title: Methicillin-resistant Staphylococcus aureus prevention practices in hospitals throughout a rural state.
abstract: BACKGROUND
  The Institute for Healthcare Improvement (IHI) created an evidence-based bundle to help reduce methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections. The study aim was to identify which components of the IHI's MRSA bundle that rural hospitals have implemented and to identify barriers that hindered implementation of bundle components.
  
  
  METHODS
  Four surveys about the IHI's MRSA bundle were administered at the Iowa Statewide Infection Prevention Seminar between 2007 and 2011. Surveys were mailed to infection preventionists (IPs) who did not attend the meetings.
  
  
  RESULTS
  The percentage of IPs reporting that their hospital implemented a hand hygiene program (range by year, 87%-94%) and used contact precautions for patients infected (range by year, 97%-100%) or colonized (range by year, 77%-92%) with MRSA did not change significantly. The number of hospitals that monitored the effectiveness of environmental cleaning significantly increased from 23%-71% (P < .01). Few hospitals assessed daily if central lines were necessary (range by year, 22%-26%). IPs perceived lack of support to be a major barrier to implementing bundle components.
  
  
  CONCLUSIONS
  Most IPs reported that their hospitals had implemented most components of the MRSA bundle. Support within the health care system is essential for implementing each component of an evidence-based bundle.
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA. Electronic address: jennifer-mcdanel@uiowa.edu.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: McDanel
authors.affiliation: Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Ward
authors.affiliation: Department of Quality, Safety, and Regulatory, Mercy Hospital, Coon Rapids, MN.
authors.forename: Laurie
authors.initials: L
authors.lastname: Leder
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA; Iowa City Veterans Affairs Health Care System, Iowa City, IA.
authors.forename: Marin L
authors.initials: ML
authors.lastname: Schweizer
authors.affiliation: Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Dawson
authors.affiliation: Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA; Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA; Clinical Quality, Safety, and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Diekema
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA.
authors.forename: Tara C
authors.initials: TC
authors.lastname: Smith
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA; Iowa City Veterans Affairs Health Care System, Iowa City, IA.
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA; Clinical Quality, Safety, and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Loreen A
authors.initials: LA
authors.lastname: Herwaldt
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D063373:Hand Hygiene / Q000379:methods; D006780:Hospitals, Rural; D006797:Housekeeping, Hospital / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D007484:Iowa / Q000453:epidemiology; D008137:Longitudinal Studies; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires
keywords: Hospital-associated infections; Institute for Healthcare Improvement; Methicillin-resistant Staphylococcus aureus; Prevention