Madhuri M Sopirala1, Lisa Yahle-Dunbar2, Justin Smyer2, Linda Wellington2, Jeanne Dickman2, Nancy Zikri2, Jennifer Martin2, Pat Kulich2, David Taylor2, Hagop Mekhjian3, Mary Nash4, Jerry Mansfield4, Preeti Pancholi5, Mary Howard4, Linda Chase4, Susan Brown4, Kristopher Kipp4, Kristen Lefeld2, Amber Myers2, Xueliang Pan6, Julie E Mangino7. 1. Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: madhuri.sopirala@uchealth.com. 2. Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH. 3. Health System Administration, The Ohio State University Wexner Medical Center, Columbus, OH. 4. Health System Nursing Administration, The Ohio State University Wexner Medical Center, Columbus, OH. 5. Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH. 6. Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH. 7. Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH.
Abstract
BACKGROUND: We describe a successful interdisciplinary liaison program that effectively reduced health care-acquired (HCA), methicillin-resistant Staphylococcus aureus (MRSA) in a university hospital setting. METHODS: Baseline was from January 2006 to March 2008, and intervention period was April 2008 to September 2009. Staff nurses were trained to be liaisons (link nurses) to infection prevention (IP) personnel with clearly defined goals assigned and with ongoing monthly education. HCA-MRSA incidence per 1,000 patient-days (PD) was compared between baseline and intervention period along with total and non-HCA-MRSA, HCA and non-HCA-MRSA bacteremia, and hand soap/sanitizer usage. Hand hygiene compliance was assessed. RESULTS: A reduction in MRSA rates was as follows in intervention period compared with baseline: HCA-MRSA decreased by 28% from 0.92 to 0.67 cases per 1,000 PD (incidence rate ratio, 0.72; 95% confidence interval: 0.62-0.83, P < .001), and HCA-MRSA bacteremia rate was reduced by 41% from 0.18 to 0.10 per 1,000 PD (incidence rate ratio, 0.59; 95% confidence interval: 0.42-0.84, P = .003). Total MRSA rate and MRSA bacteremia rate also showed significant reduction with nonsignificant reductions in overall non-HCA-MRSA and non-HCA-MRSA bacteremia. Hand soap/sanitizer usage and compliance with hand hygiene also increased significantly during IP. CONCLUSION: Link nurse program effectively reduced HCA-MRSA. Goal-defined metrics with ongoing re-education for the nurses by IP personnel helped drive these results.
BACKGROUND: We describe a successful interdisciplinary liaison program that effectively reduced health care-acquired (HCA), methicillin-resistant Staphylococcus aureus (MRSA) in a university hospital setting. METHODS: Baseline was from January 2006 to March 2008, and intervention period was April 2008 to September 2009. Staff nurses were trained to be liaisons (link nurses) to infection prevention (IP) personnel with clearly defined goals assigned and with ongoing monthly education. HCA-MRSA incidence per 1,000 patient-days (PD) was compared between baseline and intervention period along with total and non-HCA-MRSA, HCA and non-HCA-MRSA bacteremia, and hand soap/sanitizer usage. Hand hygiene compliance was assessed. RESULTS: A reduction in MRSA rates was as follows in intervention period compared with baseline: HCA-MRSA decreased by 28% from 0.92 to 0.67 cases per 1,000 PD (incidence rate ratio, 0.72; 95% confidence interval: 0.62-0.83, P < .001), and HCA-MRSA bacteremia rate was reduced by 41% from 0.18 to 0.10 per 1,000 PD (incidence rate ratio, 0.59; 95% confidence interval: 0.42-0.84, P = .003). Total MRSA rate and MRSA bacteremia rate also showed significant reduction with nonsignificant reductions in overall non-HCA-MRSA and non-HCA-MRSA bacteremia. Hand soap/sanitizer usage and compliance with hand hygiene also increased significantly during IP. CONCLUSION: Link nurse program effectively reduced HCA-MRSA. Goal-defined metrics with ongoing re-education for the nurses by IP personnel helped drive these results.
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