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258 Evaluation of Strategies to Reduce Hospital Acquired (HAI) Methicillin Resistant Staphylococcus aureus (MRSA) Transmission and Infection

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Alexis Raimondi, MS, RN, CIC , Beth Israel Medical Center, Brooklyn, NY
Brian Koll, MD, FACP, FIDSA , Beth Israel Med Ctr, New York, NY
Marie Moss, MPH, RN, CIC , Beth Israel Med Ctr, New York, NY
Barbara Smith, RN, CIC , St. Luke's-Roosevelt Hospital Center, New York, NY
Eloisa Santos, RN, CIC , St. Luke's-Roosevelt Hospital Center, New York, NY
Patricia Friedmann, MS , Beth Israel Med Ctr, New York, NY
Nancy Nugent , Beth Israel Med Ctr, New York, NY
Richard Smith, CIC , Long Island College Hospital, Brooklyn, NY
David Crimmins, RN, CIC , Beth Israel Med Ctr, New York, NY
Angela Gabasan, RN, CIC , St. Luke's-Roosevelt Hospital Center, New York, NY
Maureen Kreider, MSN, RN, CIC , Beth Israel Med Ctr, New York, NY
Eileen Abruzzo, RN, CIC , Long Island College Hospital, Brooklyn, NY
Kathryn Stanak, RN, CIC , Beth Israel Med Ctr, New York, NY
William Riley, MD , Beth Israel Med Ctr, New York, NY
Emilia Sordillo, MD, PhD , St. Luke's-Roosevelt Hospital Center, New York, NY
Douglas V. Sepkowitz , Long Island College Hospital, Brooklyn, NY
Clarinda MacLow , Beth Israel Med Ctr, New York, NY
Barry Kreiswirth, PhD , Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, NJ
Bruce Polsky, MD , St. Luke's-Roosevelt Hospital Center, New York, NY
Background: MRSA causes up to 70% of all HAIs, prolongs hospital length of stay by six days and is associated with significant morbidity and mortality.  The additional cost of a HAI MRSA infection is up to $10,000.  The overall prevalence of MRSA in the United States has dramatically increased over the past few years with 46.3 per 1,000 patients either colonized or infected with MRSA.  A substantial proportion of MRSA colonized patients subsequently develop a HAI MRSA infection.

Objective: To determine if active surveillance cultures combined with standard infection prevention intervention strategies can reduce MRSA transmission, decrease MRSA HAIs among patients in six intensive care units (ICUs) across a network of five hospitals and to assess the impact of environmental cleaning protocols on MRSA transmission and infection.

Methods: A MRSA infection prevention practice bundle consisting of hand hygiene, contact precautions and active surveillance along with environmental decontamination protocols were implemented.  Checklists were used to monitor compliance with the bundle and environmental protocols.  Active surveillance cultures were done within 24 hours of admission.  BBL CHROMagar was used for MRSA identification.  Strain typing of isolates was done to determine if MRSA transmission occurred.

Results: 5,568 patients were followed over 12 months.  4,504 patients were screened for MRSA colonization within 24 hours of admission.  451 (10%) patients were colonized with MRSA.  MRSA colonization significantly increased as the number of admissions for an individual patient increased. No significant association between the number of admissions and MRSA infections was found.  Compliance with the MRSA infection prevention practice bundle ranged from 91% - 100%.  There were no significant differences between ICUs regarding adherence to the MRSA infection prevention bundle.  There were significant differences between ICUs regarding adherence to MRSA decontamination environmental protocols ranging from 54% - 100%.  As compliance with environmental decontamination protocols significantly increased over the year (p < 0.0001), the MRSA HAI rate decreased from 2.1% to 0.9% (p = 0.09).  23 patients developed a HAI MRSA infection.  Molecular typing showed that 85% of patients were infected with their own strain.  The predominant strains were USA 100 and 300.

Conclusions: There were no differences between the ICUs regarding adherence to the MRSA infection prevention bundle.  Environmental protocols were shown to be a more significant determinant than active surveillance in the prevention of MRSA infections.