title: Implementation of an industrial systems-engineering approach to reduce the incidence of methicillin-resistant Staphylococcus aureus infection.
abstract: OBJECTIVE
  To measure the effectiveness of an industrial systems-engineering approach to a methicillin-resistant Staphylococcus aureus (MRSA) prevention program.
  
  
  METHODS
  Before-after intervention study.
  
  
  METHODS
  An intensive care unit (ICU) and a surgical unit that was not an ICU in the Pittsburgh Veterans Administration hospital.
  
  
  METHODS
  All patients admitted to the study units.
  
  
  METHODS
  We implemented an MRSA infection control program that consisted of the following 4 elements: (1) the use of standard precautions for all patient contact, with emphasis on hand hygiene; (2) the use of contact precautions for interactions with patients known to be infected or colonized with MRSA; (3) the use of active surveillance cultures to identify patients who were asymptomatically colonized with MRSA; and (4) use of an industrial systems-engineering approach, the Toyota Production System, to facilitate consistent and reliable adherence to the infection control program.
  
  
  RESULTS
  The rate of healthcare-associated MRSA infection in the surgical unit decreased from 1.56 infections per 1,000 patient-days in the 2 years before the intervention to 0.63 infections per 1,000 patient-days in the 4 years after the intervention (a 60% reduction; P = .003). The rate of healthcare-associated MRSA infection in the ICU decreased from 5.45 infections per 1,000 patient-days in the 2 years before to the intervention to 1.35 infections per 1,000 patient-days in the 3 years after the intervention (a 75% reduction; P = .001). The combined estimate for reduction in the incidence of infection after the intervention in the 2 units was 68% (95% confidence interval, 50%-79%; P < .001).
  
  
  CONCLUSIONS
  Sustained reduction in the incidence of MRSA infection is possible in a setting where this pathogen is endemic. An industrial systems-engineering approach can be adapted to facilitate consistent and reliable adherence to MRSA infection prevention practices in healthcare facilities.
authors.affiliation: VA Pittsburgh Healthcare System, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15240, USA. Robert.Muder@va.gov
authors.forename: Robert R
authors.initials: RR
authors.lastname: Muder
authors.forename: Candace
authors.initials: C
authors.lastname: Cunningham
authors.forename: Ellesha
authors.initials: E
authors.lastname: McCray
authors.forename: Cheryl
authors.initials: C
authors.lastname: Squier
authors.forename: Peter
authors.initials: P
authors.lastname: Perreiah
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jain
authors.forename: Ronda L
authors.initials: RL
authors.lastname: Sinkowitz-Cochran
authors.forename: John A
authors.initials: JA
authors.lastname: Jernigan
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001336:Automobiles; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D003470:Culture Media; D006235:Hand Disinfection; D006801:Humans; D015994:Incidence; D007221:Industry / Q000379:methods; D017053:Infection Control / Q000379:methods*; D016106:Methicillin Resistance; D010356:Patient Isolation; D011159:Population Surveillance / Q000379:methods; D016730:Program Development; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016635:Universal Precautions
chemical_list: D000900:Anti-Bacterial Agents; D003470:Culture Media