Use this table to quickly find a mentor for the prevention of MRSA with demographics similar to your own, or use 'ctrl+f' in your web browser to search for specific key words on this page.
Beth Israel Medical Center – New York, NY
Availability Status: Available to answer requests
Licensed Beds: 1111
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: August 2006
Mentor Contact Name: Brian Koll, MD, FACP, FIDSA
Mentor Contact Email: bkoll@chpnet.org
Mentor Contact Phone: 212-420-2853
Additional Information:
98% compliance with all infection prevention measures (Hand Hygiene, Contact Precautions, Environmental Cleaning or Active Surveillance Testing) demonstrating sustained improvement over time.
Active surveillance has identified that 11% of patients admitted are admitted with
MRSA which is a decrease from past years. These patients are placed on contact precautions.
Sustained decrease in hospital-acquired MRSA rate from 4.0 to 0.5 per 1,000 patient discharges.
MRSA infection rate decreased from 10% to < 1%
MRSA infection rate = 0.5 per 1,000 patient days
There continues to be a decrease in hospital-acquired MRSA infections as well as decreases in the rate of other drug-resistant organisms with a 33% decrease seen in 2010
Molecular typing has not shown MRSA transmission between patients. Patients infected with their own colonizing strain
MRSA conversion rate (not colonized on admission but colonized with follow-up active surveillance) = 0.5% with median length of stay > 1 month.
Control of MRSA and other drug resistant organisms has saved the hospital $3.0 million in avoided costs.
Keys to success:
Beth Israel Medical Center built on its success with the CLABs and ventilator bundles to launch the MRSA bundle.
Because hand hygiene compliance, use of contact precautions, and compliance with CLABs and ventilator bundle are 90+%, a system to ensure compliance with the decontamination of the environment and equipment component of the bundle was emphasized through work with environmental services, transporters and radiology.
Active surveillance cultures were also instituted in areas of the hospital where there is a high prevalence of MRSA such as the ICU and also select surgical populations.
Creation of an intranet site for patients and their families to obtain information on MRSA, use of precautions
Partnership with health care union to train front line staff to be infection prevention coaches
Mentor designation - 3/13/07
Information updated - 4/8/11
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Blount Memorial Hospital – Maryville, TN
Availability Status: Available to answer requests
Licensed Beds: 194
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: January 2004
Mentor Contact Name: Ann Henry, RN, MA, Infection Control Coordinator; Linda Chapman, RN, MS, MSN, Director of Quality Management
Email: ahenry@bmnet.com; lachapma@bmnet.com
Mentor Contact Phone: 865-980-4860 (Henry); 865-981-2476 (Chapman)
Additional Information:
• Developed and implemented a new MRSA protocol that involved empiric contact precautions (ECP) and active surveillance cultures (ASC) for patients admitted from LTCF. Treated all patients admitted from LTCF as “MRSA-positive until proven innocent” by placing them automatically on ECP while awaiting results from ASC for MRSA. Required a negative MRSA culture to discontinue ECP.
• Met with individual LTCF administrators and staff to discuss and educate on MRSA recommendations and new hospital policies.
• Conducted daily infection control rounds for surveillance of compliance with ECP and ASC protocols the first six months of the project and intermittently as needed thereafter. Addressed observed protocol compliance failures immediately by meeting with clinical supervisors and their respective unit staff within 24 hours of occurrence.
• Conducted targeted follow-up surveillance on all reported compliance failures.
• Purchased additional isolation carts and revised isolation cart package contents to more efficiently and economically provide care for patients in ECP.
• Implemented a concomitant hand hygiene program throughout the hospital.
• Developed new easy-to-understand patient and family educational brochures on MRSA and ECP.
The HO-MRSA incidence trend moved from an upward quarterly trend (+0.048) to a sustained downward trend (-0.024).
The HO-MRSA rate has decreased 50%
The MRSA reportable isolate rate has decreased 75%
Average length of stay among hospitalized LTCF residents has decreased by 2.2 days.
