Abstract
Background
Screening patients at risk of multidrug-resistant organism (MDRO) carriage is a cornerstone of infection prevention and control to identify carriers and prevent transmission. In 2021, the Swiss Centre for Infection Prevention Swissnoso published the first national recommendations for the prevention and control of MDROs, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, carbapenemase-producing Enterobacterales (CPE), and Candida auris. This study evaluated the adherence of institutional guidelines to these recommendations across Swiss acute care hospitals and identified barriers to their implementation.
Methods
A 28-item online survey was conducted in spring 2023 among Swiss acute care hospitals. The primary outcome was the adherence of institutional guidelines to national recommendations, assessed using a weighted score that accounted for different grades of recommendation for on-admission screening. Secondary outcomes included adherence to recommended body sites for screening, the implementation of universal screening during hospitalization, and perceived barriers to implementation.
Results
A total of 68 of 142 invited hospitals (47%) responded. Overall adherence with national recommendations for on-admission screening across the five MDRO targets was 69% (weighted score; interquartile range [IQR], 55–86%). Screening adherence was higher for patients exposed to foreign healthcare systems compared to those exposed to Swiss healthcare institutions. Recommendations concerning screening of specific body sites were less frequently followed when they were only conditionally recommended. Only 12 institutions (20%) reported conducting universal cross-sectional screening during hospitalisation in designated high-risk wards. Non-adherence of healthcare personnel was perceived as the most significant barrier to guideline implementation.
Conclusions
Swiss acute care hospitals showed moderate overall adherence to national MDRO prevention and control recommendations in non-outbreak settings. Adherence was particularly low for on-admission screening of patients transferred from Swiss healthcare institutions experiencing ongoing outbreaks and for active surveillance cultures during hospitalization in high-risk units. While the publication of national guidelines was an important step toward MDRO transmission prevention, ensuring consistent implementation remains a significant challenge.
Supplementary Information
The online version contains supplementary material available at 10.1186/s13756-025-01624-4.
Keywords: Bacterial multidrug resistance, Non-epidemic, Guideline adherence, Screening, Surveillance
Introduction
Multidrug-resistant organisms (MDROs) are an urgent global threat, leading to increased morbidity and mortality among carriers [1–3]. Switzerland remains a setting of low endemicity for MDROs, with most cases linked to introductions from abroad and local outbreaks [4–7]. Screening patients at risk of MDRO carriage is a key strategy to prevent onward transmission to other patients and to the hospital environment [8, 9].
Following a national survey that identified the need for uniform screening guidelines for MDROs [10], the Swiss National Centre for Infection Prevention, Swissnoso, published the first national recommendations for the prevention and control of MDROs in the non-outbreak setting in October 2021 [11]. The expert panel prioritized MDROs that pose a high epidemiological risk to healthcare facilities due to their transmission potential, pathogenicity, and/or limited treatment options, namely: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (excluding Escherichia coli), and carbapenemase-producing Enterobacterales (CPE).
Healthcare facilities were also encouraged to apply the preventive measures recommended for CPE to other carbapenemase producers, such as Acinetobacter baumannii (CPAB) and Pseudomonas aeruginosa (CPPA), which may exhibit plasmid-mediated resistance to multiple antibiotic classes, including carbapenems. In addition, separate recommendations for Candida auris were published in January 2022 [12, 13].
Nevertheless, the implementation of national screening guidelines remains challenging [14], with adherence levels potentially as low as 50% [15]. The aim of this study was to evaluate the level of adherence to these national recommendations and to identify barriers to their adoption in Swiss acute care hospitals.
Methods
Study design and setting
In 2023, the Swiss Federal Office of Public Health (FOPH) commissioned Swissnoso to investigate the adherence to the national recommendations for prevention and control of MDRO and C. auris in Swiss acute care facilities. Online access to these guidelines is free of charge. Implementing such guidelines is one of the key elements required according to the “Structural minimum requirements for the prevention and control of healthcare-associated infections”, which Swissnoso has recently launched in consultation with the FOPH [16].
The guidelines consider prior hospitalisation in a high MRDO prevalence setting in- and outside the country as one of the main risk factors for carrying MDRO. Until now, data protection regulations and digitalisation challenges have prevented this data from being made available in an easily accessible form. At the point of care, medical teams rely on patient interviews and medical notes to obtain such information.
