A Regional Approach To Developing Standardized Methicillin Resistant Staphylococcus aureus (MRSA) Infection Control Practices for Implementation in 25 Upstate New York Acute Care Hospitals

ISSUE: Since the emergence of MRSA in the early seventies, there have been numerous and even conflicting published recommendations on preventing nosocomial (N) transmission in acute care hospitals. The impact of these recommendations has led to variations in interpretation and implementation of MRSA infection control practices among hospitals. The Iroquois Healthcare Association (IHA) set out to assist member hospitals in improving MRSA infection control strategies (ICS) through standardization. PROJECT: Beginning in December of 2003, IHA (which represents 57 hospitals in 31 counties in Upstate New York) recruited Infection Control Professionals (ICP) from 25 hospitals to develop and assess which MRSA ICS were most effective in reducing N-MRSA transmission. ICS were organized into 4 practice categories. Small work groups developed evidence-based practice standards for each of the 4 categories as well as compliance monitoring activities. Core teams in each hospital were responsible for implementing the project practices either hospital-wide or within selected units. N-MRSA incidence rates were captured prior to and after implementing revised practices using standardized surveillance methods. RESULTS: Best Practices (BP) were established and implemented in all project hospitals March 1, 2005. BP categories included: case tracking, isolation practices, case screening and environment of care standards. Three additional optional protocols (OP) were implemented in some hospitals and included: surveillance culture screening, gown point-of-wear and electronic MRSA alert. Since implementation, hand hygiene compliance averaged accross all hospitals 69% and gown/glove compliance increased from 72.4% to 92%. Average N-MRSA rates in the intensive care unit (ICU) have resulted in a downward trend; pre-intervention 3.19/1000 patient days and post-intervention 2.26/1000 patient days. LESSONS LEARNED: This project established a mechanism for health care professionals from rural, community and teaching hospitals to partner and work collaboratively on a patient care issue resulting in heightened understanding, establishment of regional evidence- based practices, and initiation of practices aimed at reducing MRSA exposure risk. Monitoring compliance with standards of practice is a challenge requiring frequent redesign and may not be feasible for all prevention strategies. Standardized methods for establishing N-MRSA rates are essential for measuring effectiveness of control measures.