Mentor designation - 4/18/08
Information updated - 3/4/10
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Mercy Medical Center – Cedar Rapids, IA
Availability Status: Available to answer requests
Licensed Beds: 445
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: September 2003
Mentor Contact Name: Stacy DeMoss
Mentor Contact Email: sdemoss@mercycare.org
Mentor Contact Phone: 319-398-6696
Additional Information:
Keys to our success:
• Developed protocols for screening patients upon admission to identify MRSA carriers. Educated staff about the rising MRSA prevalence in the community, the anticipated benefits of the screening program, and how to handle the anticipated increase in isolation cases on each unit.
• Changed the contact isolation protocol to include gown, gloves, and mask as the personal protective equipment required for every person entering the room, visitors included. Every person who enters a patient's room performs hand hygiene before coming in contact with the patient and then performs hand hygiene again before exiting the room.
• Nursing home residents or persons transferred from acute care facilities are placed into contact isolation and nasal swabs are collected. The patient remains in contact isolation until nasal swab is ruled negative for MRSA. Persons with skin and/or soft tissue infections are also placed into contact isolation, the wound opened by the physician, if appropriate, and a culture collected to rule out MRSA.
• Beginning in January 2005, total joint patients have been screened for MRSA nasal carriage during pre-surgical teaching and evaluation sessions. Cardiologists and vascular surgeons have now agreed to use the total joint protocol for persons scheduled for CABG or ICD or pacer implants. This program is under development.
• Support of the nurse managers has been important to the initiation and maintenance of the change. Members of the patient care team, including physical therapists, speech and occupational therapists and social workers, are staunch supporters of the process and assist visitors to understand the purpose of the precautions and encourage visitor involvement in reducing the spread of multidrug-resistant organisms.
A house-wide hand hygiene campaign was launched by our hospital in 2007. Initial audits of compliance were at 71%. The average for 2009 compliance was 91%. We used a PDSA (Plan Do Study Act) model for the kick-off of the campaign. Teams submitted their ideas in a contest for a $1000 grand prize for their department.
Reduction in MRSA HCAI rates from 0.81 in 2004 (per 1000 patient days) to 0.11 (per 1000 patient days) for the calendar year of 2009. We have seen a decrease every year in HCA MRSA infections.
No deep joint total knee MRSA infections since September 2005.
Mentor designation - 6/5/07
Information updated - 4/27/10
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Mission Hospital – Asheville, NC
Availability Status: Available to answer requests
Staffed Beds: 673
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: September 2006
Mentor Contact Name: Susanne Ferrigno, Infection Control Specialist; Amy Hearing, Quality Resource Specialist
Mentor Contact Email: Susanne.Ferrigno@msj.org; Amy.Hearing@msj.org
Mentor Contact Phone: 828-213-5463 (Ferrigno); 828-213-3522 (Hearing)
Additional Information:
Isolation Compliance Hand Hygiene Compliance
1st Qtr 2011 94% 96%
1st Qtr 2010 96% 94%
2nd Qtr 2010 94% 95%
3rd Qtr 2010 95% 96%
4th Qtr 2010 96% 96%
1st Qtr. 2009 88% 94%
2nd Qtr. 92% 94%
3rd Qtr. 90% 95%
4th Qtr. 90% 95%
1st Qtr. 2008 77% 90%
2nd Qtr 79% 92%
3rd Qtr. 91% 92%
4th Qtr. 89% 94%
The isolation compliance rate increased from 84% in 2008 to >94% in 2010. Hand hygiene compliance increased from 92% in 2008, 95% in 2009 to 96% in 2010.
Nosocomial MRSA Infection Rate per 10,000 Patient Days:
1st Qtr 2011 3.6
2010
1st Qtr 1.3
2nd Qtr 1.9
3rd Qtr 4.0 corresponding increase in patients being admitted with MRSA
4th Qtr 3.5
2009
1st Qtr 3.3
2nd Qtr 2.1
3rd Qtr 2.7
4th Qtr 2.3
Baseline
2009 2.6
2008 1.7
2007 3.1
2006 6.9
The nosocomial MRSA infection rate increased in the first quarter of 2009 to 3.3 infections per 10,000 patient days, compared to 1.7 infections per 10,000 patient days in 2008. The MRSA Committee developed an action plan in response to this spike that included reviewing cases and targeting education with problem areas and increased monitoring for isolation compliance. The rate dropped slightly throughout 2009, and there were 55% less total nosocomial MRSA infections in 2009 than there were in the baseline year prior to PCR screening. Near the end of 2010 the rate again increased. and continues into 2011.