In addition, a national mandatory outbreak reporting system requires hospitals to report outbreaks to the respective cantonal health authorities. This information is exchanged on a platform, which is only accessible to the cantonal health authorities. It remains at the discretion of the cantonal health authorities to forward these reports to the hospitals in their canton. The guidelines, however, strongly recommend declaring local MDRO outbreaks in a transparent manner to other hospitals.
The guidelines define intensive care units, organ transplant wards, and haemodialysis wards as high-risk units.
Survey development and distribution
Local infection prevention and control (IPC) staff responsible for the acute care hospitals were contacted via email and invited to complete an online survey assessing the adherence of their institutional guidelines with the national recommendations. A summary of the national recommendations is provided in Supplementary Table 1. High-risk units in the survey were defined according to the guideline’s definition. The survey was open from the May 11 to July 7, 2023, and comprised 28 questions covering the following main aspects: personal and institutional characteristics; practice regarding routine targeted on-admission screening for MDRO and C. auris, including indications for screening, and anatomical sites sampled; active surveillance cultures (ASC) during hospitalisation (e.g., universal or ward-specific cross-sectional screening surveys); the number of screenings performed per patient; application of pre-emptive contact precautions; perceived barriers to adherence with the national recommendations; and reporting practices (for details, see Supplementary Document). The survey was translated into German, French, and Italian. To encourage participation, Swissnoso offered a small incentive (10 gift vouchers of 20 Swiss Francs each (approx. 20 Euro) by raffle among all participants).
Adherence score for on-admission screening
To assess adherence to the national recommendations for on-admission screening, we developed weighted scores. Two points were assigned for each absolutely recommended on-admission screening indication and one point for each conditionally recommended indication. The strengths of recommendation and the number of recommended indications for individual MDROs differed as outlined in the supplementary document. Scores were therefore calculated separately for each MDRO: MRSA (maximum score: 9), VRE (maximum score: 11), ESBL-producing Enterobacterales (maximum score: 9), CPE/CPAB/CPPA (maximum score: 10) and C. auris (maximum score: 3). Maximum scores varied according to differences in recommendations across MDROs.
Overall adherence scores were calculated for the four main MDROs (MRSA, VRE, ESBL, CPE), with and without inclusion of C. auris (maximum scores: 39 and 42, respectively). A separate score was also computed for the six MDROs evaluated in the survey, again with and without inclusion of C. auris (maximum score: 59 and 62, respectively). Adherence was considered 100% when the maximum score was achieved. Details of the score calculation are provided in Supplementary Table 2.
Statistical analysis
Statistical analysis was performed using IBM SPSS Statistics Version 28.0.1.0 (IBM Corp., Armonk, NY, USA). Continuous variables summarised as median and interquartile range (IQR), and categorical variables as frequencies and percentages. Incomplete answers were excluded from the analysis.
Results
Overall, 142 acute care institutions were invited to participate, and 67 (47.1%) responded. Of these, 61 (43.0%) provided evaluable responses and were included in the analysis. The included institutions covered 144 hospitals sites, accounting for 67.5% of beds in general acute care hospitals and 33.2% of beds in specialized hospitals (Fig. 1).
Fig. 1.
Flowchart of hospital inclusion in the survey including the corresponding number of beds. All general acute care hospitals (green) and specialized hospitals (light green) were targeted
The participating institutions comprised 38 small hospitals (< 200 beds; 62.3%), 15 medium-sized hospitals (200–500 beds; 24.6%), and eight large hospitals (> 500 beds; 11.5%). Among the 82 non-responding or excluded institutions, 70 (85.4%) were small hospitals, 10 (12.2%) were medium-sized hospitals, and two (2.4%) were large hospitals. The median number of beds among evaluated institutions was 142 (range, 13-1876) compared to 51 (range, 0-789) in non-responding institutions [17]. The distribution of language regions participating or not in the survey is shown in Supplementary Table 3.
Two third of the participating institutions (40, 65.6%) reported having one or more intensive care units (ICU) in their affiliated hospitals.
