MRSA Prevention Initiative Results in Additional Significant Decline in Other Bacteremia Rates across 130 VHA Facilities
Hospital-onset (HO) bacteremia is one of the most serious healthcare-associated infections and a major cause of morbidity and mortality. Gram-negative rods (GNRs), such as E. coli, are responsible for about 25% to 30% of hospital-onset bacteremia and have become more problematic due to emerging drug resistance combined with lack of investment in antimicrobial drug discovery. As a result, 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 retrospective cohort study assessed the effect of the MRSA Initiative on hospital-onset GNR bacteremia (E coli, Klebsiella and Pseudomonas) at 130 VA facilities from January 2003 to December 2013. Using data from VINCI (Veterans Affairs Informatics and Computing Infrastructure), which includes patient information extracted from VA's electronic medical record system, investigators identified 11,196 Veterans with hospital-onset GNR bacteremia during the study period. Bacteremia episodes were classified as community-acquired (CA), healthcare-associated (HCA), and hospital-onset (HO) according to previously published and standardized definitions.
- 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 HO GNR bacteremia rates.
- During this time, the proportions of CA and HCA GNR episodes increased, while HO episodes decreased, particularly in the second half of the study period.
- 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.
- Due to the retrospective, quasi-experimental nature of the study, it is possible that additional external factors influenced the incidence rates of HO GNR bacteremia.
- Data for improvements of horizontal components (e.g., hand hygiene compliance) were not available. Investigators also did not have data regarding the primary source of bacteremia.
This study was partly funded by HSR&D. Drs. Goto, O'Shea, Livorsi, and Perencevich (Director) are part of HSR&D's Center for Comprehensive Access & Delivery Research and Evaluation (CADRE) in Iowa City, IA.
Goto M, O’Shea A, Livorsi D, et al and Perencevich E. The Effect of a Nationwide Infection Control Program Expansion on Hospital-Onset Gram-Negative Rod Bacteremia in 130 Veterans Health Administration Medical Centers: An Interrupted Time Series Analysis. Clinical Infectious Diseases. June 28, 2016; Epub ahead of print.