An extensive MRSA Risk Assessment was done for 2010 data and identified several areas for intervention:
1. Identification of patients with a history of MRSA earlier in their admission
2. Identification of patients with a history of MRSA or MRSA PCR positive prior to surgery
3. Unit-level quantification of isolation compliance
4. Hand hygiene compliance low on a few nursing units
Roughly half of all nosocomial MRSA infections were surgical site infections. The MRSA Committee targeted surgical site infections in 2010 with interventions such as education and recommendation for universal chlorhexadine skin prep prior to surgery. Non-emergency patients get 2 pre-op baths/showers with chlorhexidine. A chlorhexidine surgical skin prep is recommended for most surgeries but this has not been accepted by a few surgeons.
In May 2011, we implemented new "admission rules" in the EMR that will detect positive MRSA results in the patient record, order an isolation cart, contact Isolation and a Nares culture to see if patient still has MRSA. The "rule" also places a MRSA Alert on the patient EMR. Patients with a history of MRSA are being placed in isolation on admission. This reduces possibility of MRSA transmission and saves time for both the nurse and MD.
The 2010 MRSA risk Assessment revealed a healthcare acssociated MRSA colonization rate of 0.58% per total number of PCR test done x100, a healthcare associated MRSA infection rate of 0.27% per 1,000 patient days and a Community Associated MRSA rate of 3.01% per population of the area the hospital serves.
Mission Hospital is a tertiary care center in Asheville, North Carolina. We are the regional referral center for western North Carolina and the surrounding region. We have 40,000 annual inpatient admissions and perform 40,000 annual surgeries.
The MRSA IHI Committee formed in 2006 as one of several initiatives launched as a result of the 5 Million Lives Campaign. It is a multidisciplinary team with representation from Infectious Disease, Infection Control, Nursing, Performance Improvement, Public Health, Microbiology, Materials Management, and Environmental Services.
In early 2006, we saw that our nosocomial MRSA infection rate was steadily increasing and had peaked at 8.0 per 10,000 patient days of care. The team set an aim to reduce nosocomial MRSA infections by 50%.
The team decided to pilot active surveillance in the ICUs beginning in September 2006. Specifically, we started to identify patients colonized with MRSA and place them on contact isolation in a timely manner. The team quarterly reviewed the nosocomial MRSA infection rate and incidence by unit to decide where screening should occur. It was expanded to the NICU and floors with highest incidence of MRSA throughout 2007.
We chose to use PCR (polymerase chain reaction) testing because of its high sensitivity, efficacy, and fast results. The faster PCR test produces results in as soon as two hours and makes putting patients on preemptive isolation unnecessary. It may also reduce risk of transmission because patients with positive results can be identified and placed on isolation sooner. Negative patients are re-screened every seven days. The decision was made not to decolonize patients prior to discharge based on current evidence.
Infection control specialists educate staff on how to do nasal swabs and educate patients and families about MRSA. Infection control specialists also report to the MRSA team on % MRSA-positive patients and infection data.
PCR testing is done on admission in four adult ICUs, NICU, eleven high-incidence units, and pre-admissions for heart surgery. This has amounted to over 22,000 annual screens and 50% of all inpatient admissions. Eight percent of patients have asymptomatic MRSA colonization and are placed on isolation to prevent nosocomial spread.
We reached the goal of reducing nosocomial MRSA infections by 50% by the end of 2007. The team conducted a cost-benefit analysis to help decide whether to expand screening hospital-wide:
- The annual cost of PCR screening is roughly $600,000.
