Impact of the VA MRSA [methicillin-resistant Staphylococcus aureus] Initiative on the Incidence of Nosocomial MRSA Infection in Intensive Care Units at the Minneapolis VA Medical Center

Background:

We measured the impact of the VA MRSA initiative [nasal screening of all hospital admissions, use of contact isolation for patients colonized or infected with MRSA and required hand washing or decolonization before and after patient contact] on the incidence of MRSA infection in our 10 bed medical intensive care unit [MICU] and 12 bed surgical intensive care unit [SICU].  

Objective:

To measure the impact of the initiative on MRSA infection in the two intensive care units.

Methods:

We used results of ongoing prospective surveillance for fiscal year 2007 [the control period] and for FY 2008 and 2009 [the intervention period].  We compared the incidence of skin and soft tissue infection [SSTI], blood stream infection [BSI] [both device-related and not], pneumonia [both ventilator-associated and not].  Denominators were, as appropriate, bed days of care, intravascular line days or ventilator days.  Comparisons were made with the Mann-Whitney U Test.

Results:

Skin and soft tissue infection [p = .007], BSIs that were not device related [p=.013] and VAPs [p=.006] were significantly less frequent after the interventions were made.   When the units were examined separately, significant [p<.05] reductions in SSTI, device related BSI and ventilator-associated pneumonias occurred in the MICU.  The only significant reduction in the SICU was in BSIs that were not device related. 

Conclusions:

The VA MRSA initiative reduced the frequency of some nosocomial MRSA infections in our ICUs.  The effect appeared to be substantially greater in the MICU.