The Impact of a Bundle Including Active Screening for MRSA on Hospital-Acquired MRSA Infections in the ICU

Background: Hospital acquired MRSA infections are a well-established cause of morbidity and mortality in the hospitalized population, increasing illness, death, length of stay and resource utilization. In the years after its emergence, MRSA was primarily recognized as hospital floral; the current trend shows MRSA as a dominant member of the community flora, necessitating surveillance of admissions as well as inpatients in a comprehensive program to control spread.

Objective: Determine the impact of bundled interventions, including surveillance cultures for MRSA, in the ICU.

Methods: On December 1, 2007 active surveillance culturing (ASC) for MRSA began in the ICU.  Upon admission or transfer to the ICU, all patients were required to receive a surveillance culture of the anterior nares. Patients colonized with MRSA were placed on contact isolation precautions throughout their admission. In October 2008, the MRSA bundle was implemented which includes ASCÕs, hand hygiene, isolation precautions for infected and colonized, decontamination of the environment and equipment, adherence to Central Venous Catheter Bundle, and adherence to Ventilator Associated Prevention Bundle.

Results: Hospital acquired MRSA in the ICU was reduced from a high of 5.1 per 1000 patient days in the 3^rd quarter of 2005 to zero for the last three quarters in 2009. ASC compliance in the ICU has been has been about 70%. Analysis of ICU length of stay showed no significant decrease during 2008-9 (Spearman rank correlation, p=0.2728).

Conclusions: Bundled interventions in the ICU have had a significant impact in the reduction of HAIÕs. This study is unable to individually delineate the risk reduction with each component of the bundle but demonstrates the success of the program.