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HSR&D Publication Briefs
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  • MRSA Prevention Initiative Results in Additional Significant Decline in Other Bacteremia Rates across 130 VHA Facilities
    VA introduced the Methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative in 2007. Although the Initiative was perceived as only targeting MRSA, it also expanded infection prevention and control programs and resources, which could result in lower rates of infection with other pathogenic bacteria. This study assessed the effect of the MRSA Initiative on hospital-onset gram-negative rod (GNR) bacteremia at 130 VA facilities. Findings showed that over the 11-year study period, the nationwide infection control program expansion that was part of the MRSA Initiative was strongly associated with a sustained and statistically significant 43% decline in hospital-onset (HO) GNR bacteremia rates. Findings suggest that the non MRSA-specific components of the Initiative (e.g., increased infection-control staffing, emphasis on hand hygiene compliance) had collateral benefits in reducing rates of HO GNR bacteremia among Veterans.
    Date: June 28, 2016
  • Targeted Cost-Saving Method for MRSA and VRE Surveillance in VA Hospitals
    Emerging antibiotic-resistant bacteria, including MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin-resistant enterococcus), are leading causes of infections in hospitalized patients that result in significant costs, morbidity, and mortality. This prospective study investigated alternative methods for targeted active surveillance (using a prediction rule to identify a group of patients at high risk for MRSA or VRE among general hospital admissions) among 585 Veterans admitted to the medical and surgical wards of one VA hospital between 8/07 and 10/09 (non-ICU patients only). Findings show that antibiotic exposure documented by VA’s electronic medical record (EMR) in the year prior to admission was the best prediction rule for MRSA and VRE infections, identifying 84% of MRSA exposure risk and 98% of VRE exposure risk, while culturing only 51% of inpatients. During the 26-month study period, active surveillance for MRSA (culturing all patients at hospital admission) on all non-ICU inpatients would cost $86,773. Targeted active surveillance with EMR documentation of antibiotics would cost $45,255, resulting in a 48% savings. Active surveillance for VRE would cost $77,275 compared to $42,468 for targeted active surveillance, resulting in a 45% savings. An overall cost savings of 47% would result if targeted surveillance for both MRSA and VRE were included.
    Date: December 1, 2010
  • Responding to Decline in MRSA Infection
    This JAMA Editorial reports on the current status of MRSA (methicillin-resistant S aureus) infection rates – and what it may mean for the future. Using data from 2005-2008, the CDC’s surveillance system showed a continuous decline of invasive MRSA disease. This includes an estimated 9.4% annual decrease in hospital onset and an estimated 5.7% annual decrease in healthcare-associated community-onset infections. There are a variety of theories for these decreases, such as general infection control efforts (e.g., wider use of alcohol-based hand rubs). However, it may be presumptuous to assume that hospital-based prevention efforts have a major effect on the natural history of such a wide-spread pathogen. Natural biologic trends are likely to override the best-laid attempts at infection control. Therefore, only by improving existing surveillance and prevention research programs can clinicians and infection control researchers begin to explain the decrease in MRSA disease.
    Date: August 11, 2010
  • Implementation of a VA Quality Improvement Initiative Improves Knowledge and Perceptions Regarding MRSA Prevention
    Implementation of the initiative at 17 VAMCs was associated with temporal improvements in knowledge and perceptions regarding MRSA prevention. Between baseline and follow-up, there were increases in the number of respondents who: correctly identified that alcohol-based hand rub is more effective at inactivating MRSA than soap and water, reported cleaning their hands when entering and exiting a patient room in the past 30 days, reported using alcohol-based hand rub over soap and water when cleaning their hands, and felt comfortable reminding others about proper hand hygiene.
    Date: February 3, 2010
  • Toyota Production System Methodology Leads to Improved Peri-Operative Care in One VAMC
    In the Toyota Production System (TPS) industrial engineering approach, front-line work groups identify problems, experiment with possible solutions, measure the results, and implement strategies to improve quality, resulting in a “ground-up” rather than “top-down” approach to solving system problems. Beginning in 2001, one VAMC instituted TPS methods to reduce Methicillin Resistant Staphylococcus Aureus (MRSA) infections on a general surgical floor. The intervention then evolved to address other areas for QI on the surgical unit, such as increasing appropriate prophylactic peri-operative antibiotic therapy. The aims of this study were to determine: 1) whether the QI intervention for peri-operative antibiotic therapy was associated with improvements in selection and duration of prophylactic therapy; and 2) if the overall MRSA prevention initiative was associated with decreased hospital stay (LOS). Findings show that use of the TPS methodology resulted in a QI intervention that was associated with an increase in appropriate peri-operative antibiotic therapy among surgical patients. The proportion of all surgical admissions in this study (n=2,550) receiving appropriate peri-operative antibiotics was significantly higher in 2004 after initiation of the TPS intervention (44.0%) compared to the previous four years (range 23.4% to 29.8%). Results also showed no statistically significant decrease in LOS over time.
    Date: September 1, 2009
  • Bloodstream Infections in Veterans with Spinal Cord Injury May Require Different Treatment Strategies
    Bloodstream infections (BSIs) are a common type of infection in people with spinal cord injury. Bloodstream infections that occur in healthcare settings (e.g., acute care, long-term care) have been traditionally classified as community-acquired, but recent evidence suggests that these infections are distinct and may have a unique epidemiology. This retrospective review assessed characteristics associated with bloodstream infections that were: hospital-acquired (HA BSI), from healthcare contact outside the hospital (HCA BSI), or were community-acquired (CA BSI). Results show that HCA bloodstream infections accounted for 25% of all BSIs in hospitalized Veterans with spinal cord injury. Antibiotic resistance was more common in Veterans with HA BSI (65.5%) compared to those with HCA (49.1%) and CA BSI (22.2%). Methicillin-resistance in Staphylococcus aureus (MRSA) was highly prevalent: 84.5% in Veterans with HA BSI, 60.6% in Veterans with HCA BSI, and 33.3% in Veterans with CA BSI. Because several differences in medical characteristics and causal micro-organisms were found, the authors suggest that treatment and management strategies for HCA and CA infections may need to vary.
    Date: August 1, 2009