- We spent roughly $100,000 in 2007 to purchase stocked isolation carts. Patient isolation days have increased over 60% since screening began and the total increased annual isolation cost attributed to MRSA screening is roughly $500,000. (This does not include additional nursing time spent for isolated patients.)
- We estimate over $2 million annual cost savings based on the nosocomial MRSA infection rate at the end of 2007 and an estimated $26,000 cost savings per avoided MRSA infection.
- Net annual cost savings are approximately $925,000.
It was decided that the benefits did not justify the costs of expanding screening hospital-wide. Any expanded screening would require a significant investment in resources. Also, there was concern about the impact of increased isolation both on nursing workload and patients.
Barriers and Lessons Learned:
- NICU testing has been changed to a broth enrichment and chromogenic agar protocol, which costs less and has 24-48 hours turnaround time. Although the NICU has the lowest positive MRSA colonization rate, it has one of the highest nosocomial MRSA colonization rates. There was also a large outbreak just prior to the start of PCR screening and none since then, so there was evidence that MRSA screening was effective.
- The % MRSA-positive rate combined with nosocomial MRSA infection rate are important measures and should be continually monitored to make informed decisions.
- Monitor cost-benefit from the beginning. Increased isolation has a profound organizational impact that is easily overlooked.
- Educating staff, patients, and families takes continuous effort. Since only certain units do screening, floating pool nurses must be trained. It can be difficult at first for nurses to explain to patients and their families what it means to be colonized with MRSA, why they are on contact isolation, and why we do not decolonize them. They need to be trained and provided with educational materials.
Mentor designation - 10/23/08
Information updated - 6/29/11
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Newark Beth Israel Medical Center – Newark, NJ
[Adult & Pediatric Mentor]
Availability Status: Available to answer requests
Licensed Beds: 567
Teaching/ Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Maria Espiritu-Fuller, MD, MPH, Hospital Epidemiologist
Mentor Contact Email: MEspiritu-Fuller@sbhcs.com
Mentor Contact Phone: 973-926-8094
Additional Information:
Newark Beth Israel Medical Center is a 600-bed tertiary care medical center that serves both an inner-city (predominantly African-American) and a suburban patient population. In recent years, we've had a significant increase in the number of admitted patients colonized with MRSA. This has resulted in an overall increase in both community-associated and health care-associated MRSA infections.
Process Measures:
An important area of measurable improvement is the screening rate of admissions to the NICU for nasal colonization with MRSA. Because this was an entirely new process, in 2006 the screening rate was 62.1%. In 2007, the rate improved to 79.8% and in 2008, 84.9%. Last year in 2009, the rate was 99.6%. This improvement was the result of intensive education of the frontline staff, streamlined laboratory processes, frequent feedback of screening data to the staff, visible infection control presence in the unit and a leadership in the NICU dedicated to make the process work.
Compliance with Active Surveillance Testing in 2010 in our five intensive care units (PICU, NICU, CTOHS, CCU, and medical ICU): 5920 patients screened out of 5961 patients admitted or transferred to an ICU = 99.31% adherence to active surveillance molecular testing.
We performed a retrospective review to identify MRSA infections over a 42-month period from January 2006 to June 2009 when all admissions to the NICU were screened for nasal carriage of MRSA and compared to an equivalent 42-month period from July 2002 to December 2005 when no nasal screening was performed. MRSA infections were identified from the microbiology database and confirmed by chart review. Nasal screening for MRSA was performed using a rapid polymerase chain reaction-based test. Positive patients were decolonized with topical mupirocin and contact isolation was maintained until decolonization was completed.
Our results showed a total of 5893 babies that were reviewed for MRSA infection during an 84-month period divided into 42 months of screened and 42 months of unscreened periods. There were no significant differences in the distribution of birth weight and gestational ages between the two time periods. Five out of 3269 babies (0.15%) were infected during the screened period compared to 29 of 2624 babies (1.11%) during the unscreened period, (chi square 23.01, p<0.0001).
During the 12 months of 2010, there was a singular hospital-onset MRSA Bloodstream Infection in one of the five intensive care units (cardiothoracic/open heart surgery ICU). The infection occurred in February 2010 and it did not re-occur in the subsequent ten months on this unit. The rate for this particular unit was 0.15 for 2010.
