title: Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) are a concern in the 22 acute care Veterans Affairs (VA) spinal cord injury units where patients with unique rehabilitation and medical needs and a high risk of infection are treated.
  
  
  METHODS
  A bundle was implemented in VA spinal cord injury units consisting of nasal surveillance for MRSA on admission/in-hospital transfer/discharge, contact precautions for patients colonized or infected with MRSA, an emphasis on hand hygiene, and an institutional culture change where infection control became everyone's responsibility.
  
  
  RESULTS
  From October 2007, through June 2011, there were 51,627 admissions/transfers/discharges and 816,254 patient-days of care in VA spinal cord injury units. The percentage of patients screened increased to >95.0%. The mean admission MRSA prevalence was 38.6% ± 19.1%. Monthly HAI rates declined 81% from 1.217 per 1,000 patient-days to 0.237 per 1,000 patient-days (P < .001). Bloodstream infections declined by 100% (P = .002), skin and soft-tissue infections by 60% (P = .007), and urinary tract infections by 33% (P = .07).
  
  
  CONCLUSIONS
  Universal surveillance, contact precautions, hand hygiene, and an institutional culture change was associated with significant declines in MRSA HAIs in a setting with a high prevalence of MRSA colonization and a high risk for infection.
authors.affiliation: MRSA/MDRO Program Office, Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA. Martin.Evans@va.gov
authors.forename: Martin E
authors.initials: ME
authors.lastname: Evans
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Kralovic
authors.forename: Loretta A
authors.initials: LA
authors.lastname: Simbartl
authors.forename: D Scott
authors.initials: DS
authors.lastname: Obrosky
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Hammond
authors.forename: Barry
authors.initials: B
authors.lastname: Goldstein
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Gary A
authors.initials: GA
authors.lastname: Roselle
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jain
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006757:Hospital Units; D006787:Hospitals, Veterans; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D012306:Risk; D013119:Spinal Cord Injuries; D013203:Staphylococcal Infections / Q000517:prevention & control*; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000900:Anti-Bacterial Agents