LB 8 Mixed-Methods Assessment of a Legislative Mandate for Methicillin-Resistant Staphylococcus aureus (MRSA) Surveillance

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Matthew E. Wise, PhD , Division of Healthcare Quality Promotion, CDC, Atlanta, GA
Ronda Cochran, MPH , Division of Healthcare Quality Promotion, CDC, Atlanta, GA
Anne Marie France, PhD, MPH , New York City Department of Health and Mental Hygiene, New York, NY
Meg Stojcevski, BS , University of Chicago Medical Center, Chicago, IL
Amy Schneider, BA , Division of Healthcare Quality Promotion, CDC, Atlanta, GA
Melissa K. Schaefer, MD , Division of Healthcare Quality Promotion, CDC, Atlanta, GA
Michael Y. Lin, MD, MPH , Rush University Medical Center, Chicago, IL
Stephen G. Weber, MD, MSc , University of Chicago Medical Center, Chicago, IL
Alexander Kallen, MD , Division of Healthcare Quality Promotion, CDC, Atlanta, GA
Background: In August 2007, the Illinois legislature passed the MRSA Screening and Reporting Act, which mandates MRSA screening for certain patients admitted to Illinois hospitals. 

Objective: To assess hospital staff perceptions of the benefits and burdens associated with implementation of this law.

Methods: Focus groups were conducted across three strata of hospital staff (leadership, midlevel, and frontline) at a convenience sample of eight Chicago-area hospitals.  All participants completed a quantitative questionnaire with items rated from 1 (strongly disagree) to 5 (strongly agree).  Focus group transcripts were thematically coded and analyzed; mean scores were compared across staff types using a clustered F-test.

Results: Hospitals participating in the study ranged in size from 138 to 665 beds; six were teaching hospitals.  Overall, 126 hospital staff participated in 23 focus groups: 25% leadership, 38% midlevel, and 37% frontline.  Only 48% of participants perceived that the quality of care was better at their facility because of the legislation (mean score: 3.4/5), but 56% reported it had an overall positive impact.  Frontline providers had a more positive view of the legislation (mean: 3.9) than midlevel (mean: 3.5) and leadership (mean: 3.2) staff (p=0.02).  Perceived benefits of the legislation included increased knowledge/awareness of MRSA, more timely/accurate information on patients colonized with MRSA, and improved patient outcomes.  Negative consequences included increased resource utilization (e.g., cost, supplies, and staff time), the psychosocial impact of screening/isolation on patients, and difficulties in managing patient flow.  Although participants were generally neutral regarding whether their work responsibilities had changed due to the legislation (mean: 3.0), frontline staff were more likely to report that their responsibilities had changed (mean: 3.6) than midlevel (mean: 2.9) and leadership (mean: 2.4) staff (p<0.01).  Over 56% of participants would recommend similar legislation in other states (mean score: 3.6), but advised facilities in states considering legislation to educate staff and patients about MRSA screening, to evaluate the impact of the screening program, and to draft a clearly defined implementation plan.

Conclusions: Staff from Chicago-area healthcare facilities perceived that mandatory MRSA screening legislation resulted in some benefits to patient safety, but also highlighted many challenges in implementing the legislation.  States considering similar initiatives should attempt to minimize these challenges by collaborating with stakeholders throughout the legislative process on optimal messaging to patients and healthcare personnel, creation of implementation plans, and development of ongoing program evaluation strategies.