Effect of a Veterans Affairs (VA) Initiative to Prevent Methicillin-Resistant Staphylococcus aureus (MRSA) Healthcare-Associated Infections (HAIs) in Spinal Cord Injury Units (SCIUs)

Roselle G, Evans M, Kralovic S, Simbartl L, Hammond M, Goldstein B, Evans (Mayfield) C, Jain R. Effect of a Veterans Affairs (VA) Initiative to Prevent Methicillin-Resistant Staphylococcus aureus (MRSA) Healthcare-Associated Infections (HAIs) in Spinal Cord Injury Units (SCIUs). Poster session presented at: Infectious Diseases Society of America Annual Meeting; 2011 Oct 20; Boston, MA.

Background: MRSA HAIs are a concern for patients in VA SCIUs. SCIUs treat patients with unique rehabilitation and medical care needs and may have a higher risk for infection. Methods: We implemented an MRSA bundle in all 22 acute care SCIUs in VA medical centers nationwide in an effort to decrease MRSA HAIs. The bundle consisted of 1) nasal surveillance for MRSA on all admissions, in-hospital transfers, and discharges; 2) Contact Precautions for patients colonized or infected with MRSA; 3) an emphasis on hand-hygiene, and 4) a culture change where infection control is everyone's responsibility. Personnel at each center entered aggregate data on surveillance compliance, MRSA prevalence, healthcare-associated MRSA transmissions and HAIs each month into a central database. Additionally, focused guidelines for SCIUs were developed and provided to all 22 SCIUs as part of a national MRSA Prevention Initiative. Results: From October 2007, when the bundle was fully implemented, through March 2011, there were 48,470 admissions/transfers/discharges and 759,106 patient-days of care in VA SCIUs. Admission screening increased from 64.1% to 94.8%, and transfer/discharge screening increased from 59.0% to 92.0% during this time. The mean ( SD) admission MRSA prevalence was 37.7% 13.0 (unit mean range 5.8% to 68.1%). Monthly MRSA transmission rates fell 15% from 1.217/1,000 patient-days to 1.031/1,000 patients days (P = 0.91, Poisson regression for trend), and HAI rates declined 91% from 1.217/1,000 patient days to 0.108/1,000 patients days (P < 0.0001, for trend). This included quarterly declines in bloodstream infections by 58%, pneumonias by 89%, urinary tract infections by 89%, and skin and soft-tissue infections by 69%, though none were individually significant by trend. Conclusion: The prevalence of MRSA colonization or infection among SCIU admissions was approximately 3-times higher than that of patients in other acute care settings. A program of universal surveillance, Contact Precautions, hand hygiene, and culture change was associated with a significant decrease in overall MRSA HAIs in VA SCIUs.