![[ Visit the Fifth Decennial online ]](images/banner.gif)
Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: In October 2001 we started a MRSA control effort on a surgical unit. This effort was expanded to the SICU in October 2003. Because of sustained reductions in the rate of MRSA infection achieved on these units, MRSA control efforts were expanded to all acute care units at VA Pittsburgh Healthcare System during the 4th quarter of fiscal year (FY) 2005. We previously reported the results of the intervention through FY 2007. This is a follow up to our previous report.
Objective: To determine the effect of the MRSA control initiative on the rates infection by MRSA and other antibiotic resistant pathogens.
Methods: Starting in the 4th quarter of FY 2005 MRSA surveillance cultures were obtained from all patients admitted to acute care units. Unit staff were notified of positive microbiology results for MRSA, VRE, ESBL + organisms, and Clostridium difficile by an automated twice daily printout generated by the hospital computer scan of microbiology results. There was a systematic effort to reduce barriers to hand hygiene. Staff received regular feedback regarding MRSA transmission, hospital associated MRSA infection, and compliance with hand hygiene and barrier precautions. There was no specific targeting of resistant organisms other than MRSA, and there was no systematic effort to change antimicrobial usages.
Results: Total patient days increased from 38,099 in FY 2004 to 42,308 in FY 2009. Rates of hospital associated infections due to organisms of interest are shown in the table. Rates are expressed as infections per 1000 patient days.
Objective: To determine the effect of the MRSA control initiative on the rates infection by MRSA and other antibiotic resistant pathogens.
Methods: Starting in the 4th quarter of FY 2005 MRSA surveillance cultures were obtained from all patients admitted to acute care units. Unit staff were notified of positive microbiology results for MRSA, VRE, ESBL + organisms, and Clostridium difficile by an automated twice daily printout generated by the hospital computer scan of microbiology results. There was a systematic effort to reduce barriers to hand hygiene. Staff received regular feedback regarding MRSA transmission, hospital associated MRSA infection, and compliance with hand hygiene and barrier precautions. There was no specific targeting of resistant organisms other than MRSA, and there was no systematic effort to change antimicrobial usages.
Results: Total patient days increased from 38,099 in FY 2004 to 42,308 in FY 2009. Rates of hospital associated infections due to organisms of interest are shown in the table. Rates are expressed as infections per 1000 patient days.
| FY04 | FY05 | FY06 | FY07 | FY08 | FY09 | |
| MRSA | 0.94 | 0.56 | 0.44 | 0.44 | 0.25 | 0.26 |
| VRE | 0.34 | 0.25 | 0.26 | 0.13 | 0.47 | 0.26 |
| ESBL | 0.05 | 0.10 | 0.13 | 0.03 | 0.05 | 0.05 |
C.difficile | 1.00 | 1.44 | 0.69 | 0.76 | 0.50 | 0.50 |
Rates of hospital associated MRSA and C. difficile infection declined throughout the post intervention period (FY06-FY09). The decline in MRSA infection rate was significant (P<.01) as was the decline in C. difficile infection (P <.005). Rates of VRE and ESBL gram negative organisms were low initially and did not changed significantly throughout the observation period.
Conclusions: Expansion of a MRSA control program from surgical units to the whole facility was followed by progressive and sustained decreases in both MRSA and C. difficile infection.