Abstract
BackgroundIn November 2004, a national target was set for the English hospital trusts to reduce the Meticillin-Resistant Staphylococcus aureus (MRSA) bacteremia rate by 60% by April 2008 against the number during 2003/04 (baseline year). In our organisation the number of MRSA bacteremias had risen since 2002 and peaked at 75 in 2005/06. A target was set to reduce the number and series of specific and non- specific interventions was introduced including universal MRSA screening. This study analyzes the impact of universal MRSA screening using a quasi-experimental design using routinely gathered data.MethodsThis study used data gathered routinely for clinical governance, quality control, financial management and outbreak monitoring purposes. Interrupted Time Series (ITS) analysis of 15 pre- and 19 post- universal MRSA screening (and decolonisation) quarterly numbers of bacteremias was carried out where Meticillin-Sensitive Staphylococcus aureus (MSSA) numbers served as non-equivalent dependent variable (control).ResultsAn immediate sharp fall in MRSA bacteremias was observed following the universal MRSA screening (and decolonisation) commenced in Q2, 2007. The number dropped sharply from 23 (Q2, 2007) to 10 (Q3, 2007) for all MRSA bacteremias, and, from 15 (Q2, 2007) to 6 (Q3, 2007) for bacteremias ≥48 hours of hospitalization. The declining trend continued reaching zero in Q2, 2009 and Q4, 2010 for those with ≥48 hours of hospitalization and all bacteremias, respectively. ITS analysis revealed significant impact of universal MRSA screening on all MRSA bacteremias (β2 -0.554, p 0.000) and those with ≥48 of hospitalization (β2 -0.577, p 0.001). Impact estimation predicted 17 and 13 bacteremias for all and those with ≥48 hours hospitalization, respectively in the 19th quarter post-intervention, if the intervention did not occur. The number of MRSA isolates from non-blood culture systemic sources as percentage of admissions also dropped significantly from 3.32% in Q2, 2007 to 1.51% in Q3, 2007 (β2 -0.506, p 0.000) which is still running low at 0.33% at the end of Q1, 2012. On the other hand, there was no statistically significant impact of universal screening on MSSA bacteremias.ConclusionsWe conclude that of all interventions, the universal MRSA screening (and decolonisation) is the most effective intervention associated with significant and sharp drop in MRSA burden.
Highlights
In November 2004, a national target was set for the English hospital trusts to reduce the Meticillin-Resistant Staphylococcus aureus (MRSA) bacteremia rate by 60% by April 2008 against the number during 2003/04
Following the introduction of Root Cause Analysis (RCA) in May 2006 a number of interventions were made in quick succession as part of the MRSA improvement programme; implementation of these interventions and compliance levels were routinely monitored by audits (Table 1)
The ratio of patients to specimen numbers was about 1:2 in line with the swabbing of nose (N) and throat (T) only. This ratio has increased since Q2, 2008 to just under 1:3 when we introduced inpatient MRSA screening at every 10 days interval
Summary
The setting is an acute NHS Trust in the north east of England serving a mixed urban/rural predominantly elderly population of approximately 500,000. This group reviews three weekly audits carried out regularly: MRSA screening, PVC care plan and hand hygiene audits in addition to other infection control audits Another daily meeting for enhanced management of known MRSA positives patients was introduced in March 2008. A web based data capture was introduced to audit MRSA screening, peripheral cannula care and hand hygiene standards This new system enabled the ICT to produce weekly audit figures efficiently at review in the weekly HCAI group meeting, identify the outliers and giving real-time feed back to the ward staff to reinforce corrective measures and best practice in a targeted and timely way.
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