Study: Resistant Infections Plummet at VA Hospitals Because of MRSA Initiative

WASHINGTON—A nationwide initiative by VA to reduce the spread of methicillin resistant Staphylococcus aureus (MRSA) within its facilities has resulted in a dramatic drop of more than 60% in hospital-acquired infections in less than three years, according to a recent study. A drug-resistant bacteria, MRSA can easily spread within hospitals, where staff travel from one sick patient to another.

This decrease is the result of the dissemination within VA of a “MRSA bundle”—a group of infection-control strategies that include active surveillance of MRSA incidents in the hospital, MRSA testing of patients as they enter and leave the hospital, contact precautions by staff and improved hygiene.

mrsa graphs-1.jpg“There has clearly been a buy-in in our facilities across the nation,” declared Martin Evans, MD, MRSA program director within VA’s Office of Infectious Diseases, at a press conference following the publication of the study in The New England Journal of Medicine. “There was no change in MRSA infection prior to implementation of the bundle, and then a 62% decrease in hospital-acquired infections.”

Implementation of the bundle began at acute-care VA hospitals nationwide in 2007. With the initiative in place, VA tracked on a monthly basis the prevalence of MRSA colonization or infection among patients, as well as hospital-associated transmission. They also tracked each facility’s adherence to the prevention plan. The researchers then looked at that accumulated data and assessed the effect the bundle had on infection control.

mrsa graphs-2.jpgFrom October 2007 through June 2010, there were 1,934,598 admissions, transfers or discharges from inpatient units in VA hospitals. During this period, the percentage of patients screened for MRSA at admission rose from 82% to 96%, meaning that VA performed 1.7 million screening tests in less than three years. The mean prevalence of MRSA colonization at the time of admission during that period was 13.6%. Patients that test positive can be kept isolated from other patients during the length of their stay at VA.

After several years of rising MRSA rates, the rate of health care-associated MRSA infections in ICUs had reached a plateau in the two years prior to the bundle’s implementation at a steady rate of 1.64 infections per 1,000 patient days. Following the implementation, that rate dropped to 0.62 infections per 1,000 patient days—a decrease of 62%.

During the same period, the rate in non-ICUs fell from 0.47 infections per 1,000 patient days to 0.26 infections—a decrease of 45%.

“We are very pleased with this study,” said Rajiv Jain, MD, VA’s chief consultant of specialty-care services. “It shows that dedicated staff can use a team of strategies to keep veterans safe while they’re receiving care at VA.”

Jain spearheaded initial development of the bundle during his tenure as chief of staff at the Pittsburgh VAMC—a project that began nearly 10 years ago. During the creation of the MRSA guidelines, Jain and his colleagues solicited the input of every employee at the hospital who came into contact with a patient or with the patient’s food or environment. The goal was to identify every possible vector by which a patient could become infected. For example, before the initiative was in place, dieticians who delivered patient trays did so ungloved; the cleaning crew did not disinfect undersides of nightstands; hospital van drivers did not wipe down seats and armrests between trips.

All of these staff members were brought into the conversation about how to stop MRSA infection, and the result is what Jain has described as a significant cultural shift in who is responsible for patient care.

According to Gary Roselle, MD, program director for VA’s Office of Infectious Diseases, this culture shift is spreading nationwide and is key to the MRSA bundle’s success. “Infection prevention is everyone’s job at VA, from the top managers to all the other personnel. The success of this initiative is an example of everyone working together to prevent infections. This study shows that we can be effective in reducing infections and that it can be sustained.”

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