Adherence to Swiss National recommendations
The overall adherence to indications for on-admission screening for the four MDROs (MRSA, VRE, ESBL, CPE) addressed in the national recommendations was 69.2% (median, IQR 56–87%). The distribution of adherence scores across individual institutions is shown in Fig. 2. When indications for C. auris were included, the overall adherence remained unchanged at 69.0% (median; IQR, 55–86%).
Fig. 2.
Distribution of the weighted score of the individual institutions indicating adherence to the Swiss national recommendations for on-admission screening. (A) Adherence scores for MDRO (MRSA, VRE, ESBL, CPE) included in the Swiss national recommendations. (B) Adherence scores for MDRO (MRSA, VRE, ESBL, CPE) and Candida auris. MRSA: methicillin-resistant Staphylococcus aureus; VRE: vancomycin-resistant Enterococci; ESBL: extended spectrum beta-lactamase; CPE: carbapenemase-producing Enterobacterales
Among the four individual MDROs, adherence ranged from 72.7% for VRE and 70.0% for CPE, to 66.7% for MRSA and ESBL (Supplementary Table 4).
The distribution of overall adherence scores, including scores for CPAB and CPPA are shown in Supplementary Fig. 1.
Individual indications for on-admission screening
For MRSA, VFE, and ESBL, hospitals adhered to 97% for the indication related to transfer from a hospital abroad (in general), to 94% for the indication transfer from a high-risk unit abroad, and to 92% for the indication hospitalization abroad within the previous 12 months. For CPE, the same indications were 95%, 89%, and 87%, respectively. Adherence to the indication “regular ambulatory consultations abroad within the last 12 months” was 54%. For C. auris, adherence for these four indications was 41%, 71%, 40%, and 21%, respectively.
Adherence to screening indications after transfer from a Swiss acute care hospital or long-term care facility with a known ongoing outbreak ranged from 59 to 89%, depending on the organism: 81–59% for MRSA, 89–62% for VRE, 79–51% for ESBL, and 81–59% for CPE, respectively. Adherence to screening after transfer from a Swiss high-risk unit was reported in 32–48% of institutions (3.2% for C. auris). Screening on admission to a high-risk unit was performed in only 2–10% of cases. Details are shown in Fig. 3. Stratifying according to hospital size revealed that, regarding MRSA, VRE, ESBL, and CPE, small hospitals (< 200 beds) as compared to large hospitals (> 500 beds) reported a lower adherence across most indications, except for transfers from a high-risk unit and for transfers from a LTCF with an ongoing outbreak with VRE or CPE. Concerning C. auris, adherence with on-admission screening was consistently lower in small hospitals as compared to large hospitals. Comparison with medium-size hospitals did not reveal a consistent pattern (Supplementary Fig. 2a.-e.). Results for CPAB and CPPA are provided in Supplementary Fig. 3.
Fig. 3.
Reported indications for on-admission screening. Full bars: recommended by Swissnoso; Striped bars: conditionally recommended by Swissnoso; Grey bars: no recommendation by Swissnoso. 
MRSA; 
VRE; 
ESBL; 
CPE; 
Candida auris. MDRO: multidrug-resistant microorganism. MRSA: methicillin-resistant Staphylococcus aureus; VRE: vancomycin-resistant Enterococci; ESBL: extended spectrum beta-lactamase; CPE: carbapenemase-producing Enterobacterales
Body sites to be screened and number of screening sets
Adherence to recommended body sites for screening exceeded 90% for MRSA, VRE, ESBL, and CPE, except for throat screening for MRSA (82%). Adherence to conditionally recommended body sites varied, with low adherence for drainage exit site screening (21–34%). For C. auris, adherence to recommended body sites ranged from 76 to 92%, whereas adherence to conditionally recommended sites ranged from 0 to 66%. An overview of adherence to the different body sites and specimen types is shown in Fig. 4. The percentage of body sites screened without a recommendation by Swissnoso is shown in Supplementary Fig. 4.
Fig. 4.
