An Infection Control Initiative That Works: How Clinical Service Units Reduced and Maintained Their Incidence of Methicillin-Resistant Staphylococcus aureus (MRSA)

Abstract

ISSUE: Duke University Medical Center is an 800-bed university-affiliated medical center. An evaluation of annual MRSA data identified 4 areas (3 ICUs, one inpatient unit) where MRSA rates had increased dramatically in the first 6 months of 2004. Infection Control (IC) developed a program aimed at reducing the rate of nosocomial MRSA by promoting involvement of the clinical service unit (CSU) in identifying infection prevention strategies. PROJECT: In June 2004, IC began the Duke MRSA Initiative, for targeted areas with significant MRSA rate increase over the past 6 months. Infection Control then met with key leaders within the CSU. Data on unit-specific trends were presented and members were educated on the risk and implications of patients acquiring MRSA. Upon completion of the presentation each CSU identified methods to decrease their MRSA rate, with input from IC. This initiative was first done in the Neuroscience CSU. The interventions included inservices for all staff, initiation of a hand hygiene "time out," initiation of an admission screening protocol and increased diligence in environmental cleaning. This initiative was also followed in the Musculo-Skeletal CSU, Surgical CSU and the Medicine CSU. Different interventions were formulated for each CSU, because they were able to identify specific areas in need of change. The role of IC was advisory, with guidance provided with inservices, skills day education and Physician's Grand Rounds. RESULTS: With the Duke MRSA Initiative in place, all 4 units targeted for MRSA reduction were successful in decreasing their rates from July-December 2004. The Neuroscience CSU rate decreased from 4.9/1000 pt. days to 0.93, the Musculo-Skeletal CSU rate from 4.0/1000 pt. days to 0.38, the Surgical CSU rate from 3.3/1000 pt. days to 0.78 and the Medicine CSU rate from 3.0/1000 pt. days to 1.1. IC continued to monitor MRSA rates and to ensure that the interventions were still in place. 2005 MRSA data show a sustained nosocomial infection reduction among the units: Neuroscience CSU at 2.4, Musculo-Skeletal CSU at 0.42, Surgical CSU at 2.0, and Medicine CSU at 1.3. LESSONS LEARNED: With increasing nosocomial and community-acquired MRSA rates, IC teams must use innovative methods to reduce and sustain low nosocomial MRSA rates. When the unit takes ownership to reduce their rate of MRSA, there is an increase in unit participation with a notable decrease in MRSA rate.