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Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units
Martin E Evans1, Stephen M Kralovic, Loretta A Simbartl
1MRSA/MDRO Program Office, Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA. Martin.Evans@va.gov
Background:
Methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) are a concern in the 22 acute care Veterans Affairs (VA) spinal cord injury units where patients with unique rehabilitation and medical needs and a high risk of infection are treated.
Methods:
A bundle was implemented in VA spinal cord injury units consisting of nasal surveillance for MRSA on admission/in-hospital transfer/discharge, contact precautions for patients colonized or infected with MRSA, an emphasis on hand hygiene, and an institutional culture change where infection control became everyone's responsibility.
Results:
From October 2007, through June 2011, there were 51,627 admissions/transfers/discharges and 816,254 patient-days of care in VA spinal cord injury units. The percentage of patients screened increased to >95.0%. The mean admission MRSA prevalence was 38.6% ± 19.1%. Monthly HAI rates declined 81% from 1.217 per 1,000 patient-days to 0.237 per 1,000 patient-days (P < .001). Bloodstream infections declined by 100% (P = .002), skin and soft-tissue infections by 60% (P = .007), and urinary tract infections by 33% (P = .07).
Conclusion:
Universal surveillance, contact precautions, hand hygiene, and an institutional culture change was associated with significant declines in MRSA HAIs in a setting with a high prevalence of MRSA colonization and a high risk for infection.
Insights
A comprehensive infection control strategy significantly reduced Methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) in Veterans Affairs spinal cord injury units. This approach involved universal surveillance, contact precautions, and enhanced hand hygiene practices.
Area of Science:
- Infectious Diseases
- Public Health
- Healthcare Management
Background:
- Healthcare-associated infections (HAIs) caused by Methicillin-resistant Staphylococcus aureus (MRSA) pose a significant threat in specialized care settings.
- Veterans Affairs (VA) spinal cord injury units present unique challenges due to patient vulnerability and high infection risk.
Purpose of the Study:
- To evaluate the effectiveness of a multifaceted infection control bundle in reducing MRSA HAIs.
- To assess the impact of universal surveillance, contact precautions, hand hygiene, and culture change on infection rates.
Main Methods:
- Implementation of a bundle including nasal MRSA surveillance, contact precautions, and hand hygiene protocols.
- Fostering an institutional culture change emphasizing shared responsibility for infection control.
Main Results:
- Significant decline in monthly MRSA HAI rates by 81% (from 1.217 to 0.237 per 1,000 patient-days).
- 100% reduction in bloodstream infections, 60% in skin/soft-tissue infections, and 33% in urinary tract infections.
- Achieved >95.0% patient screening for MRSA, with a mean admission prevalence of 38.6%.
Conclusions:
- A comprehensive infection control strategy, including universal surveillance and enhanced hygiene, effectively reduced MRSA HAIs.
- The intervention demonstrated success in a high-prevalence MRSA setting with at-risk patient populations.
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