Effectiveness of Core and Enhanced Strategies as a Method to Reduce Methicillin Resistant Staphylococcus aureus and Vancomycin Resistant Enterococcus infections in a Tertiary Care Hospital

Background: Methicililn resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE) infections are major causes of hospital-acquired infections. MRSA and VRE infections are related to increased lengths of hospital stays which leads to increased costs, mortality, and morbidity.  The University of Minnesota Medical Center, Fairview, a 884 staffed bed hospital, historically participated in core management strategies as identified in a variety of published professional guidelines.  Despite implementation of core management strategies; reductions of infections with MRSA and VRE were not fully achieved.

Objective: The purpose of this study was to identify and implement enhanced strategies for the purpose of reducing infections with MRSA and VRE.

Methods: The infection prevention department reviewed and evaluated all existing core strategies to identify improvement opportunities.  Core strategies included: administrative support, education and training , early identification and surveillance (flagging known patients, house-wide surveillance and targeted active surveillance for MRSA and VRE), dissemination of data to managers, contact isolation precautions, environmental management (cleaning and disinfection) of the patient’s environment and equipment, and implementation of  an antimicrobial stewardship team.  The review and evaluation identified gaps in select practices as well as opportunities to initiate enhanced strategies based on studies presented or published from professional conferences and epidemiology publications.   Enhanced strategies included: restructuring of environmental service’s isolation education and training, use of adenosine triphosphate (ATP) bioluminescent testing to identify high contamination surfaces in the patient’s environment, implement the use of ATP to identify effectiveness of cleaning with microfiber cloths, implementation of ATP for monitoring discharged room cleanliness, targeted application of chlorhexidine bathing of patients, and adoption of a culture which supports reduction of infections as a method to reduce MRSA and VRE infections.

Results: Implementation of select enhanced strategies in addition to existing core strategies resulted in reducing MRSA infections from 0.2/1000 patient days in 2009 to 0.12/1000 patient days in first three quarters of 2010 and VRE infections from 0.7/1000 patient days in 2009 to 0.26/1000 patient days in the first three quarters of 2010.

Conclusions: Review and evaluation of core strategies and published research assisted in identifying enhanced strategies compatible with the hospital’s operation and patient population. And finally, a multidisciplinary approach and culture to reduce hospital associated infections was effective in achieving the desired results.