Body sites targeted for on-admission screenings in percentage of total answers. (a) MRSA, (b) VRE, (c) ESBL, (d) CPE, and (e) Candida auris. Black bars: recommended by Swissnoso, striped bars: to be considered by Swissnoso. MRSA: methicillin-resistant Staphylococcus aureus; VRE: vancomycin-resistant Enterococci; ESBL: extended spectrum beta-lactamase; CPE: carbapenemase-producing Enterobacterales
Participating institutions primarily reported obtaining one screening set, and less frequently two or three screening sets (Supplementary Table 5), which is in line with the recommendations for MRSA, VRE, ESBL, and CPE, but not for C. auris, for which two screening sets are recommended. Results for CPAB and CPPA, which are not specifically mentioned in the current Swissnoso recommendations, were compared to the recommended body sites for CPE and shown in Supplementary Fig. 5 and Supplementary Table 5.
Active surveillance cultures during hospitalization
Only a minority of institutions (N = 12, 19.7%) reported performing active surveillance cultures (ASC) during hospitalisation (Table 1; Supplementary Table 6 for CPAB and CPPA). Two institutions did not specify which MDROs were targeted. ASC were primarily performed in ICUs, haemato-oncology wards, and haemodialysis units. Weekly ASC was most common in ICUs, whereas monthly screening was more frequent in other wards.
Table 1.
Active surveillance cultures (ASC) during hospitalization. Number (N) and percentage (%) of institutions reporting to perform some kind of ASC during hospitalization. MRSA: methicillin-resistant Staphylococcus aureus; VRE: vancomycin-resistant enterococci; ESBL: extended spectrum beta-lactamase; CPE: carbapenemase-producing Enterobacterales
| MRSA | VRE | ESBL | CPE | C. auris | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| N | % | N | % | N | % | N | % | N | % | |
| Institutions performing active surveillance cultures during hospitalization | 7 | 11.5 | 10 | 16.4 | 7 | 11.5 | 5 | 8.2 | 3 | 4.9 |
|
Wards with ACS during hospitalization* ICU Haemato-oncological Haemodialysis Other# |
3 3 4 4 |
4.9 4.9 6.6 6.6 |
4 6 1 7 |
6.6 9.8 1.6 11.5 |
4 4 1 5 |
6.6 6.6 1.6 8.2 |
4 4 1 5 |
6.6 6.6 1.6 8.2 |
2 2 0 3 |
3.3 3.3 - 4.9 |
ICU: intensive care unit. *more than one ward could have been indicated by one institution. #other: neonatology, septic orthopaedic ward, general orthopaedic ward, visceral surgery ward, neurosurgical ward, COVID-19 dedicated ward
Perceived challenges of implementing screening
Regarding the challenges of implementing MDRO screening, non-adherence of healthcare personnel was most frequently identified as the most prominent challenge, followed by laboratory costs. When the priorities were dichotomised (first to third priority vs. fourth to sixth priority), the main challenges remained adherence of healthcare personnel and diagnostic costs, followed by staffing costs and patient compliance (Fig. 5).
Fig. 5.
Challenges and obstacles of performing screening for MDRO. Priorities are given in percentages of all answers (N = 61). The first priority represents the biggest challenge and the sixth priority the least important challenge
Discussion
One year after publication of the Swiss national guidelines, the self-reported adherence score, reflected by the median percentage achieved by the participating institutions, was relatively high with 69%. Adherence to specific recommendations, particularly those concerning patient transfers from healthcare settings abroad, was high. In contrast, adherence to the recommendations for screening patients transferred from Swiss healthcare facilities with suspected or confirmed MDRO outbreaks and to the recommendations for transfers from or to high-risk wards was markedly lower. The latter may be due to ongoing uncertainty regarding the definition of high-risk groups and which patients should be prioritised for testing [18]. In particular, the lack of a centralised, national platform through which hospitals can access timely and reliable information on ongoing outbreaks could explain the lower adherence to screening for domestic transfers [19]. Finally, concerns about stigmatisation and the potential impact on the reputation of facilities with high MDRO prevalence are also thought to hinder active surveillance cultures [20]. However, these aspects were not explored in our study.
Interestingly, adherence to recommendations for VRE was highest among all MDROs, potentially reflecting heightened awareness of VRE in Switzerland and earlier IPC guidance issued by Swissnoso [13, 19–22]. Conversely, adherence to the recommendations for C. auris screening was strikingly low in small hospitals, suggesting that these hospitals face unique practical and diagnostic challenges that need to be further investigated in order to be addressed [21, 22].