In addition to the above MRSA BSI HAI, there were four additional MRSA HAI MRSA positives in skin and soft tissue in a singular ICU (NICU) during the twelve months of 2010.
Our attributable cost of MRSA infection in the NICU was $48,022. By preventing 24 infections in 42 months, we realized savings of $1,152,000 in 42 months or the equivalent of $329,000 per year.
In our neonatal intensive care unit (NICU), babies were being admitted colonized with MRSA at birth and we have shown that mothers were also colonized at the time of delivery. Because of these findings, we instituted MRSA screening for nasal colonization for all admissions to our NICU.
The systematic process for implementation included the following:
Collaborative effort by a team consisting of representatives from Neonatology, Nursing, Microbiology Laboratory, Housekeeping, Infection Control and Epidemiology. The purpose of the team was to implement infection control measures including surveillance, identification of infected and colonized patients, use of cohort methods and isolation techniques, intensive environmental sanitation and health care worker education.
The steps in the process were:
• Screening all admissions for nasal colonization with MRSA
• Surveillance and search for infected cases
• Use of isolation techniques to prevent the spread of MRSA to other babies
• Sustaining the control measures
• Aggressive environmental cleaning procedures
• Cohorting of infected and colonized babies
• Decolonizing positive babies with topical mupirocin
• Regular team meetings to monitor results
• Implementing MRSA screening using PCR-based technology in order to shorten turn-around time
In summary, the key factors for success are:
Collaboration
Education
Admission screening with PCR
Early identification of colonized babies and decolonization with mupirocin
Isolation of colonized and infected babies
Lessons learned:
• Perform a unit-specific risk assessment for MRSA to identify the high-risk areas. There is significant unit-to-unit variation in colonization and infection rates with MRSA.
• Develop a methodology to identify the unrecognized cases of MRSA colonization being admitted to the hospital.
Mentor designation - 4/7/07
Information updated - 6/28/11
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Saint Clare's Health System – Denville, NJ
Availability Status: Available to answer requests
Staffed Beds: 260
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: January 2006
Mentor Contact Name: Norma Atienza, RN Director Clinical Quality and Epidemiology and Laura Anderson, RN, Nurse Epidemiologist
Mentor Contact Email: natienza@saintclares.org; landerson@saintclares.org
Mentor Contact Phone: 973-625-6597; 973-625-6598
Additional Information:
Saint Clare's Health System continues to conduct Active Surveillance Testing of our CCU and high risk patients for MRSA. Since that time, we have been 99% compliant with collecting MRSA nasal screens in all patients admitted or transfred into the CCU.
Environmental Services continues to do monthly audits for daily room cleaning and terminal cleaning observations. Compliance is currently at 99% Sussex, 90% Dover and 88% Denville.
In 2010, we had 4 MRSA infections (compared to 13 in 2008 and 10 in 2009). The breakdown is 3 Respiratory, 3 Wound, 1 Blood and 1 infected PEG site.
The cost of MRSA infections varies from $27,083 to $34,900 according to the U.S. Outcome Research Group. Using the lowest estimated direct medical cost of $27,083, Saint Clare's saved approximately $162.498 in 2010 (4 infections) compared to 2009 when 10 infections cost the hospital approximately $270,830.
Hand hygiene compliance has shown great improvement over the years. The Infection Control nurses do observations for compliance before as well as after patient contact including compliance with PPE. Saint Clare’s had a system wide compliance rate of 85.4 in 2010.
Through all our efforts, MRSA hospital-acquired infection rates have continued to declined from 0.84 in 2003, 0.54 in 2004, 0.48 in 2005, and 0.35 in 2006 to 0.29 in 2007, 0.16 in 2008, 0.13 in 2009 and 0.06 in 2010.
Rate in 2008 was 0.16. Rate in 2009 was 0.13. In 2010, MRSA rates continued to drop and our MRSA infection rate is even lower at 0.06 - an improvement of 93% since our efforts began back in 2003.
