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RRP 09-163 – HSR&D Study

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RRP 09-163
Assessment of MRSA prevention practice in VA Spinal Cord Injury Centers
Charlesnika Tyon Evans PhD MPH BS
Edward Hines Jr. VA Hospital, Hines, IL
Hines, IL
Funding Period: April 2010 - March 2011

BACKGROUND/RATIONALE:
Controlling MRSA spread in hospital settings where individuals with spinal cord injury/disorder (SCI/D) receive care is complicated by the use of common areas for rehabilitation/exercise and difficulties associated with hand hygiene for people with impaired hand function. VA SCI/D Services released 'Guidelines for Implementation of MRSA Prevention Initiative in the Spinal Cord Injury Centers;' however, it is unclear how VA SCI centers have implemented these guidelines.

OBJECTIVE(S):
1) To examine adoption of the MRSA Care Guidelines across VA SCI Centers using the Promoting Action on Research Implementation in Health Services (PARiHS) conceptual framework; 2) To develop recommendations to guide implementation efforts to reduce the spread of MRSA in VA SCI Centers.


METHODS:
Anonymous internet-based surveys were sent to VA SCI healthcare workers (HCWs) (related to personal practice/perceptions) and MRSA Prevention Coordinators (MPCs) (related to hospital policy) at all 24 VA SCI Centers. Semi-structured telephone interviews were conducted with a purposive sample of HCWs and MPCs from nine SCI Centers.

FINDINGS/RESULTS:
295 (43.8%) VA SCI HCWs participated in the survey. Complete data was available for 234 HCWs, including nurses (56.4%), therapists (24.4%), physicians (11.1%), and other health professionals (8.1%). Two-thirds of respondents were familiar with the SCI MRSA guidelines. Over half (57.7%) reported documenting patient education after MRSA screening in progress notes. Three-fourths reported gowning and gloving before entry into a MRSA-positive patient's room and nearly all reported hand hygiene after removing gloves and gowns. Two-thirds reported that they usually/always feel comfortable reminding other staff to gown and glove. Half reported that they always require visitors/family members to gown and glove when providing direct patient care. Over half of respondents reported that in the past 12 months, they 'usually/always' provided MRSA education to SCI/D patients (53.4%) or visitors/family providing direct patient care (57.5%). Similar results were found for providing hand hygiene education. Half of HCWs reported that the hand hygiene and MRSA education that they provided was 'good/excellent'. Importantly, HCWs' perceptions of the strength of the evidence for MRSA prevention practices varied. HCWs rated evidence as stronger for contact precautions (75%) than for active MRSA surveillance at admission/discharge (66%). Evidence supporting handwashing before and after patient contact for HCWs was rated strong by 87.3%, while only 65.4% strongly rated evidence for SCI/D patient handwashing. Three-fourths of HCWs agreed that MRSA transmission in hospitalized SCI/D patients could be prevented. 15 (62.5%) MPCs participated in their survey. Over two-thirds of MPCs reported that notifications to other hospital services when a MRSA positive SCI patient was attending appointments was done through a progress note/CPRS. Only 26.7% of MPCs reported having a policy for cleaning wheelchairs. Interviewees (n=30) consisted of MPCs and SCI/D HCWs. Interviews identified practical concerns about using contact precautions when providing direct patient care as opposed to entering patient rooms and identifying whether environmental services or nurses were responsible for cleaning equipment and bed rails.

IMPACT:
This study is a collaborative effort, providing data and recommendations for VA IDPO and SCI/D Services to reduce MRSA infections and transmission in SCI units.

PUBLICATIONS:

Journal Articles

  1. Balbale SN, Hill JN, Guihan M, Hogan TP, Cameron KA, Goldstein B, Evans CT. Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: a mixed methods study. Implementation science : IS. 2015 Sep 9; 10:130.
  2. Hill JN, Hogan TP, Cameron KA, Guihan M, Goldstein B, Evans ME, Evans CT. Perceptions of methicillin-resistant Staphylococcus aureus and hand hygiene provider training and patient education: results of a mixed method study of health care providers in Department of Veterans Affairs spinal cord injury and disorder units. American journal of infection control. 2014 Aug 1; 42(8):834-40.
  3. Evans ME, Kralovic SM, Simbartl LA, Obrosky DS, Hammond MC, Goldstein B, Evans CT, Roselle GA, Jain R. Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units. American journal of infection control. 2013 May 1; 41(5):422-6.
Conference Presentations

  1. Hill JN, Guihan M, Hogan TP, Smith BM, LaVela SL, Weaver FM, Anaya HD, Evans (Mayfield) CT. Conducting Retrospective and Prospective Implementation Evaluations Using the PARIHS Framework. Poster session presented at: National Institutes of Health / AcademyHealth Conference on the Science of Dissemination and Implementation; 2016 Dec 14; Washington, DC.
  2. Balbale SN, Hill JN, Guihan M, Hogan TP, Cameron K, Goldstein B, Evans (Mayfield) CT, Babale S. Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in VA spinal cord injury and disorder centers using the PARIHS framework: a mixed-methods study. Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 15; Minneapolis, MN.
  3. 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.
  4. Evans (Mayfield) C, Hill JN, Guihan M, Hogan TP, Chin A, Cameron KA, Kerr A. MRSA and Hand Hygiene Education: Perceptions and Practices of Healthcare Workers at VA Spinal Cord Injury Centers. Poster session presented at: Society for Healthcare Epidemiology of America Scientific Annual Meeting; 2011 Apr 1; Dallas, TX.


DRA: Brain and Spinal Cord Injuries and Disorders, Other Conditions
DRE: Prevention
Keywords: Clinical practice guidelines, Infectious disease, QUERI Implementation, Spinal cord injury
MeSH Terms: none