International comparison
International data on adherence to national screening recommendations are scarce and findings are highly variable. A national US study reported that only 40% of ICUs routinely screening all admissions for MDRO [15]. In contrast, a French survey found that 96% of ICUs had written protocols for screening and isolation, with systematic screening for at least one MDRO in 78% of units. However, adherence to targeted screening based on risk factors was lower, and deviations from national guidelines were common [23].
A study from the Dutch-German border region similarly identified discrepancies between local and national screening protocols [24], while an Irish study found that only 18% and 14% of hospitals fully adhered to national screening recommendations for CPE and ESBL, respectively [25]. Comparisons across these studies are challenging due to differences in targeted organisms, screening strategies (on admission, universal, or contact-based), and ward types (e.g., ICU-only vs. general wards). A European survey reported that 21.7% of institutions conducted regular on-admission screening, mostly focusing on high-risk patients [26]. Similar to our findings, reported barriers to implementation included financial and cultural obstacles, staff shortage, and resource limitations. Factors such as leadership engagement, institutional culture, and availability of infrastructure likely contribute to the wide variation in implementation [27].
Practical implementation
Adherence to recommendations on the anatomical sites and number of sets for screening was generally high for MRSA, VRE, ESBL, and CPE. However, for C. auris, the recommendation to obtain two screening sets was frequently not followed. This is remarkable, as international guidelines recommend more than two screening sets to maximise C. auris detection [28–31]. Inadequate sampling may lead to undetected carriers and silent transmission within healthcare settings [32].
Only a minority of institutions reported conducting ASC during hospitalisation, despite such practices being recommended for high-risk wards by Swissnoso and other international bodies [33]. MDRO outbreaks are common in ICUs, hematology-oncology wards, and hemodialysis units, where patient vulnerability is higher [5, 34, 35]. ASC can support better understanding of local MDRO epidemiology, improve early detection of hidden transmission chains, and ultimately reduce the spread of MDROs within hospitals [36–39].
Strengths and limitations
The strength of our study is the assessment of national-level adherence to MDRO screening guidelines using a detailed and structured scoring system. This score could serve as a future benchmarking tool for national surveillance.
The study has limitations. First, the data are based on self-reported institutional policies rather than bedside practices, which limits the ability to assess screening behaviour at the patient level. Second, the hospitals that did not respond were generally smaller and had fewer beds, which could bias the results towards better-resourced facilities with more established infection control programmes. However, the proportion of smaller hospitals that participated still accounted for 62% of all participating institutions and thus contributed significantly to the dataset. Based on the number of institutions, affiliated hospital sites and the total number of beds surveyed, we consider the sample to be reasonably representative of acute care institutions in Switzerland. Third, institutional characteristics such as ownership (public versus private) or network affiliations were not analysed and may influence implementation. Additionally, several respondents indicated institutional guidelines for C. auris were still under development, suggesting our findings may underestimate current clinical practice in this area. Finally, although adherence to national recommendations appeared satisfactory overall, this does not necessarily reflect actual clinical practice. Observational audits would be required to validate the extent to which written guidelines are implemented at the bedside.
Conclusions
Overall, adherence to the Swiss national recommendations for the prevention and control of MDROs in the non-outbreak setting was moderate. Periodic assessment of adherence scores could serve as a valuable benchmark for health authorities to identify barriers and support underperforming institutions. Establishing interregional or national systems for timely reporting of MDRO outbreaks would further facilitate the implementation of key recommendations and strengthen coordinated infection prevention efforts.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
We would like to thank all participating institutions for their time and effort to fill out the survey.
List of abbreviations
- C. auris
Candida auris
- CPAB
carbapenemase-producing Acinetobacter baumannii
- CPE
carbapenemase-producing Enterobacterales
- CPPA
carbapenemase-producing Pseudomonas aeruginosa
- E. coli
Escherichia coli
- ESBL
extended-spectrum beta-lactamase
- ICU
Intensive care unit
- IPC
Infection prevention and control
- IQR
interquartile range
- MDRO
multidrug-resistant organisms
- MRSA
methicillin-resistant Staphylococcus aureus
- VRE
vancomycin-resistant Enterococci
Author contributions
DVG and ACB conceived and conducted the survey, AM, NB, and SH provided input on the content of the survey. DVG and ACB analysed the data. DVG and ACB drafted the manuscript, AM, NB, AW, SG, CB, GC, PJ, HS, LS, AFW, MS, STS, and SH provided intellectual input on the manuscript. All authors approved the final version of the manuscript.