St. Clare's Health System has one Infection Control department for three acute care campuses of varying sizes (Denville: 260 staffed beds; Dover: 50; and Sussex: 41). In 2003, Saint Clare’s infection rate for MRSA was 0.84. With the arrival of a new epidemiology director and staff in 2004, we looked at new ways to decrease the transmission of MRSA as well as our health care-acquired infections. MRSA colonized patients had previously not been isolated, so we began isolating all MRSA positive patients. In addition to standard precautions, contact precautions were also implemented.
Hand Hygiene Campaign: Compliance rate to hand washing was 72 percent in 2004. We heightened our hand washing awareness in 2005 and began a hand hygiene campaign. Monthly hand hygiene audits were done by actual observation. A data collection tool was revised and unit-based “hand washing secret agents” were asked to perform 20 observations a month in a patient care unit. Secret agents are an interdisciplinary mix including RNs, LPNs, nursing assistants, unit secretaries, respiratory therapists and medicine staff. Results were sent to the epidemiology department for data analysis and reporting. Concurrent corrective actions were implemented for departments with low compliance rates. Compliance rate went up to 82 percent by the end of 2005. Tickets were designed in 2007 to be given to those that are caught not washing their hands as a gentle reminder to be compliant. Hand hygiene compliance was also integrated in the employee’s annual evaluation. Additional alcohol hand gel dispensers were also installed in high traffic areas to increase compliance.
Environmental cleaning: In 2005 and 2006 all efforts continued with collaboration and emphasis on environmental services. All discharge units are terminally cleaned including changing cubical curtains for all patients that were on isolation during their stay. Environmental Staff were also evaluated on actual cleaning and went through a rigorous educational session on the importance of a clean environment for the prevention and control of infection. Policies were revised appropriately.
Infection Control Liaison: In 2006, we began our Infection Control Liaison Program. Staff members from the nursing units were assigned to be the “Infection Control Expert” on their units. They meet regularly with the Infection Control Practitioners (ICP) to review unit specific goals and health care-acquired infection rates. They serve as the eyes and ears of the ICPs in the units and also as an infection control resource for their co-staff. New ideas are discussed and shared and contribute to the development of new policies and protocols.
Flagging Positive Cases: In 2004, we worked with our IT and Admitting Departments to have a system of identifying positive cases of not only MRSA but all MDRO patients including C. Diff when they are readmitted into our acute care facilities. These are the cases that were not cleared of infection before discharge. If they are re-admitted, admitting staff must review the MDRO/C. Diff status on Admission Face Sheet and must notify the unit to ensure the patient is properly and efficiently isolated. In August 2009, we added a flag into our computerized charting system to help alert staff of readmissions.
Education: With the heightened awareness of MRSA, especially in the community, we have been providing multiple educational sessions on the prevention and control of infections, especially MRSA. Isolation protocols and practices are reviewed with our nursing staff in different scenarios, informal, formal, group, or one-to-one sessions. MRSA education is also expanded to our visitors and to the community that we serve.
Screening: 2007 brought mandatory MRSA nasal screening in New Jersey. By state law, all hospitals were to begin MRSA nasal screenings in a designated high risk area (such as the ICU). At Saint Clare’s, we expanded our screening population to many high risk populations. All nursing home, hemodialysis inpatients and all past positive MRSA patients are being screened. In early 2007, we identified an increase in our MRSA orthopedic surgical site infections so all pre-op orthopedic patients are also screened pre-operatively as well as all surgical patients that are being discharged to a nursing home or rehabilitation facility. The program was rolled out in our three acute care facilities. Standing orders for MRSA nasal screening were developed. Rapid PCR testing began in November 2007 (initially screens were done via culture plating). All positive patients are immediately isolated and placed on contact precautions.
We are continuously reviewing and evaluating our program goals and outcomes. Through active participation via conferences and webinars with APIC, IHI, CDC and other related associations, new ideas and innovations are developed to further improve our prevention strategies.
