Methods: We implemented a “MRSA bundle” in all 153 acute care VA medical centers nationwide in an effort to decrease MRSA HAIs. The bundle consisted of 1) nasal surveillance for MRSA on all admissions, in-hospital transfers, and discharges, 2) contact precautions for patients carrying MRSA, 3) an emphasis on hand-hygiene, and 4) a culture change where infection control became everyone’s responsibility. Personnel at each center entered aggregate data on surveillance compliance, MRSA prevalence, healthcare-associated MRSA transmissions, and HAIs each month into a central database.
Results: From October 2007 through June 2009 when the bundle was fully implemented, there were 1,213,646 admissions and transfers (230,470 to intensive care units (ICUs) and 983,176 to non-ICUs) and 5,296,757 bed-days of care (846,570 ICU and 4,450,187 non-ICU). Admission screening increased from 82% to 92%, and transfer/discharge screening increased from 71% to 92% during this time. The mean (±SD) admission MRSA prevalence was 13.2 ± 4.9% (facility mean range 5.2% to 29.1%). In-hospital MRSA transmission rates fell 23% in the non-ICU (P = 0.01, linear regression) and 32% in the ICU (P = 0.004) setting. HAI rates declined 24% in the non-ICU setting (P = 0.04). This included declines in bloodstream infections by 58%, pneumonias by 43%, urinary tract infections by 30%, and skin and soft-tissue infections by 26%. HAI rates in ICUs did not change in the two years before full implementation of the MRSA bundle (P = 0.69 for trend), but declined 77% (P < 0.001) with full implementation of the bundle. MRSA ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) were the most common infections observed. During the analysis period, MRSA VAPs decreased 53% and CLABSIs decreased 44%, while the ventilator utilization rate decreased 19.7% (P <0.001) and the central line utilization rate increased 16.2% (P <0.001). In this setting, non-device related MRSA bloodstream infections declined 58%, pneumonias 67%, urinary tract infections 79%, and skin and soft-tissue infections 32%.
Conclusions: A program of universal surveillance, contact precautions, hand hygiene, and culture change was associated with a decrease in MRSA in-hospital transmissions and HAIs.