A Bundled Approach to Reduce Methicillin-Resistant Staphylococcus aureus Infections in a System of Community Hospitals

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) infections pose a significant challenge to U.S. healthcare facilities, but there has been limited study of initiatives to reduce infection and increase patient safety in community hospitals. To address this need, a multifaceted program for MRSA infection prevention was developed for implementation in 159 acute care facilities. This program featured five distinct tools-active MRSA surveillance of high-risk patients, enhanced barrier precautions, compulsive hand hygiene, disinfection and cleaning, and executive champions and patient empowerment-and was implemented during 1Q-2Q 2007. Postintervention (3Q 2007-2Q 2008), 10.2% of patients with high-risk for infection or complications due to MRSA had nasal colonization. Volume of disposable gown and alcohol-based hand sanitizer use increased substantially following program implementation. Self-reported rates, based on NHSN definitions, of healthcare-associated central line-associated bloodstream infections and ventilator-associated pneumonia due to MRSA decreased 39% (p < .001) and 54% (p < .001), respectively. Infection rates continued to decrease during the follow-up period (1Q-4Q 2009). This sustained improvement demonstrates that reducing healthcare-associated MRSA infections in a large number of diverse facilities is possible and that a "bundled" approach that translates science into clinical and executive performance expectations may aid in overcoming traditional barriers to implementation.

Targeted Versus Universal Decolonization to Prevent ICU Infection

“…Throughout the study, corporatewide campaigns were used to ensure compliance with national practice guidelines. [16][17][18] Each hospital obtained approval from an institutional review board, with more than 90% of the hospitals delegating review to the Harvard Pilgrim Health Care institutional review board. Patient notices about group-specific protocols were posted in each ICU room.…”

Incidence and Risk Factors for and the Effect of a Program To Reduce the Incidence of Surgical Site Infection after Cardiac Surgery

“…We undertook such a complex effort on the basis of evidence that single, simple interventions are unlikely to be successful in achieving such a goal. Hence, many efforts at infection prevention and control are now using (and recommending) a bundled approach with multi-modal strategies that have a greater potential for making a difference in outcomes and achieving a sustainable culture change [23][24][25][26]. Additionally, the data set used in the present study was limited in several ways.…”

Infection prevention practices in adult intensive care units in a large community hospital system after implementing strategies to reduce health care-associated, methicillin-resistant Staphylococcus aureus infections

“…We found that there was variability in infection prevention and control measures and that the use of special approaches and technologies was not always subsequent to the full implementation of basic evidence-based practices. Implementation of evidence-based practices has been shown to reduce HAIs, 17,18,[23][24][25] and, therefore, consistent use of these basic practices (Table 2) should precede the deployment of technology solutions. This is in agreement with the Society for Healthcare Epidemiology of America Compendium guidance that recommends special approaches and technology only if CLABSI rates remain unacceptably high despite implementation of basic practices.…”

“…The MRSA "ABCs" were implemented in 2007 and involved active MRSA surveillance of high-risk patients, use of barrier precautions, promotion of hand hygiene and disinfection, recruitment of executive champions, and patient empowerment. 17 …”