Funding
This study was conducted as a part of the mandate by the Federal Office of Public Health of Switzerland.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
not applicable.
Consent for publication
not applicable.
Competing interests
Dr Sarah Tschudin-Sutter serves as editor-in-chief for ARIC, and Dr Andreas Widmer serves as associated editor for ARIC. The authors have no other competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.World Health Organization (WHO). Biggest Threats and Data [Internet]. 2020. Available from: https://www.cdc.gov/drugresistance/biggest-threats.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fdrugresistance%2Fbiggest_threats.html
- 2.Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European economic area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019;19(1):56–66. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629–55. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Anresis - Swiss Centre for Antibiotic Resistance. https://www.anresis.ch/antibiotic-resistance/resistance-data-human-medicine/. Resistance Data Human Medicine.
- 5.Thoma R, Seneghini M, Seiffert SN, Vuichard Gysin D, Scanferla G, Haller S, et al. The challenge of preventing and containing outbreaks of multidrug-resistant organisms and Candida auris during the coronavirus disease 2019 pandemic: report of a carbapenem-resistant acinetobacter baumannii outbreak and a systematic review of the literature. Antimicrob Resist Infect Control. 2022;11(1):1–11. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Piezzi V, Wassilew N, Atkinson A, D’Incau S, Kaspar T, Seth-Smith HMB, et al. Nosocomial outbreak of vancomycin-resistant Enterococcus faecium (VRE) ST796, switzerland, 2017 to 2020. Eurosurveillance. 2022;27(48):2200285. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Vock I, Aguilar-Bultet L, Goldenberger D, Ragozzino S, Kuster S, Tschudin-Sutter S. Epidemiology of patients harboring carbapenemase-producing bacteria and comparison with patients with detection of extended-spectrum beta-lactamase-producing Enterobacterales - A retrospective cohort study. Infect Control Hosp Epidemiol. 2023;44(12):1959–65. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Karmarkar EN, O’Donnell K, Prestel C, Forsberg K, Gade L, Jain S, et al. Rapid assessment and containment of Candida auris transmission in postacute care settings-orange county, california, 2019. Ann Intern Med. 2021;174(11):1554–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Salgado CD, Farr BM. What proportion of hospital patients colonized with Methicillin-Resistant Staphylococcus aureus are identified by clinical Microbiological cultures?? Infect Control Hosp Epidemiol. 2006;27(2):116–21. [DOI] [PubMed] [Google Scholar]
- 10.Martischang R, Buetti N, Balmelli C, Saam M, Widmer A, Harbarth S. Nation-wide survey of screening practices to detect carriers of multi-drug resistant organisms upon admission to Swiss healthcare institutions. Antimicrob Resist Infect Control. 2019;8(1):37. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Vuichard-Gysin D, Senn L, Tschudin-Sutter S, Kuster S, Buetti N, Eder M et al. Prävention und Kontrolle von multiresistenten Erregern (MRE) im Nicht-Ausbruch-Setting [Internet]. 2021 [cited 2024 Apr 11]. Available from: https://www.swissnoso.ch/fileadmin/swissnoso/Dokumente/5_Forschung_und_Entwicklung/8_Swissnoso_Publikationen/211115_StAR_Teil_II_DE_MDRO-non-outbreak_FINAL.pdf
- 12.Vuichard-Gysin D, Sommerstein R, Martischang R, Harbarth S, Kuster SP, Senn L et al. Candida auris - Recommendations on infection prevention and control measures in Switzerland. Swiss Med Wkly. 2020;150(39). [DOI] [PubMed]
- 13.Swissnoso. Empfehlungen zur Infektionsprävention und-kontrolle bei Candida auris [Internet]. 2022 Jan [cited 2024 Sep 5]. Available from: https://swissnoso.ch/fileadmin/swissnoso/Dokumente/6_Guidelines_Publikationen_ab_Maerz_2023/240326_C_auris_Empfehlungen_DE.pdf
