Advertisement

Eight years of decreased methicillin-resistant Staphylococcus aureus health care-associated infections associated with a Veterans Affairs prevention initiative

  • Martin E. Evans
    Correspondence
    Address correspondence to Martin E. Evans, MD,Lexington Veterans Affairs Medical Center, 1101 Veterans Dr, Room B415, Lexington, KY 40502. (M.E. Evans).
    Affiliations
    MRSA/MDRO Prevention Office, National Infectious Diseases Service, Patient Care Services, Veterans Health Administration, Washington, DC

    Lexington Veterans Affairs Medical Center, Lexington, KY

    Department of Internal Medicine, Division of Infectious Diseases, University of Kentucky School of Medicine, Lexington, KY
    Search for articles by this author
  • Stephen M. Kralovic
    Affiliations
    National Infectious Diseases Service, Patient Care Services, Veterans Health Administration, Washington, DC

    Cincinnati Veterans Affairs Medical Center, Cincinnati, OH

    Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH
    Search for articles by this author
  • Loretta A. Simbartl
    Affiliations
    National Infectious Diseases Service, Patient Care Services, Veterans Health Administration, Washington, DC
    Search for articles by this author
  • Rajiv Jain
    Affiliations
    Patient Care Services, Veterans Health Administration, Washington, DC (retired)
    Search for articles by this author
  • Gary A. Roselle
    Affiliations
    National Infectious Diseases Service, Patient Care Services, Veterans Health Administration, Washington, DC

    Cincinnati Veterans Affairs Medical Center, Cincinnati, OH

    Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH
    Search for articles by this author

      Highlights

      • The Veterans Affairs MRSA Prevention Initiative was implemented in October 2007.
      • MRSA healthcare-associated infection (HAI) rates were tracked over 8 years.
      • Monthly HAI rates fell 87.0% in intensive care units (ICUs) and 80.1% in non-ICUs
      • MRSA HAI rates fell 80.9% in spinal cord injury units and 49.4% in long-term care.
      • All were all statistically significant declines (P < .0001 for trend).

      Background

      Declines in methicillin-resistant Staphylococcus aureus (MRSA) health care associated infections (HAIs) were previously reported in Veterans Affairs acute care (2012), spinal cord injury (SCIU) (2011), and long-term-care facilities (LTCFs) (2012). Here we report continuing declines in infection rates in these settings through September 2015.

      Methods

      Monthly data entered into a national database from 127 acute care facilities, 22 SCIUs, and 133 LTCFs were evaluated for trends using negative binomial regression.

      Results

      There were 23,153,240 intensive care unit (ICU) and non-ICU, and 1,794,234 SCIU patient-days from October 2007-September 2015, and 22,262,605 LTCF resident-days from July 2009-September 2015. Admission nasal swabbing remained >92% in all 3 venues. Admission prevalence changed from 13.2%-13.5% in acute care, from 35.1%-32.0% in SCIUs, and from 23.1%-25.0% in LTCFs during the analysis periods. Monthly HAI rates fell 87.0% in ICUs, 80.1% in non-ICUs, 80.9% in SCIUs, and 49.4% in LTCFs (all P values < .0001 for trend). During September 2015, there were 2 MRSA HAIs reported in ICUs, 20 (with 3 in SCIUs) in non-ICUs, and 31 in LTCFs nationwide.

