MRSA and Hand Hygiene Education: Perceptions and Practices of Healthcare Workers at VA Spinal Cord Injury Centers

Background: Educating healthcare workers (HCWs) about the control of MRSA spread in hospital settings is a key component of prevention programs. However, little is known about the perceived adequacy of education that HCWs receive about MRSA and hand hygiene, or regarding strategies HCWs use to educate patients. Understanding these issues is especially important in the context of spinal cord injury/disorders (SCI/D) given that MRSA prevention efforts are complicated by use of common areas for rehabilitation and exercise, shared equipment, and patient hand hygiene challenges due to impaired hand function.

Objective: To describe the perceptions and practices of SCI/D HCWs related to MRSA and hand hygiene education.  

Methods: A web-based survey was completed by 295 (43.8%) of 673 VA SCI/D HCWs at 24 VA SCI Centers across the U.S. in August 2010. Complete data for 234 respondents was used for this descriptive analysis.

Results:  HCW respondents consisted of nurses (56.4%), therapists (24.4%), physicians (11.1%), and other health professionals (8.1%). Respondents mostly rated the evidence for handwashing in preventing resistant organisms (like MRSA) in SCI patients as ‘strong/very strong' for HCWs (87.1%), SCI patients (65.4%), and SCI patients with poor hand function (58.1%). HCWs mostly rated the adequacy of training they had received as 'good/excellent' on hand hygiene (91.0%), MRSA prevention (85.0%), and how to educate patients about MRSA (76.1%). The most commonly reported strategies to educate providers included in-services (≥80%) and receiving brochures/leaflets (≥60%); return demonstration of skill was reported for hand hygiene (48.3%) and MRSA training (26.1%). Over half of respondents reported that in the past 12 months, they ‘usually/always' provided MRSA education to SCI patients (60%) or visitors/family providing direct patient care (53.8%). Similar results were seen for educating about hand hygiene. Over half of HCWs reported that they ‘usually/always' educate these stakeholders. About three-fourths reported having brief discussions with stakeholders, 36-44% reported using brochures/leaflets, and 18-24% used return demonstration of skill/teach-back methods. Half of HCWs reported that the hand hygiene and MRSA education they provided was good/excellent.

Conclusions: The vast majority of HCWs reported that the education they have received about MRSA and hand hygiene was good/excellent; however, only half of HCWs reported that they frequently provide education to patients or to visitors, family or caregivers, and not all thought the evidence to support handwashing efforts was strong for those with SCI/D. Education is an important component of MRSA prevention and is recommended by both the CDC and VA. MRSA prevalence rates in this population demonstrate a need to improve the education of patients and families.