Program evaluation of the Methicillin Resistant Staphylococcus aureus (MRSA) Program at the VA Puget Sound Health Care System.
Grandjean, Marcus W.
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Methicillin Resistant Staphylococcus aureus (MRSA) is among the most common and costly hospital-acquired infections, and a major target of quality improvement efforts. A bundle of infection control practices has been reported to dramatically reduce hospital acquired MRSA colonization transmissions. The bundle includes active, prospective screening to identify MRSA carriers, initiation of infection control precaution measures, and methods to modify cultural perceptions. However, little is known about the implementation of specific infection control practices, and their effect on MRSA colonization transmissions. Objective: Our objective is to describe the implementation of the MRSA Program at VA Puget Sound Health Care System (VAPSHCS), and test the association of two specific implementation interventions with hospital infection control practices and MRSA colonization transmission rates: a hospital Director's performance measure directed at improving MRSA screening rates, and an electronic patient record flag directed at improving use of infection control precautions. Setting: The study took place at a 432 bed Veterans Health Administration hospital which provides tertiary, acute, critical, and surgical healthcare. Methods: Student's t-test was used to compare the difference in compliance with infection control practices for the 3 month pre-intervention period and 3 month post-intervention period for each intervention, and Pearson's chi-square analysis was used to compare the rate of MRSA colonization transmissions for the same 3 month pre- intervention period and 3 month post-intervention periods. Descriptive statistics summarize compliance with infection prevention improvement strategies and MRSA colonization transmission rates over time. Results: The MRSA Program was initiated in March 2007, and surveillance data were collected from 10,333 unique inpatients through May 2011. It took a total of 12 months after initiation of MRSA Program in the critical care unit to achieve compliance rates of 90%, 21 months for acute care to achieve the same target, and 13 months following initiation of documented observations to achieve 90% for initiation of infection-control precautions. Active MRSA screening increased from 88.1% in the 3 months before initiating the Director's performance measure, to 89.1% in the 3 months after (p=0.36). Initiation of infection-control precautions increased from 93.9% in the 3 months before initiation of an electronic patient record flag, to 95.8% in the 3 month post-intervention period (p<0.05). MRSA colonization transmissions rates increased from 1.7 per 1,000 patient days before the Director's performance measure to 2.0 per 1,000 patient days after (p=0.36); and decreased from 2.7 transmissions per 1,000 patient days of care before the electronic patient record flag to 1.5 transmissions per 1,000 patient days of care after (p<0.05). Conclusion: Overall, it took more than 12 months to achieve stable compliance for two key components of the MRSA Program elements: active screening and initiation of infection control precautions. An electronic patient record flag was associated with improved compliance with infection control precautions, which may affect the rate of MRSA colonization transmissions. Use of a hospital Director's performance measure might be hypothesized to have influenced rapid change by engaging staff toward systematic solutions; however, use of a Director's performance measure was not associated with increased screening or a decrease in transmission rates. Future research should examine differences in implementation of MRSA Program elements among sites.
- Health services