Author: Martin Evans, MD
Director of the VHA MRSA/MDRO Program
MRSA hospital-acquired infections (HAIs) cause increased suffering, the need for increased procedures, treatments, and time in the hospital, and sometimes an increased risk of death among patients. Beginning in 2002, staff working at the VA Pittsburgh Healthcare system successfully brought down MRSA HAIs using a “bundle” of infection control strategies. In 2007, VA leadership in Central Office, Washington, D.C. decided to have all 153 medical centers nationwide implement the bundle.
The “MRSA bundle” consisted of gently swabbing the nose of all patients admitted or transferred within the hospital to detect those carrying MRSA (known as universal active surveillance); preventing spread of the organism by placing those with MRSA in their own room away from those not carrying the organism; insisting that healthcare workers do hand hygiene and wear gloves and gowns when caring for the patient, and striving for a culture change where infection prevention and control becomes everyone’s responsibility.
From October 2007, when the MRSA Prevention Initiative was fully implemented nationwide though June 2010 (when we ended our analysis), patients spent more than 8 million days in VA hospitals, and more than 1.7 million swabs were done. This was 96% of all swabbing opportunities. VA healthcare providers brought MRSA HAIs down 62% from a two-year baseline in our 196 ICUs, and down 45% in our 428 non-ICUs. This was an estimated decrease of more than 1,000 MRSA HAIs in the ICUs over what would have been expected given the trend before 2007.
The thoroughness of active surveillance and the rapidity of results (sometimes available before patients were admitted from the Emergency Department), gave infection control personnel what they needed to keep the organism from spreading in their hospitals. The constant opportunities for active surveillance and need to act on the results probably kept infection control high on everyone’s list of priorities and drove a system-wide culture change, where healthcare workers began to appreciate infection prevention and control more and made the fight against MRSA HAIs their own mission. This had not occurred to such an extent before the MRSA Prevention Initiative even though programs were in place to emphasize hand hygiene, isolate properly, and prevent device-associated ICU infections.
Does your institution do active surveillance for MRSA?
**The views expressed are those of the author and do not necessarily represent those of the Department of Veterans Affairs.