Thursday, May 6, 2010

No MRSA here (part 2)

I'm in Charlottesville to participate in a debate at UVA with Dennis Maki on whether impregnated central venous catheters should be used in the critical care setting. I was assigned to argue the "no" side of the debate. Now I must have been temporarily insane when I accepted that invitation since no one in the world knows more about this topic than Dennis Maki. But I think it should be fun.

Now to the topic of this post. I've blogged before about the progress we have made at our hospital on reducing MRSA infections in our ICUs. We recently were able to sustain a period of no MRSA infections for over 6 months, and in the last 9 months we have had only 1 device-related MRSA infection (a VAP) in our 8 ICUs. Critics have argued (and rightly so) that just because our ICUs are doing well, it may not be so in the rest of the hospital. Our hospital leadership supported us in recruiting a new infection preventionist to take on the task of doing surveillance for device associated infections outside of our ICUs. And this morning before I traveled to Charlottesville, I finished an analysis of the first quarter data. Drum roll please!!!...For the first three months of 2010, we had zero nosocomial MRSA bloodstream infections associated with either peripheral IV lines or central lines across the hospital (ICU and wards, 820 beds). What's the significance of this? It's yet another finding that dispels the widely propagated myth that the only way to control MRSA in the hospital is by active detection and isolation. The only unit in our entire hospital where we obtain surveillance cultures for MRSA is our NICU (a unit that accounts for only 5% of our beds). And it validates our horizontal strategic approach to infection prevention--a focus on interventions that prevent all infections (e.g., hand hygiene, chlorhexidine bathing in ICU patients, the central line bundle, and lots of feedback to frontline providers).

Now I better get back to sharpening my arguments for the debate!

4 comments:

  1. Congrats on your hospital's achievement and good luck with the debate. My question is how does your hospital track hand hygiene compliance and how do you enforce compliance among staff?

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  2. We hire students (undergraduate and graduate) who we train to be observers. They are paid an hourly wage, which allows us to obtain nighttime observations as well as year-round coverage. So for about $21,000 we obtained 45,000 observations last year. Feedback is given weekly via email to providers. Our compliance rates are driven primarily by the feedback.

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  3. Mike,

    Do you isolate patients that are high risk for MRSA (ie recently hospitalized, nursing home pts, etc) pending swab results? In our ICU we tend to isolate pts transferred from the floor until culture results are back.

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  4. We do not isolate patients on the basis of high risk, and we don't perform cultures to assess for colonization.

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