to entering the room in some situations, describe __________

 Masks worn by all prior to entering the room

 Masks worn prior to entering the room in some situations, describe __________

 Removal of personal protective equipment (gowns, gloves, etc) prior to exciting the room

 Sign outside the room describing the isolation precautions that are in use

 Hand hygiene upon exiting the room (either before or after leaving the room)

--Question 29:

Has been significantly shortened and now only asks for 1 response for all the measurements rather than a response for each form of measurement

--Question 35a:

If so when did this program begin? (month/year) _______________________

Added questions (based on new survey numbering):

-- Question 7 on ABCs version 6 on Illinois version:

Currently, how many post-acute care (such as rehabilitation or assisted living) beds does your facility have?

-- Question 15 on ABCs version and 14 on Illinois version:

Please specify the test used for MRSA surveillance testing. (check one)

 Culture

 Polymerase chain reaction (PCR)

 Both – culture and PCR

 Other, please describe ______________________________

--Question 17 b on ABC version and 17b on Illinois version:

Do you currently routinely screen any healthcare workers for MRSA colonization? (check one)

 Yes

 No

-- Question 36, both versions:

36. Is vancomycin currently used as the preferred antibiotic for pre-operative prophylaxis for any surgical procedure? (check one)

 Yes, please list surgical procedures: ________________________

 No

--Question 40, 40a, and 40b:

At your institution, is MRSA decolonization currently routinely offered to any specific group of people colonized or infected with MRSA?

 Yes

 No (if no SKIP to question #41)

40a. Which group(s) are offered decolonization (check all that apply)?

 Pre-surgical patients

 Patients on dialysis

 Immunocompromised patients

 Patients with recurrent MRSA infections

 ICU patients

 Staff members known to be colonized or infected

 Other groups, please describe: ___________________________

40b. What method is used for decolonization (check all that apply)?

 Nasal mupirocin,

 Chlorhexidine showers/baths or showers/baths with other skin cleansers (other than soap or detergent)

 Oral decontamination (e.g. use of chlorhexidine mouthwash)

 Systemic antibiotics (oral or intravenous)

 Other, please describe: _________________)

--Question 41 both versions:

Does your facility currently have a laboratory based system that rapidly (within 24 hours) notifies infection control staff of new MRSA-colonized or MRSA-infected patients? (check one)

 Yes

 No

--Question 42 both versions:

Has your facility implemented a “central line bundle” (full barrier precautions at insertion, chlorhexidine for skin cleansing, daily assessment of need for central line, subclavian as preferred site) for the prevention of central line-associated infections? (check one)

 Yes, the bundle has been implemented facility-wide

 Yes, the bundle has been implemented in specific units

 No