Print page

PROJECT NAME: Methicillin-Resistant Staphylococcus Aureus (MRSA) Prevention

TIME FRAME: 2006 - 2008

DESCRIPTION / PROBLEM: Methicillin-resistant Staphylococcus aureus (MRSA) is a multi-drug resistant organism and a common cause of health care-associated infection in the U.S.  Infections resulting from MRSA increase patient morbidity, mortality and hospital costs. Hospitals throughout the country are taking steps to prevent the transmission of MRSA.

Fletcher Allen has been tracking hospital-acquired MRSA for approximately 20 years. Within the last two years, the Infection Control Team at Fletcher Allen has intensified these efforts as a new strain of MRSA has been identified. The organization has implemented a number of steps to prevent MRSA infections and to decrease the transmission of MRSA in the hospital, in accordance with evidence-based guidelines established by the Centers for Disease Control and Prevention.

PROJECT GOALS: To decrease hospital-acquired and health care-associated MRSA.

INTERVENTIONS:

• The Infection Control Team closely monitors and analyzes MRSA cases and trends – both hospital and non-hospital related cases – on a daily basis. Results of in-hospital transmission are compiled monthly and are shared with staff throughout the organization via the FAHC on-line quality database.
• In January 2007, Fletcher Allen began screening patients in the surgical, medical and pediatric intensive care units for MRSA upon admission and once a week. Infants in the Neonatal Intensive Care Unit are screened for MRSA weekly.  In October 2007 quarterly screening of all outpatient dialysis patients was started.
• The Infection Control Department launched an internal Hand Hygiene campaign in 2007 to promote hand hygiene among health care providers. Along with this effort, Infection Control increased the availability of antimicrobial hand soap and alcohol hand sanitizer on patient units and throughout the organization including public spaces such as waiting rooms and near the cafeterias.
• Efforts have been made to improve the availability of cleaning products in the inpatient areas, with the addition of wall-mounted cleaning stations.
• Fletcher Allen Infection Control team is working with the Vermont Department of Health to develop treatment and infection control guidelines for MRSA to be distributed to providers throughout the state. Fletcher Allen also helped produce an educational brochure “Living with MRSA” for providers.

EVALUATION:

Fletcher Allen tracks its hospital-acquired MRSA rate – which includes MRSA infection and colonization – on an ongoing basis. It also tracks hand hygiene compliance by observing caregivers’ hand hygiene practices, measuring how much hand hygiene product has been used, and gathering patient feedback about hand hygiene on surveys. Infection Control regularly tracks results of its MRSA screening, monitoring the rate of positive cases and the length of time it took to identify those cases.

RESULTS:

The rate of MRSA transmission within hospitalized patients at Fletcher Allen has declined from 2006 to the present. The screening in the intensive care units has revealed that approximately 8 percent of patients are positive for MRSA at the time of admission to the unit. This includes patients with a prior history of MRSA and those coming in from the community with no prior diagnosis of MRSA.

Knowing when a patient is positive enables the intensive care units to provide the proper care and precautions – thereby reducing the transmission of MRSA within the hospital. One specific example to illustrate the successful prevention of infection: primary bloodstream infections caused by MRSA have been reduced by 50 percent since 2006. This is a direct reflection of several quality improvement initiatives including implementation of the Institutes for Healthcare Improvement 100 Thousand Lives campaign prevention of central line-associated bloodstream infection improvement bundle.

Once considered primarily a health care-associated pathogen, Fletcher Allen has seen a significant increase in community-onset infections in the past year. Many patients with these infections require treatment in the Emergency Department or admission to the hospital for IV antibiotics. The prevention and control of infections remains a Fletcher Allen priority.  With implementation and monitoring of evidenced-based practices along with continual education we hope to see further decline in the frequency of MRSA health-care associated infections.

More information about quality at Fletcher Allen can be found at Fletcher Allen’s Quality of Care Reports Web site:

http://www.FletcherAllen.org/Quality/index.html

For more information about this project, contact the James M. Jeffords Institute for Quality and Operational Effectiveness at Fletcher Allen:

James M. Jeffords Institute for Quality and Operational Effectiveness

Fletcher Allen Health Care

111 Colchester Avenue

Burlington, VT 05401

Phone: (802)847-9795

Fax: (802)847-8959