Results of a multicentre randomised controlled trial of statistical process control charts and structured diagnostic tools to reduce ward-acquired meticillin-resistant Staphylococcus aureus: the CHART Project.
Statistical process control (SPC) charts have previously been advocated for infection control quality improvement. To determine their effectiveness, a multicentre randomised controlled trial was undertaken to explore whether monthly SPC feedback from infection control nurses (ICNs) to healthcare workers of ward-acquired meticillin-resistant Staphylococcus aureus (WA-MRSA) colonisation or infection rates would produce any reductions in incidence. Seventy-five wards in 24 hospitals in the UK were randomised into three arms: (1) wards receiving SPC chart feedback; (2) wards receiving SPC chart feedback in conjunction with structured diagnostic tools; and (3) control wards receiving neither type of feedback. Twenty-five months of pre-intervention WA-MRSA data were compared with 24 months of post-intervention data. Statistically significant and sustained decreases in WA-MRSA rates were identified in all three arms (P<0.001; P=0.015; P<0.001). The mean percentage reduction was 32.3% for wards receiving SPC feedback, 19.6% for wards receiving SPC and diagnostic feedback, and 23.1% for control wards, but with no significant difference between the control and intervention arms (P=0.23). There were significantly more post-intervention 'out-of-control' episodes (P=0.021) in the control arm (averages of 0.60, 0.28, and 0.28 for Control, SPC and SPC+Tools wards, respectively). Participants identified SPC charts as an effective communication tool and valuable for disseminating WA-MRSA data.
Curran
E
E
Health Protection Scotland, Glasgow, UK.
Harper
P
P
Loveday
H
H
Gilmour
H
H
Jones
S
S
Benneyan
J
J
Hood
J
J
Pratt
R
R
D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D003627:Data Interpretation, Statistical; D006282:Health Personnel; D006757:Hospital Units / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D016106:Methicillin Resistance; D015233:Models, Statistical; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects; D006113:United Kingdom / Q000453:epidemiology