title: A bundled approach to reduce methicillin-resistant Staphylococcus aureus infections in a system of community hospitals.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) infections pose a significant challenge to U.S. healthcare facilities, but there has been limited study of initiatives to reduce infection and increase patient safety in community hospitals. To address this need, a multifaceted program for MRSA infection prevention was developed for implementation in 159 acute care facilities. This program featured five distinct tools-active MRSA surveillance of high-risk patients, enhanced barrier precautions, compulsive hand hygiene, disinfection and cleaning, and executive champions and patient empowerment-and was implemented during 1Q-2Q 2007. Postintervention (3Q 2007-2Q 2008), 10.2% of patients with high-risk for infection or complications due to MRSA had nasal colonization. Volume of disposable gown and alcohol-based hand sanitizer use increased substantially following program implementation. Self-reported rates, based on NHSN definitions, of healthcare-associated central line-associated bloodstream infections and ventilator-associated pneumonia due to MRSA decreased 39% (p < .001) and 54% (p < .001), respectively. Infection rates continued to decrease during the follow-up period (1Q-4Q 2009). This sustained improvement demonstrates that reducing healthcare-associated MRSA infections in a large number of diverse facilities is possible and that a "bundled" approach that translates science into clinical and executive performance expectations may aid in overcoming traditional barriers to implementation.
authors: Clinical & Physician Services Group, HCA. Jonathan.perlin@hcahealthcare.com
authors: Jonathan B
authors: JB
authors: Perlin
authors: Jason D
authors: JD
authors: Hickok
authors: Edward J
authors: EJ
authors: Septimus
authors: Julia A
authors: JA
authors: Moody
authors: Jane D
authors: JD
authors: Englebright
authors: Richard M
authors: RM
authors: Bracken
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods / Q000592:standards; D005260:Female; D063373:Hand Hygiene; D006764:Hospitals, Community; D006797:Housekeeping, Hospital / Q000379:methods / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification* / Q000472:pathogenicity; D008875:Middle Aged; D009096:Multi-Institutional Systems; D009297:Nasal Mucosa / Q000382:microbiology; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D014481:United States; D055815:Young Adult