SHEA Abstract: Multi-Center Prevention Effort Significantly Cuts MRSA

General News

Mar 23 2009

Description:
This CDC analysis was presented in an abstract at a special late-breaker session during the SHEA 19th Annual Scientific Meeting on March 21. The CDC team concluded that successful implementation of the multi-faceted MRSA prevention program using PD resulted in significant MRSA reduction with sustained decreases demonstrated over time, showing hospitals can make headway in the fight against drug resistant superbugs.

A Successful Multi-Center Intervention to Prevent Transmission of Methicillin-resistant Staphylococcus aureus (MRSA)

Katherine Ellingson, PhD1, Nancy Iversen, BSN, RN, CIC2, Jerry M. Zuckerman MD3, Dorothy Borton, RN, BSN, CIC3, Linda Goss MSN, RN CIC4, Kay Lloyd4, Pei-Jean Chang, MPH1, John Stelling, MD5, Alex Kallen, MD1, Monique Sternin6, Curt Lindberg, DMan7, Jon C. Lloyd, MD7, Margaret Toth, MD, John A. Jernigan, MD, MS1, for the Positive Deviance MRSA Prevention Partnership.

1CDC, Atlanta, GA, USA, 2Billings Clinic, Billings, MT, USA, 3Albert Einstein Healthcare Network, Philadelphia, PA, USA 4 University of Louisville Hosp., Louisville, KY, USA 5Brigham and Women’s Hosp., Boston, MA, USA, 6Positive Deviance Initiative, Boston, MA, USA, 7Plexus Institute, Bordentown, NJ, USA.


Background: Reports of successful multicenter interventions to reduce endemic antimicrobial resistance problems among U.S. hospitals are rare. In 2006, three hospitals (Billings Clinic, Billings, MT; Albert Einstein Medical Center, Philadelphia, PA; and University of Louisville Hospital, Louisville, KY) partnered with the Plexus Institute and the Centers for Disease Control and Prevention to implement a hospital-based intervention to prevent MRSA transmission and share electronic data for objective evaluation of the intervention.

Objective: To analyze the impact of a multicenter intervention to prevent MRSA transmission in hospitals.

Methods: The intervention, introduced simultaneously in all hospitals in early 2007, consisted of: 1) active surveillance testing for MRSA in selected intensive care units, 2) Contact Precautions for MRSA carriers, 3) hand hygiene promotion, and 4) Positive Deviance, a social change process that engages staff in using existing resources to solve problems collaboratively. No routine attempts to suppress MRSA colonization were used. Clinical microbiology results for all inpatient areas generated between 1/1/2005 and 9/30/2008 were electronically extracted from the laboratory information systems in each hospital. MRSA cases were defined by positive clinical (non-surveillance) cultures from patients with no MRSA-positive cultures in the previous year. Monthly hospital-wide MRSA incidence densities, and monthly proportions of S. aureus resistance to methicillin, were modeled for each hospital using interrupted time series (ITS) regression analyses; overall impact across hospitals was estimated by pooling individual model estimates using inverse variance-weighting.

Results: Accounting for pre-intervention trends, ITS analyses revealed a significant intervention-associated reduction in MRSA incidence density across the three hospitals (p=0.0008 for pooled effect). In the 20-month post-intervention period, each hospital demonstrated significant reductions in MRSA incidence density (by 26%, 31%, and 62%; p<0.0001 for pooled trend).

There was a trend towards intervention-associated reduction in methicillin resistance across hospitals that did not reach statistical significance (p=.11 for pooled effect), but reductions in methicillin resistance were noted in the post-intervention period at each hospital (by 7%, 15%, and 28%; p=0.02 for pooled trend).

Conclusions: Successful implementation of a multifaceted MRSA prevention program using a novel approach to social and behavioral change resulted in a significant reduction in pooled MRSA incidence, with sustained decreases demonstrated over time; results also suggest post-intervention improvement in the S. aureus antibiogram. These results were achieved without the use of hospital-wide active surveillance or MRSA decolonization strategies.