A national VA initiative to decrease nosocomial MRSA infection: a pre-post survey of employee knowledge, attitudes, and prevention practices

Burkitt KH, Obrosky DS, Sinkowitz-Cochran RL, Cuerdon T, Miller LJ, Mor MK, Jain R, Moreland ME, Muder RR, Fine MJ. A national VA initiative to decrease nosocomial MRSA infection: a pre-post survey of employee knowledge, attitudes, and prevention practices. Paper presented at: VA HSR&D National Meeting; 2008 Feb 14; Baltimore, MD.

Objectives: Our objectives were to assess employee knowledge, attitudes, and prevention practices before and after implementation of a national MRSA prevention initiative. Methods: We administered pre-and post-intervention surveys to all employees with direct patient contact who worked on one or more medical, surgical, or intensive care units at 17 VA hospitals nationally. Surveys assessed MRSA knowledge, barriers to proper hand hygiene, and prevention practices and attitudes. The multifaceted MRSA prevention intervention included: MRSA surveillance cultures on admission and discharge; hand hygiene promotion and training; and compliance monitoring of these measures. We used random effects multivariable logistic regression to compare baseline and follow-up survey responses, controlling for hospital and employee job type. Results: Evaluable surveys from 14 VA hospitals were completed by 78.4% of 1,855 respondents at baseline and 74.2% of 1,525 respondents at follow-up. Significant changes were observed over time for both knowledge and barriers. The frequency of employees answering all 5 knowledge questions correctly increased from 8.6% to 17.0% (p < .001). The largest increase was the best method for hand hygiene (alcohol hand rub), increasing from 19.8% to 31.8% (p < .001). Employees reporting one or more barriers to hand hygiene decreased from 24.6% to 19.2% (p < .01). The frequency of employee-reported use of alcohol hand rub instead of soap increased from 52.3% to 61.9% (p < .001). Employee comfort with reminding co-workers to perform hand hygiene (61.0% to 69.8%; p < .001) and use gloves (63.3% to 70.0%; p < .005) both increased over time. Employee recognition that MRSA represents a problem on their unit increased from 54.3% to 64.3% (p < .001) and their level of optimism that unit staff could prevent MRSA increased from 71.0% to 75.5%; (p < .05). Implications: A multifaceted MRSA prevention initiative improved self-reported employee knowledge, attitudes, and prevention practices and reduced perceived barriers to hand hygiene. Impacts: Improving employee knowledge, perceptions, and attitudes regarding MRSA is an essential intermediate step to prevent nosocomial MRSA infection. If these results lead to reduced MRSA transmission/infection rates, such an initiative has the potential to substantially reduce the morbidity, mortality, and medical care costs due to this common nosocomial infection throughout the VA Healthcare System.