January 11, 2017
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MRSA declines in VA hospitals after federal initiative

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Health care-associated MRSA rates fell substantially in Veterans Affairs facilities over the course of 8 years following the introduction of the Veterans Affairs MRSA Prevention Initiative, according to findings recently published in the American Journal of Infection Control.

A press release accompanying the study reported that MRSA infection rates were “unacceptably high” leading up to 2007, prompting the U.S. Department of Veterans Affairs to implement the initiative at all VA facilities in October of that year. It included having a dedicated MRSA prevention coordinator at each facility to oversee intervention bundles, such as universal active screening for MRSA on admission, during unit-to-unit transfers and upon discharge; contact precautions for patients colonized or infected with MRSA; hand hygiene adherence; and “institutional culture change” to make infection prevention the responsibility of everyone at the facility.

“Understanding how and why rates of MRSA have diminished in recent years is essential for the continued progress of effective prevention programs,” Martin E. Evans, MD, of the MRSA/MRDO prevention office, National Infectious Diseases Service and Patient Care Services at the Veterans Health Administration, Washington, DC., said in the press release. “As we seek to protect patients from MRSA and other resistant organisms, our study supports the need for strong infection prevention programs at every healthcare facility.”

Evans and colleagues reviewed monthly data from 133 long-term care facilities, 22 spinal cord injury units and 127 different acute care facilities around the United States, resulting in 23,153,240 ICU and non-ICU patient-days, as well as 1,794,234 patient-days in spinal cord injury units from October 2007 to September 2015. Researchers also evaluated 22,262,605 long-term care facility patient days from July 2009 to September 2015.

MRSA prevalence at admission increased slightly from 13.2% to 13.5% in acute care facilities, Evans and colleagues wrote, and from 23.1% to 25% in long-term care facilities. Admission prevalence fell in spinal cord injury units during the study period, from 35.1% to 32%.

In September 2015, ICUs had two health care-associated MRSA infections, non-ICUs had 20, including three in spinal cord injury units, and long-term care facilities had 31. Monthly infection rates plunged in all three types of facilities, researchers wrote. Infection rates fell by 49.4% in long-term care facilities, 80.9% in spinal cord injury units, 80.1% in non-ICUs and 87% in ICUs.

“We speculate that active surveillance was the primary driver of the downward trends seen in the VA, because MRSA health care-associated infection rates had not changed prior to October 2007 when the initiative was fully implemented, even though formal recommendations for hand hygiene and device-related infection control bundles had been in place for several years,” Evans and colleagues wrote. – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.