Mentor designation - 5/1/08
Information updated - 5/27/11
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Veterans Administration Pittsburgh Healthcare System (VAPHS)–Pittsburgh, PA
Availability Status: Available to answer requests
Licensed Beds: 146
Teaching/ Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: August 2001
Mentor Contact Name: Candace Cunningham, RN, MRSA Coordinator
- Acute Care; Cheryl Creen, RN, MRSA Coordinator - Long-term Care
Mentor Contact Email: candace.cunningham@va.gov or cheryl.creen@va.gov
Mentor Contact Phone: 412-360-3612 (Cunningham); 412-822-3210 (Creen)
Additional Information:
October 2006: VAPHS system-wide celebration of success in achieving goal of 50% reduction in MRSA HAIs.
January 2007: VAPHS reports system wide: >90% nares swabbing rates, 60% increase in compliance with hand hygiene and contact isolation precautions and 50% reduction in MRSA HAI's.
In 2011, these improvements in patient safety and quality of care have been sustained.
Current Hand Hygiene adherence averages are entry 85.6% and exit 91.2% in acute care.
Outcome Measures:
Current Q1FY11 acute care Transmission rate is 2.3/1000 patient days.
Infection rate is 0.5/1000 patient days.
In comparison, Q3FY09 acute care Transmission rate was 1.6/1000 patient days.
Infection rate was 0.2/1000 patient days
Compliance with surveillance testing for acute care composite rate for admission and discharge is 91.5% for Q1FY11.
In the past 6 months, acute care has had 5 HAI MRSA infections 2 SSI, 1 SST, 1 Sec. BSI and 1 CA UTI. Four of these occurred in colonized patients.
The acute care med-surg unit has gone 477 days without a MRSA HAI and the SICU has gone 253 days without a MRSA HAI. Both units have an infection rate of 0.0/1000 patient days for the past 6 months.
August 2001 to June 2005: An industrial model (Toyota Production System or TPS) was piloted on a surgical specialty nursing unit and surgical intensive care unit to enable the staff to comply with evidence-based precautions (SHEA guidelines) to prevent MRSA HAIs. TPS-trained mentors and team leaders worked with staff to standardize routines and create system changes that enabled them to implement strict hand hygiene, active surveillance and contact isolation precautions with dramatic reductions in MRSA HAIs in the two pilot units in the 125 bed acute care facility (VAPHS-UD).
July 2005: VAPHS initiated hospital-wide implementation of hand hygiene, active surveillance and appropriate contact isolation precautions in its 125 bed acute care and 275 bed long term care facility. Clinical and administrative leaders and staff representatives attend Positive Deviance (PD) workshop. PD is an approach to behavioral and cultural transformation from within an organization which enables the staff and patients to assume true ownership of the problem (MRSA HAIs) and solutions.
August 2005: Orders for active surveillance culture (nares swabs) "hard wired" in to EMR on every patient on admission and discharge. Culture results reported to nursing units daily. Performance data (nares swabbing rates, MRSA transmission and infection rates) reported to nursing units weekly.
August through November 2005: Discovery and action dialogs with 500 staff and patients in the two facilities to discuss their practices and ideas on how to prevent MRSA transmissions and associated infections. Volunteers emerge to work on the problem.
September 2005: Weekly 15 minute stand-up briefings in each nursing unit initiated. Staff reports their performance data, successes and improvement opportunities and identify barriers which clinical and administrative leaders attending the briefings can help eliminate.
August 2006: MRSA status of patients shared with support services where staff create ways of applying transmission-based precautions for MRSA colonized and infected patients.
November 2006: Patients engaged in "Partners in Your Care" (Univ. Penn/Steris) to learn about the importance of hand hygiene for themselves, their families and their care givers.
February 2011: Prevention efforts have been sustained by the continued application of Positive Deviance and data driven culture change. The national VHA has implemented the MRSA Prevention Initiative in all VA hospitals and recently decided to expand strategies to address MDRO's with an initial focus on C. Difficile. The titile has also changed to the MDRO Prevention Initiative nationwide.
Mentor designation - 3/13/07
Information updated - 5/31/11