      Conclusions

      MRSA HAI rates declined significantly in acute care, SCIUs, and LTCFs over 8 years of the Veterans Affairs MRSA Prevention Initiative.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Evans M.E.
        • Kralovic S.M.
        • Simbartl L.A.
        • Freyberg R.
        • Obrosky D.S.
        • Roselle G.A.
        • et al.
        Veterans Affairs methicillin-resistant Staphylococcus aureus prevention initiative associated with a sustained reduction in transmissions and healthcare-associated infections.
        Am J Infect Control. 2013; 41: 1093-1095
        • Evans M.E.
        • Kralovic S.M.
        • Simbartl L.A.
        • Obrosky D.S.
        • Hammond M.C.
        • Goldstein B.
        • et al.
        Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units.
        Am J Infect Control. 2013; 41: 422-426
        • Evans M.E.
        • Kralovic S.M.
        • Simbartl L.A.
        • Freyberg R.W.
        • Obrosky D.S.
        • Roselle G.A.
        • et al.
        Nationwide reduction of healthcare-associated methicillin-resistant Staphylococcus aureus infections in Veterans Affairs long-term care facilities.
        Am J Infect Control. 2013; 42: 60-62
        • Jain R.
        • Kralovic S.M.
        • Evans M.E.
        • Ambrose M.
        • Simbartl L.A.
        • Obrosky D.S.
        • et al.
        Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections.
        N Engl J Med. 2011; 364: 1419-1430
        • National Healthcare Safety Network
        Multidrug-resistant organism & Clostridium difficile-associated disease (MDRO/CDI) module.
        (Available from:) (Accessed June 28, 2016)
        • Pronovost P.
        • Needham D.
        • Berenholtz S.
        • Sinopoli D.
        • Chu H.
        • Cosgrove S.
        • et al.
        An intervention to decrease catheter-related bloodstream infections in the ICU.
        N Engl J Med. 2006; 355: 2725-2732
        • Render M.L.
        • Hasselbeck R.
        • Freyberg R.W.
        • Hofer T.P.
        • Sales A.E.
        • Almenoff P.L.
        Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement.
        BMJ Qual Safety. 2011; 20: 725-732
        • Jones M.
        • Ying J.
        • Huttner B.
        • Evans M.
        • Maw M.
        • Nielson C.
        • et al.
        Relationship between the importation, transmission, and nosocomial infections of methicillin-resistant Staphylococcus aureus: an observational study of 112 Veterans Affairs medical centers.
        Clin Infect Dis. 2013; 58: 32-39
      1. Positive deviance initiative.
        (Available from:) (Accessed June 28, 2016)
        • Perlin J.B.
        • Hickok J.D.
        • Septimus E.J.
        • Moody J.A.
        • Englebright J.D.
        • Bracken R.M.
        A bundled approach to reduce methicillin-resistant Staphylococcus aureus infections in a system of community hospitals.
        J Healthc Qual. 2013; 35: 57-69
        • Clancy M.
        • Graepler A.
        • Wilson M.
        • Douglas I.
        • Johnson J.
        • Price C.S.
        Active screening in high-risk units is an effective and cost-avoidant method to reduce the rate of methicillin-resistant Staphylococcus aureus infection in the hospital.
        Infect Control Hosp Epidemiol. 2006; 27: 1009-1017
        • Huang S.S.
        • Yokoe D.S.
        • Hinrichsen V.L.
        • Spurchise L.S.
        • Datta R.
        • Miroshnik I.
        • et al.
        Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia.
        Clin Infect Dis. 2006; 43: 971-978
        • Lawes T.
        • Lopez-Lozano J.M.
        • Nebot C.
        • Macartney G.
        • Subbarao-Sharma R.
        • Dare C.R.
        • et al.
        Turning the tide or riding the waves? Impacts of antibiotic stewardship and infection control on MRSA strain dynamics in a Scottish region over 16 years: non-linear time series analysis.
        BMJ Open. 2015; 5: e006596
        • Evans M.E.
        • Kralovic S.M.
        • Simbartl L.A.
        • Jain R.
        • Roselle G.A.
        Effect of a Clostridium difficile infection prevention initiative in Veterans Affairs acute care facilities.
        Infect Control Hosp Epidemiol. 2016; 37: 720-722
        • Goto M.
        • O'Shea A.
        • Livorsi D.J.
        • McDanel J.S.
        • Jones M.
        • Richardson K.K.
        • et al.
        The effect of a nationwide infection control program expansion on hospital-onset gram-negative rod bacteremia in 130 Veterans Health Administration medical centers: an interrupted time series analysis.
        Clin Infect Dis. 2016; 63: 642-650
        • Wyllie D.
        • Paul J.
        • Crook D.
        Waves of trouble: MRSA strain dynamics and assessment of the impact of infection control.
        J Antimicrob Chemother. 2011; 66: 2685-2688
        • Huang S.S.
        • Septimus E.
        • Kleinman K.
        • Moody J.
        • Hickok J.
        • Avery T.R.
        • et al.
        Targeted versus universal decolonization to prevent ICU infection.
        N Engl J Med. 2013; 368: 2255-2265
        • Marzec N.S.
        • Bessesen M.T.
        Risk and outcomes of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia among patients admitted with and without MRSA nares colonization.
        Am J Infect Control. 2016; 44: 405-408
        • Nelson R.E.
        • Stevens V.W.
        • Jones M.
        • Samore M.H.
        • Rubin M.A.
        Health care-associated methicillin-resistant Staphylococcus aureus infections increases the risk of post-discharge mortality.
        Am J Infect Control. 2015; 43: 38-43
        • Nelson R.E.
        • Jones M.
        • Liu C.F.
        • Samore M.H.
        • Evans M.E.
        • Graves N.
        • et al.
        The impact of healthcare-associated methicillin-resistant Staphylococcus aureus infections on post-discharge healthcare costs and utilization.
        Infect Control Hosp Epidemiol. 2015; 36: 534-542