Calfee DP, Davila S, Chopra V, Patel PK, Snyder A, Ratz D, Rolle AJ, Olmsted RN, Popovich KJ. Quantitative Results of a National Intervention to Prevent Hospital-Onset Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: A Pre-Post Observational Study.
Ann Intern Med 2019;
171:S66-S72. [PMID:
31569232 DOI:
10.7326/m18-3535]
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Abstract
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most common causes of health care-associated infection (HAI).
OBJECTIVE
To evaluate the effect of education and a tiered, evidence-based infection prevention strategy on rates of hospital-onset MRSA bloodstream infection (BSI).
DESIGN
Prospective, national, nonrandomized, interventional, 12-month, multiple cohort, pre-post observational quality improvement project.
SETTING
Acute care, long-term acute care, and critical access hospitals with a disproportionate burden of HAI.
PATIENTS
All patients admitted to participating facilities during the project period.
INTERVENTION
A multimodal infection prevention intervention consisting of recommendations and tools for prioritizing and implementing evidence-based infection prevention strategies, on-demand educational videos, Internet-based live educational presentations, and access to content experts.
MEASUREMENTS
Rates of hospital-onset MRSA BSI, overall and stratified by hospital type, during 12-month baseline and postintervention periods. Variation in outcomes across hospital types was examined.
RESULTS
Between November 2016 and May 2018, 387 hospitals in 23 states and the District of Columbia participated, 353 (91%) submitted MRSA data, and 172 (49%) indicated that MRSA prevention was a priority. Unadjusted overall rates of hospital-onset MRSA BSI were 0.075 (95% CI, 0.065 to 0.085) and 0.071 (CI, 0.063 to 0.080) per 1000 patient-days in the baseline and postintervention periods, respectively.
LIMITATIONS
The intervention period was short. Participation and adherence to recommended interventions were not fully assessed. Baseline rates of hospital-onset MRSA BSI were relatively low. Prevention of MRSA was a priority in a minority of participating hospitals. Patient characteristics and other MRSA risk factors were not assessed.
CONCLUSION
In hospitals with a disproportionate burden of HAIs, access to tools to assist with implementation of evidence-based prevention strategies and education resources alone may not be sufficient to prevent MRSA BSI.
PRIMARY FUNDING SOURCE
Centers for Disease Control and Prevention.
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