Reduction of Methicillin- Resistant Staphylococcus aureus (MRSA) Health Care Associated Infections in Two Spinal Cord Injury Units Using the VHA MRSA Bundle- A Two Year Perspective

Background:

The VHA-MRSA Prevention Bundle (MPB) was implemented in September 2007 in our two Spinal Cord Injury (SCI) Units. We review our data for reduction in healthcare-associated MRSA transmissions (HCA-T) and discuss differences in the two nursing units to account for infection outcomes over a 25 month period.

Objective:

We analyze process and outcome data to determine if the VHA MRSA Prevention Bundle is effective in reducing MRSA HCA-T in our SCI units (1A,1B) in the face of high endemic rates and high prevalence rates on admission to the facility. Methods: The two SCI units of 20 beds each implemented the VHA-MPB in September 2007.  The MPB included 1) nares screening of all patients on admission, transfer and discharge for MRSA carriage; 2) hand hygiene before and after care; 3) Contact Precautions at admission if MRSA-positive within 1 year or a positive nares screen or infection site culture on admission; 4) increased awareness of MRSA carriage required a change in attitude on the part of staff to include monitored patient room cleaning, use of disposable equipment and disinfection of reusable patient-care equipment; 5) Leadership support. Each unit recruited interested staff champions to facilitate the use of the total bundle practices for all patients. Results: When demographics for the units were compared (1A, 1B), they had comparable numbers of admissions (n=336,323), transfers or discharges (n=275,279), patients positive on admission by nares screen or history (n=162,156), patients with infection on admission (n=25,24), and total prevalence of MRSA positive patients on admission (n=45%, 44%). Admission and exit swabbing compliance differed with 1A at 97% and 89%, while 1B had lower rates for both (88%, 79%). The number of MRSA HCA-T on each unit was comparable (n=32, 39). However, the number of new infections differed significantly. The most common infections were skin and soft tissue infection (SSTI) on 1A and urinary tract infections and SSTI on 1B.   

Outcome Measures	NU 1A	NU 1B
MRSA Transmissions (colonized & infected)	32	39
MRSA Colonized on the unit	23	13
MRSA Infected on the unit	9	26
Bed Days of Care	12,516	12,580
MRSA Healthcare Assoc Infection Rate	2.6	3.1

Conclusions:

MRSA HCA-T were comparable on both units. Higher number of new infections on 1B correlated with lower compliance with MRSA screening. When participation of the clinical staff in infection prevention measures using the method of Positive Deviance (PD) was assessed, 1A was very active. 1A had active champions, a stable & supportive nurse manager, attended weekly prevention team meetings, conducted Unit Briefings and updated their posted outcome & process data graphs monthly. 1B did not participate in the PD aspects of the VHA-MPB.  Making infection prevention a priority for all staff is a critical  component for the prevention of MRSA transmission.