- 14.Finocchiaro Castro M, Lisi D, Romeo D. Experimental evidence on the role of shared protocols as coordination device on clinical best practices. Sci Rep. 2024;14(1). [DOI] [PMC free article] [PubMed]
- 15.Pogorzelska M, Stone PW, Larson EL. Wide variation in adoption of screening and infection control interventions for multidrug-resistant organisms: A National study. Am J Infect Control. 2012;40(8):696–700. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Swissnoso FOPH. Structural minimum requirements for the prevention and control of healthcare-associated infections [Internet]. 2020 Sep [cited 2025 Aug 7]. Available from: https://www.swissnoso.ch/fileadmin/swissnoso/Dokumente/5_Forschung_und_Entwicklung/8_Swissnoso_Publikationen/Swissnoso_Minimalstandards_V3_D_220524.pdf
- 17.Bundesamt für Gesundheit. Kennzahlen der Schweizer Spitäler 2021 [Internet]. 2023. Available from: https://spitalstatistik.bagapps.ch/data/download/kzp21_publication.pdf?v=1679384362
- 18.M Bar Ilan, A Kjerulf. Who should be screened for carbapenemase-producingEnterobacterales and when? A systematic review. J Hosp Infect. 2023;142:74–87. Available from: 10.1016/j.jhin.2023.09.018Epub 2023 Oct 5. [DOI] [PubMed]
- 19.Lee BY, Bartsch SM, Hayden MK, Welling J, DePasse JV, Kemble SK et al. How Introducing a Registry With Automated Alerts for Carbapenem-resistant Enterobacteriaceae (CRE) May Help Control CRE Spread in a Region. Clinical Infectious Diseases [Internet]. 2020 Feb 14 [cited 2025 Jul 19];70(5):843–9. Available from: 10.1093/cid/ciz300 [DOI] [PMC free article] [PubMed]
- 20.Bushuven S, Dettenkofer M, Dietz A, Bushuven S, Dierenbach P, Inthorn J et al. Interprofessional perceptions of emotional, social, and ethical effects of multidrug-resistant organisms: A qualitative study. PLoS One [Internet]. 2021 Feb 1 [cited 2025 Jul 19];16(2):e0246820. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246820 [DOI] [PMC free article] [PubMed]
- 21.Leonhard SE, Chong GM, Foudraine DE, Bode LGM, Croughs P, Popping S, et al. Proposal for a screening protocol for Candida auris colonization. J Hosp Infect. 2024;146:31–6. [DOI] [PubMed] [Google Scholar]
- 22.Candida auris |. Candida auris (C. auris) | CDC [Internet]. [cited 2025 Aug 7]. Available from: https://www.cdc.gov/candida-auris/
- 23.Coppéré Z, Voiriot G, Blayau C, Gibelin A, Labbe V, Fulgencio JP, et al. Disparity of the screen-and-isolate policy for multidrug-resistant organisms: A National survey in French adult ICUs. Am J Infect Control. 2018;46(12):1322–8. [DOI] [PubMed] [Google Scholar]
- 24.Gunnink LB, Arouri DJ, Jolink FEJ, Lokate M, de Jonge K, Kampmeier S et al. Compliance to Screening Protocols for Multidrug-Resistant Microorganisms at the Emergency Departments of Two Academic Hospitals in the Dutch–German Cross-Border Region. Tropical Medicine and Infectious Disease. 2021, Vol 6, Page 15. 2021;6(1):15. [DOI] [PMC free article] [PubMed]
- 25.Lynch BL, Schaffer K. Can guidelines for the control of multi-drug-resistant Gram-negative organisms be put into practice? A National survey of guideline compliance and comparison of available guidelines. Journal of Hospital Infection. Volume 102. W.B. Saunders Ltd; 2019. pp. 1–7. [DOI] [PubMed]
- 26.Tacconelli E, Buhl M, Humphreys H, Malek V, Presterl E, Rodriguez-Baño J, et al. Analysis of the challenges in implementing guidelines to prevent the spread of multidrug-resistant gram-negatives in Europe. BMJ Open. 2019;9(5):e027683. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Goedken CC, Guihan M, Brown CR, Ramanathan S, Vivo A, Suda KJ, et al. Evaluation of carbapenem-resistant Enterobacteriaceae (CRE) guideline implementation in the veterans affairs medical centers using the consolidated framework for implementation research. Implement Sci Commun. 2021;2(1):1–14. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Government of Western Australia D of H. Guidelines for the Screening and Management of Multi-resistant Organisms in Healthcare Facilities [Internet]. 2023 [cited 2024 Sep 30]. Available from: health.wa.gov.au.
