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Background: Proper HH is well recognized as the most effective way to avoid MRSA of all types. Despite great attentions on HH and MRSA prevention, sustaining HH compliance remains a challenge. The Neonatal Intensive Care unit (NICU) in our institution features private patient (pt) rooms and has instituted a bundle of MRSA control measures: 1) active MRSA screening using real-time PCR assay upon admission and weekly thereafter; 2) contact isolation for MRSA patient; and 3) cohorting nursing assignment. The presence of these resource-consuming measures, however, was unable to eradicate MRSA transmission.
Objective: To measure the impacts of HH compliance on MRSA transmission and on MRSA associated length of stay (LOS) and charges.
Methods: This retrospective observational study took place between 4/2009 and 10/2010 in our NICU. MRSA transmission was defined as MRSA-free infants at admission developed MRSA colonization or infection during stay. “Secret shoppers” conducted monthly HH compliance measured by hand hygiene before or after patient contact or after environment contact. Linear regression was used to examine the correlation between HH compliance rate and MRSA transmission rate per 1000 patient-days (PD). We estimated episode of MRSA transmission avoided by adhering to HH by multiplying excess transmission rate with average monthly PD. Using our previously published numbers on MRSA attributable LOS and charges, we estimated LOS and charges avoided by preventing MRSA transmission.
Results: The overall HH compliance in NICU was 68.8%, and overall MRSA transmission rate was 2.0/1000 PD. HH compliance was negatively associated with MRSA transmission rate (correlation coefficient: -0.22, p>0.05). Figure. Sustaining HH compliance ≥80% was associated with a 40% reduction of MRSA transmission risk (incidence rate ratio: 0.60, p=0.06), or an estimated reduction of 1.3 episodes of MRSA transmission per month. This reduction yielded an avoidance of 14.8 days of hospital LOS or $70,300 charges should the transmission resulted in a MRSA colonization or a 79.4 days of LOS and $215,4000 charges should the transmission resulted in a MRSA infection.
Conclusions: This study underscored the importance of HH and suggested HH as a cost-effectiveness means for preventing MRSA transmission in hospitals.
