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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;

Objectives:
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.

Methods:
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.

Results:
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.

Implications:
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.

Impacts:
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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