- 29.Public Health England. Guidance for the laboratory investigation, management and infection prevention and control for cases of Candida auris [Internet]. 2017 Aug [cited 2024 Sep 30]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/637685/Updated_Candida_auris_Guidance_v2.pdf
- 30.Alanio A, Snell HM, Cordier C, Desnos-Olivier M, Dellière S, Aissaoui N et al. First Patient-to-Patient intrahospital transmission of clade I Candida auris in France revealed after a Two-Month incubation period. Microbiol Spectr. 2022;10(5). [DOI] [PMC free article] [PubMed]
- 31.World Health Organization. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities [Internet]. 2017. Available from: https://apps.who.int/iris/bitstream/handle/10665/259462/9789241550178-eng.pdf;jsessionid=85DE4A4E4B8FC565277505A37E819ED9?sequence=1 [PubMed]
- 32.D’Agata EMC, Gautam S, Green WK, Tang YW. High rate of false-negative results of the rectal swab culture method in detection of Gastrointestinal colonization with vancomycin-resistant enterococci. Clin Infect Dis. 2002;34(2):167–72. [DOI] [PubMed] [Google Scholar]
- 33.Siegel JD, Rhinehart E, Jackson M, Chiarello R, the Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-Resistant organisms in healthcare settings, 2006. Am J Infect Control. 2006;35(10 Supplement 2):S165–93. [DOI] [PubMed] [Google Scholar]
- 34.Schärer V, Meier MT, Schuepbach RA, Zinkernagel AS, Boumasmoud M, Chakrakodi B, et al. An intensive care unit outbreak with multi-drug-resistant Pseudomonas aeruginosa - spotlight on sinks. J Hosp Infect. 2023;139:161–7. [DOI] [PubMed] [Google Scholar]
- 35.Catho G, Martischang R, Boroli F, Chraïti MN, Martin Y, Koyluk Tomsuk Z et al. Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care. Crit Care. 2021;25(1). [DOI] [PMC free article] [PubMed]
- 36.Jung J, Park JH, Yang H, Lim YJ, Kim EO, Lim CM et al. Active surveillance testing to reduce transmission of carbapenem-resistant, gram-negative bacteria in intensive care units: a pragmatic, randomized cross-over trial. Antimicrob Resist Infect Control [Internet]. 2023 Dec 1 [cited 2024 Jan 8];12(1):1–8. Available from: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-023-01222-2 [DOI] [PMC free article] [PubMed]
- 37.Geladari A, Karampatakis T, Antachopoulos C, Iosifidis E, Tsiatsiou O, Politi L et al. Epidemiological surveillance of multidrug-resistant gram-negative bacteria in a solid organ transplantation department. Transpl Infect Disease. 2017;19(3). [DOI] [PubMed]
- 38.Ben-David D, Cohen Y, Levi G, Keren-Paz A, Tasher D, Zandman-Goddard G et al. Contribution of active surveillance cultures to the control of hospital-acquired carbapenem-resistant acinetobacter baumannii in an endemic hospital setting. Infect Control Hosp Epidemiol. 2023;1–8. [DOI] [PMC free article] [PubMed]
- 39.Giuffre M, Geraci DM, Bonura C, Saporito L, Graziano G, Insinga V et al. The increasing challenge of multidrug-resistant gram-negative bacilli: results of a 5-year active surveillance program in a neonatal intensive care unit. Med (United States). 2016;95(10). [DOI] [PMC free article] [PubMed]
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Supplementary Materials
Data Availability Statement
No datasets were generated or analysed during the current study.