Nationwide safety program successfully cuts hospital-onset MRSA infections

To help prevent these infections, Johns Hopkins Armstrong Institute researchers and collaborators from NORC at the University of Chicago and AHRQ conducted an 18-month program centered on helping healthcare teams consistently implement a comprehensive set of infection prevention strategies targeting MRSA transmission and infection.

Participating hospital units received education and implementation resources on hand hygiene, environmental cleaning, device-associated infection prevention, chlorhexidine bathing and nasal decolonization. The program also engaged front-line workers across disciplines, including environmental services personnel.

Lisa Maragakis, M.D., M.P.H., senior author of the study, professor of medicine and epidemiology, Johns Hopkins University School of MedicineTaking the available evidence and implementing it is quite complex because you have to make sure that every front-line personnel member of the healthcare team is aware of the evidence and has the knowledge, skills and tools they need to implement it. The system and workflow also have to support making sure those things happen every single time for every patient."

Researchers compared infection rates during the 18-month implementation period with rates during the 12 months before the program began. Across participating ICUs and non-ICUs, the rate of hospital-onset MRSA bloodstream infections was 65% lower during the implementation period. Researchers also observed a 39% reduction in MRSA-positive clinical cultures collected later during hospitalization, a 37% reduction in bloodstream infections from all causes and a 31% reduction in central line-associated bloodstream infections.

The researchers also found changes in how participating units approached infection prevention. The proportion of ICUs reporting nasal MRSA decolonization for all patients increased from 35% to 61%, while the proportion of non-ICUs reporting the practice increased from 13% to 35%. Monitoring of environmental cleaning also increased from 50% to 75% among ICUs and from 52% to 76% among non-ICUs.

Collaboration among institutions helped make it possible to implement the program across hospitals nationwide, with researchers at NORC and AHRQ contributing to the coordination and infrastructure needed to support participating sites.

"It really was a large collaborative project," Maragakis says. "Each researcher brought something different to the table, and that was important to making a project of this scale possible."

Researchers say many of the toolkit's strategies address fundamental infection prevention practices that can help reduce the spread of other organisms and healthcare-associated infections as well.

"This toolkit is about MRSA prevention, but once you get into it, you'll see it's really about preventing healthcare-associated infections and organism transmission," Maragakis says. "There will be collateral benefits to doing these basics of infection prevention well beyond MRSA prevention."

Other Johns Hopkins researchers who contributed to the study are Clare Rock, Valeria Fabre, Sara Cosgrove, Kathleen Speck, Samuel Kim, Kerri Huber, Cheryl Conners and Sandra Swoboda.

Source:

Johns Hopkins Medicine

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