title: A statewide collaborative to reduce methicillin-resistant Staphylococcus aureus bacteremias in New Mexico.
abstract: BACKGROUND
  Infection control guidelines recommend multiple concurrent interventions to reduce methicillin-resistant Staphylococcus aureus (MRSA) infections. A quasi-experimental study was conducted to investigate the effect of an infection control collaborative conducted from July 1, 2008, through June 30, 2009, to decrease the rate of hospital-onset bacteremias by 40%.
  
  
  METHODS
  An MRSA curriculum was developed and delivered during three learning sessions. Guidelines, key literature, policies, and educational tools were disseminated. Teams were surveyed at the end of the collaborative and again 18 months later.
  
  
  RESULTS
  Teams were recruited from 12 acute care hospitals and 1 long-term acute care hospital, with capacities ranging from 22 to 623 licensed beds. Hospital intervention teams reported 44 hospital-onset, 18 health care-associated, and 122 community-onset MRSA bacteremias in the baseline year, yielding a hospital-onset rate of 0.79 per 10,000 patient-days. By the second six months of the intervention, this rate fell to 0.41, representing an aggregate 48% decline--but a nonsignificant result. Rates of health care-associated and community-onset bacteremias were unchanged. At baseline, 4 hospitals routinely performed active surveillance testing (AST) on 241 beds, which increased to 7 hospitals and 369 beds by July 2009. A follow-up survey completed by 11 hospitals indicated that barriers were similar for large and small facilities. A final survey performed 18 months postcollaborative indicated that 2 additional hospitals had initiated AST, 5 had expanded the use of AST, and only 1 had discontinued AST.
  
  
  CONCLUSIONS
  A collaborative model was successfully used to engage a diverse group of hospitals in a rural state to produce measurable improvement and sustained changes in processes of care.
authors.affiliation: Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA. skellie@salud.umn.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Kellie
authors.forename: Anne
authors.initials: A
authors.lastname: Timmins
authors.forename: Carlene
authors.initials: C
authors.lastname: Brown
mesh_terms: D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control*; D003299:Cooperative Behavior; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006761:Hospitals / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008507:Medically Underserved Area; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus; D009516:New Mexico; D019982:Organizational Case Studies; D010348:Patient Care Team; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*