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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3119 — Assessing the Effect and Implementation of a Patient Education Strategy about MRSA Prevention for Veterans with Spinal Cord Injury and Disorder

Evans CT, Center for Management of Complex Chronic Care (CMC3), SCI-QUERI, Northwestern University; Guihan M, and Hill JN, CMC3, SCI-QUERI; Goldstein B, Office of Patient Care Services, SCI/D Services; Cameron K, Northwestern University;

Individuals with spinal cord injuries and disorders (SCI/D) are at increased risk for Methicillin-resistant staphylococcus aureus (MRSA) colonization and infection. This study assessed the effect of MRSA prevention educational materials on knowledge and behavior of Veterans with SCI/D and explored potential barriers to implementing the new materials into clinical practice.

A blinded, block-randomized controlled trial was conducted at two VA SCI Centers. Subjects were recruited March-September 2010 from inpatient, outpatient, and long-term care settings and had to be 18+ years of age, cognitively intact, and available for telephone or in-person follow-up. Subjects were randomized to the nurse-administered intervention or the usual care group. Usual care included dissemination of the existing patient information brochure. Nurses provided interactive education to subjects using an SCI-specific brochure. Pre- and post- test MRSA knowledge and prevention/behaviors scores were assessed. Feasibility of implementing this approach in clinical settings was evaluated via nurse educator interviews.

Thirty participants were randomized to the intervention and 31 to usual care. Participants were primarily male, older (mean age = 64.5), white (63.9%), with tetraplegia (63.9%), and an average injury duration of 20.5 years. Knowledge scores did not differ by treatment group but pre- and post-test scores did increase significantly for both groups. Intervention group patients were significantly more likely to express an intention to clean hands (90.0% vs 64.5%, p = 0.03) and ask providers about their MRSA status (46.7% vs 16.1%, p = 0.01). Nurses using the toolkit to educate patients rated the quality of the intervention materials as “high/very high” and indicated that the new materials could easily be incorporated into MRSA screening at admission and/or at discharge. Nurses described the interactive educational process as extremely useful in generating conversation and questions with patients.

A targeted educational strategy improved patient knowledge about MRSA and MRSA prevention, hand hygiene practices, intention to improve hand hygiene, and engagement with providers about their MRSA status.

This educational strategy has been disseminated to the 24 VA SCI Centers and is available on the VA SCI/D Services website. A facilitated implementation of the toolkit has been completed in 4 VA SCI Centers.

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