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DECREASING HOSPITAL ACQUIRED METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) THROUGH ACTIVE SURVEILLANCE PowerPoint Presentation
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DECREASING HOSPITAL ACQUIRED METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) THROUGH ACTIVE SURVEILLANCE. Confidential: For Quality Improvement Purposes Only. INFECTION CONTROL Jorge Parada MD,MPH Janis Bartel Alexander Tomich Emie Pua Gigi Marinakos-Trulis MICROBIOLOGY

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slide1

DECREASING HOSPITAL ACQUIRED METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) THROUGH ACTIVE SURVEILLANCE

Confidential: For Quality Improvement Purposes Only

team members
INFECTION CONTROL

Jorge Parada MD,MPH

Janis Bartel

Alexander Tomich

Emie Pua

Gigi Marinakos-Trulis

MICROBIOLOGY

Paul Schreckenberger, PhD

Sandy Chakonas

Colleen Jarosz

NURSING ADMINISTRATION

Paula Hindle

Sue Flores

Vada Grant

PEDIATRIC INFECTIOUS DISEASES

Malliswari Challipalli MD

Andrew Bonwit MD

INFORMATION TECHNOLOGY

Laura Digangi

Julie Glen

Connie Giere

Media

John Griffin

The nurses who collected the MRSA screens and made this program possible

TEAM MEMBERS

Confidential: For Quality Improvement Purposes Only

background
Background
  • The incidence of MRSA colonization and infections is increasing annually.
  • MRSA is associated with serious infections, increase hospital length of stay, patient morbidity and mortality, as well as increased cost of hospitalization.
  • In August, 2007 Illinois law mandated active surveillance for all ICU patients as well as all high risk non-ICU patients
  • Magnet Forces of Magnetism - Force 7,Quality Improvement: “The organization has structures and processes for the measurement of quality and programs for improving the quality of care and services within the organization”

Confidential: For Quality Improvement Purposes Only

project aim statement
Project Aim Statement
  • A multidisciplinary task force developed a program to screen ALL inpatients for MRSA upon admission (for the purpose of identifying them early), isolating them appropriately, and thereby limiting hospital associated MRSA transmission and infection.
  • The goal was to decrease the incidence of hospital acquired MRSA.

Confidential: For Quality Improvement Purposes Only

prior pilot interventions
Prior Pilot Interventions
  • Neonatal Intensive Care Unit (NICU) initiated active surveillance for all births, transfers in, and biweekly surveillance - January, 2005
  • Surgical Intensive Care Unit (SICU) initiated screening on admission and weekly surveillance for select patient populations (stay greater than 7 days, on ventilator greater than 5 days, dialysis) - June, 2005

Confidential: For Quality Improvement Purposes Only

pilot interventions
Pilot Interventions:

SICU

Rates from 3.7 → 0.7

75% REDUCTION

SUSTAINED OVER TIME

Confidential: For Quality Improvement Purposes Only

solutions implemented
Solutions Implemented
  • Plan: UNIVERSAL SCREENING of ALL INPATIENTS
  • MRSA Guidelines written, distributed and available on Loyola intranet under Policies
    • Details screening process
    • Decolonization treatment regimen outlined
  • PCR rapid testing machine - decreased testing time from 48 →2 hours
  • Videotape on MRSA education purchased
  • Original Loyola video developed outlining MRSA screening (from specimen collection, through lab processing to results reported) February,2008

Confidential: For Quality Improvement Purposes Only

solutions implemented timeline
Solutions Implemented - Timeline
  • October 15, 2007: All ICU patients screened
  • November 27, 2007: All hospitalized patients screened
  • March 4th, 2008: Pre-op screening for elective surgery (PAT/SAC)
  • Additional Infectious Disease Clinics:January,2008

Confidential: For Quality Improvement Purposes Only

infection control mrsa program
Infection Control MRSA Program
  • Nursing Grand Rounds on MRSA
  • Surgical Grand Rounds on MRSA
  • Nurse Managers meeting on MRSA
  • Multiple MRSA-focused in-services, memos
  • Loyola Patient/Family MRSA Informational Brochures developed and now available on Loyola intranet visa Employee Resources
  • Loyola MRSA Educational Video for staff
  • MRSA Guidelines available on Loyola intranet
  • CD demonstrating technique for collection of MRSA nasal swab/screen

Confidential: For Quality Improvement Purposes Only

results
Results
  • INPATIENT:
    • Number of screens performed (Nov 27th-May 1st) >10,000 which is 88% of admissions
    • Number of positive screens (7%)
  • PREADMISSION TESTING
    • Number of screens performed (March 4th-May 1st) 1168
    • Number positive screens (4%)

Confidential: For Quality Improvement Purposes Only

slide11

Universal MRSA Screening

(all patients admitted to hospital)

ICUMRSA Screening

(all patients admitted to ICU)

6-Month

pre-surveillance rate

0.5294

68%

REDUCTION IN

NOSOCOMIAL

MRSA RATES

ICU surveillance rate

0.3924

Universal

surveillance rate

0.1713

Confidential: For Quality Improvement Purposes Only

next steps
Next Steps
  • Emergency Department MRSA screeningfor all hospital admissions
  • Continued emphasison prevention of infection:
    • Hand washing,
    • Appropriateisolation and cohorting of patients
    • Environmental cleaning
  • Decolonizationof MRSA carriers

Confidential: For Quality Improvement Purposes Only