BACKGROUND/RATIONALE:
Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infection in the U.S. and in persons with spinal cord injury or disorder (SCI/D). Materials developed for the general VA population do not address the unique challenges that face Veterans with SCI/D.

OBJECTIVE(S):
1) Identify and evaluate current VA/non-VA MRSA education documentation for patients, caregivers, and providers using input from an expert panel, patient and provider focus groups and caregiver interviews;
2) Revise and adapt existing VA MRSA education materials to address important unique SCI/D-related issues;
3) Assess the effect of educational materials on knowledge and behavior in patients via a randomized controlled trial (RCT) at two VA SCI Centers;
4) Develop a toolkit in preparation of national roll-out to all VA SCI centers.

METHODS:
Multiple methodologies were used at two sites including: an expert panel, focus groups with SCI/D patients and providers, input from an "educated consumer panel", and an RCT of SCI/D patients randomized to control (usual care) or intervention (new educational materials) group with a pre-test/post-test assessment of knowledge and behavior.

FINDINGS/RESULTS:
Six focus groups with 33 providers (76% nurses/24% physicians) and 1 patient focus group (n=8) were conducted at two sites. We found that at baseline, patient education about MRSA and hand hygiene was limited, providers identified a need for SCI/D-specific educational materials and effective ways to teach patients about MRSA. New educational materials were developed based on focus group data and expert panel input and tested with 61 patients (Intervention n=30, Control n=31). Overall, the mean knowledge score increased between the pre-test and post-test period (12.4 vs. 14.0, p=0.003), but the change in score did not significantly differ between the intervention and control groups (1.7 vs. 1.5, p=0.81). Most subjects' hand hygiene behavior either stayed the same or increased (57.4% to 86.9%). Intervention group subjects were significantly more likely to report improved hand hygiene behavior (60.0% vs. 29.0%, p=0.02) and more likely to report having asked their provider about their MRSA status (46.7% vs. 16.1%, p=0.03) compared to controls.

IMPACT:
This study developed and tested educational materials that will be included as part of a toolkit to assist providers in providing MRSA information to patients with SCI/D and their informal caregivers in a future national implementation study.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Evans CT, Hill JN, Guihan M, Chin A, Goldstein B, Richardson MS, Anderson V, Risa K, Kellie S, Cameron KA. Implementing a patient education intervention about Methicillin-resistant Staphylococcus aureus prevention and effect on knowledge and behavior in veterans with spinal cord injuries and disorders: a pilot randomized controlled trial. The journal of spinal cord medicine. 2014 Mar 1; 37(2):152-61. [view]
2. Hill JN, Evans CT, Cameron KA, Rogers TJ, Risa K, Kellie S, Richardson MS, Anderson V, Goldstein B, Guihan M. Patient and provider perspectives on methicillin-resistant Staphylococcus aureus: a qualitative assessment of knowledge, beliefs, and behavior. The journal of spinal cord medicine. 2013 Mar 1; 36(2):82-90. [view]
3. Ramanathan S, Hill JN, Cameron KA, Safdar N, Guihan M, Evans CT. Relationship between knowledge and attitudes of methicillin-resistant Staphylococcus aureus and hand hygiene behavior in Veterans with spinal cord injury and disorder. American journal of infection control. 2015 May 1; 43(5):537-9. [view]

Conference Presentations

1. Evans (Mayfield) C, Guihan M, Hill JN, Goldstein B, Cameron K. Assessing the effect and implementation of a patient education strategy about MRSA prevention for Veterans with spinal cord injury and disorder. Poster session presented at: VA HSR&D National Meeting; 2012 Jul 18; National Harbor, MD. [view]
2. Evans (Mayfield) C, Hill JN, Cameron K, Risa K, Kellie S, Richardson M, Doruelo P, Anderson V, Rosin LD, Williamson P, Gruber S, Goldstein B, Guihan M. Development of MRSA educational materials for Veterans with a spinal cord injury: A patient safety research agenda between QUERI and operations. Poster session presented at: VA “One Team toward One Dream” National Quality, Patient Safety and Systems Redesign Conference; 2010 Jun 22; San Francisco, CA. [view]
3. Evans (Mayfield) C, Hill JN, Cameron K, Risa K, Kellie S, Richardson M, Doruelo P, Anderson V, Rosin LD, Williamson P, Gruber S, Goldstein B, Guihan M. Provider and patient perceptions on MRSA prevention in spinal cord injury centers. Poster session presented at: VA HSR&D Field-Based Quality Improvement in Parallel Circuits Meeting on VA System Redesign, Operational Systems Engineering, and Implementation Research; 2010 Jul 14; Indianapolis, IN. [view]
4. Evans (Mayfield) C, Hill JN, Cameron K, Risa K, Richardson M, Doruelo P, Goldstein B, Guihan M. Provider and patient perceptions on MRSA prevention in spinal cord injury centers. Poster session presented at: International Conference on Healthcare-Associated Infections; 2010 Mar 18; Atlanta, GA. [view]
5. Evans (Mayfield) C, Guihan M, LaVela SL, Weaver FM. SCI Quality Enhancement Research Initiative (QUERI): Building and Implementing. Presented at: Academy of Spinal Cord Injury Professionals Annual Meeting; 2013 Sep 2; Las Vegas, NV. [view]
6. Evans (Mayfield) C, Hill JN, Cameron K, Risa K, Kellie S, Richardson M, Doruelo P, Anderson V, Williamson P, Gruber S, Goldstein B, Guihan M. Spinal cord injury provider and patient perceptions on MRSA prevention. Poster session presented at: Academy of Spinal Cord Injury Professionals Annual Meeting; 2010 Sep 22; Las Vegas, NV. [view]
7. Hill JN, Guihan M, Hogan TP, Evans (Mayfield) C, Smith BM, Weaver FM. Using a Common Framework to Implement Clinical Practice Change: Experiences in the Spinal Cord Injury System of Care. Poster session presented at: VA HSR&D National Meeting; 2012 Jul 18; National Harbor, MD. [view]

DRA: none
DRE: Prevention
Keywords: Education (patient), Infectious disease, Spinal cord injury
MeSH Terms: none