Provider and Patient Perceptions on MRSA Prevention in Spinal Cord Injury Centers

Background: MRSA is a frequent cause of community- and healthcare-associated infection.  Individuals with spinal cord injury (SCI) are at high risk for MRSA colonization and infection. Thus, the Department of Veterans Affairs (VA) released guidelines for the SCI Centers focused on strategies to prevent the spread of MRSA. Although general MRSA prevention education materials are available, none address unique issues among those with a disability (e.g. how can a person with impaired hand function perform hand hygiene).

Objective: The goal of this study was to understand SCI provider and patient perspectives on hand hygiene and other MRSA prevention strategies.

Methods: 6 focus groups were conducted with providers and 1 with patients at two VA SCI Centers. A panel of experts in SCI medicine and nursing, infectious disease, and patient education assisted in refinement of the focus group protocol. Questions addressed topics on knowledge and understanding about MRSA and testing and preventive behaviors to prevent transmission (hand hygiene, contact precautions). All focus groups were analyzed using latent content and constant comparative analysis.

Results: 33 providers participated in the focus groups; representing inpatient care (23), outpatient care (9), home care (5), and residential care (4); 76% were nurses and 14% were physicians. 8 patients participated; all were male, 75% had tetraplegia, with a mean age at injury of 46 years. 5 reported never having MRSA, 2 had MRSA in the past, 1 was unsure. Emergent and unique themes are represented in the table below.

Conclusions: Data gathered from this study are being used to develop and pilot test MRSA educational materials for SCI units. The educational materials developed and lessons learned from this study will be used in a larger implementation study to reduce MRSA infections in the SCI population.

Patients	Physicians	Inpatient/ Outpatient Nurses	Residential Care Facility Nurses	Home Health Nurses
Common Themes across Groups
Lack of General MRSA Knowledge
Perceived Severity of MRSA Lessened Because of Prevalence in SCI Population
Lack of Consistency in Hospital Policy (Dissonance Between Isolation Policy and SCI Unit Policies Regarding “Patient Freedom”)
Lack of Consistent & Specialized Education on MRSA in SCI for SCI Patients, Physicians, and Nurses
Lack of Communication Among and Between Providers and Patients about Patient MRSA Status and Proper Hand Hygiene
Lack of Communication Between Providers about Current MRSA Prevention Strategies
Unique Themes
Isolation procedures dissonant with patient rules	Keeping up on new MRSA information	Resource barriers to patient education	Caregiver adherence to hand hygiene relatively unknown	Do quadriplegics need to do hand hygiene?
Frequency of MRSA testing is too much	Multi-bed rooms barriers to hand hygiene	Patient ability to understand MRSA information	Patient misunderstanding of MRSA status	Lack of resources in home setting