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.