Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units
Background Methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) are a concern in the 22 acute care Veterans Affairs (VA) spinal cord injury units where patients with unique rehabilitation and medical needs and a high risk of infection are treated. Methods A bun...
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| Veröffentlicht in: | American journal of infection control 2013-05, Vol.41 (5), p.422-426 |
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| creator | Evans, Martin E., MD Kralovic, Stephen M., MD, MPH Simbartl, Loretta A., MS Obrosky, D. Scott, MS Hammond, Margaret C., MD Goldstein, Barry, MD, PhD Evans, Charlesnika T., MPH, PhD Roselle, Gary A., MD Jain, Rajiv, MD |
| description | Background Methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) are a concern in the 22 acute care Veterans Affairs (VA) spinal cord injury units where patients with unique rehabilitation and medical needs and a high risk of infection are treated. Methods A bundle was implemented in VA spinal cord injury units consisting of nasal surveillance for MRSA on admission/in-hospital transfer/discharge, contact precautions for patients colonized or infected with MRSA, an emphasis on hand hygiene, and an institutional culture change where infection control became everyone’s responsibility. Results From October 2007, through June 2011, there were 51,627 admissions/transfers/discharges and 816,254 patient-days of care in VA spinal cord injury units. The percentage of patients screened increased to >95.0%. The mean admission MRSA prevalence was 38.6% ± 19.1%. Monthly HAI rates declined 81% from 1.217 per 1,000 patient-days to 0.237 per 1,000 patient-days ( P < .001). Bloodstream infections declined by 100% ( P = .002), skin and soft-tissue infections by 60% ( P = .007), and urinary tract infections by 33% ( P = .07). Conclusion Universal surveillance, contact precautions, hand hygiene, and an institutional culture change was associated with significant declines in MRSA HAIs in a setting with a high prevalence of MRSA colonization and a high risk for infection. |
| doi_str_mv | 10.1016/j.ajic.2012.06.006 |
| format | Article |
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Scott, MS ; Hammond, Margaret C., MD ; Goldstein, Barry, MD, PhD ; Evans, Charlesnika T., MPH, PhD ; Roselle, Gary A., MD ; Jain, Rajiv, MD</creator><creatorcontrib>Evans, Martin E., MD ; Kralovic, Stephen M., MD, MPH ; Simbartl, Loretta A., MS ; Obrosky, D. Scott, MS ; Hammond, Margaret C., MD ; Goldstein, Barry, MD, PhD ; Evans, Charlesnika T., MPH, PhD ; Roselle, Gary A., MD ; Jain, Rajiv, MD</creatorcontrib><description>Background Methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) are a concern in the 22 acute care Veterans Affairs (VA) spinal cord injury units where patients with unique rehabilitation and medical needs and a high risk of infection are treated. Methods A bundle was implemented in VA spinal cord injury units consisting of nasal surveillance for MRSA on admission/in-hospital transfer/discharge, contact precautions for patients colonized or infected with MRSA, an emphasis on hand hygiene, and an institutional culture change where infection control became everyone’s responsibility. Results From October 2007, through June 2011, there were 51,627 admissions/transfers/discharges and 816,254 patient-days of care in VA spinal cord injury units. The percentage of patients screened increased to >95.0%. The mean admission MRSA prevalence was 38.6% ± 19.1%. Monthly HAI rates declined 81% from 1.217 per 1,000 patient-days to 0.237 per 1,000 patient-days ( P < .001). Bloodstream infections declined by 100% ( P = .002), skin and soft-tissue infections by 60% ( P = .007), and urinary tract infections by 33% ( P = .07). Conclusion Universal surveillance, contact precautions, hand hygiene, and an institutional culture change was associated with significant declines in MRSA HAIs in a setting with a high prevalence of MRSA colonization and a high risk for infection.</description><identifier>ISSN: 0196-6553</identifier><identifier>EISSN: 1527-3296</identifier><identifier>DOI: 10.1016/j.ajic.2012.06.006</identifier><identifier>PMID: 23149087</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Anti-Bacterial Agents - therapeutic use ; Bacteremia - prevention & control ; Bacterial diseases ; Biological and medical sciences ; Cerebrospinal fluid. Meninges. Spinal cord ; Cross Infection - prevention & control ; Discharge ; Epidemiology. Vaccinations ; Female ; General aspects ; Hospital Units ; Hospitals, Veterans ; Human bacterial diseases ; Humans ; Infection Control ; Infectious Disease ; Infectious diseases ; Intensive Care Units ; Male ; Medical sciences ; Medical screening ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; MRSA ; Nervous system (semeiology, syndromes) ; Neurology ; Risk ; Risk factors ; Spinal Cord Injuries ; Staphylococcal Infections - prevention & control ; Staphylococcal infections, streptococcal infections, pneumococcal infections ; Staphylococcus infections ; United States ; United States Department of Veterans Affairs ; Veterans</subject><ispartof>American journal of infection control, 2013-05, Vol.41 (5), p.422-426</ispartof><rights>2013</rights><rights>2014 INIST-CNRS</rights><rights>Published by Mosby, Inc.</rights><rights>Copyright Mosby-Year Book, Inc. May 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c568t-90270173f2829676ab07df0f3cb6fd860899c1a24e4a9fe2a319ea4e6fe90693</citedby><cites>FETCH-LOGICAL-c568t-90270173f2829676ab07df0f3cb6fd860899c1a24e4a9fe2a319ea4e6fe90693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0196655312009261$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27300547$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23149087$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Evans, Martin E., MD</creatorcontrib><creatorcontrib>Kralovic, Stephen M., MD, MPH</creatorcontrib><creatorcontrib>Simbartl, Loretta A., MS</creatorcontrib><creatorcontrib>Obrosky, D. Scott, MS</creatorcontrib><creatorcontrib>Hammond, Margaret C., MD</creatorcontrib><creatorcontrib>Goldstein, Barry, MD, PhD</creatorcontrib><creatorcontrib>Evans, Charlesnika T., MPH, PhD</creatorcontrib><creatorcontrib>Roselle, Gary A., MD</creatorcontrib><creatorcontrib>Jain, Rajiv, MD</creatorcontrib><title>Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units</title><title>American journal of infection control</title><addtitle>Am J Infect Control</addtitle><description>Background Methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) are a concern in the 22 acute care Veterans Affairs (VA) spinal cord injury units where patients with unique rehabilitation and medical needs and a high risk of infection are treated. Methods A bundle was implemented in VA spinal cord injury units consisting of nasal surveillance for MRSA on admission/in-hospital transfer/discharge, contact precautions for patients colonized or infected with MRSA, an emphasis on hand hygiene, and an institutional culture change where infection control became everyone’s responsibility. Results From October 2007, through June 2011, there were 51,627 admissions/transfers/discharges and 816,254 patient-days of care in VA spinal cord injury units. The percentage of patients screened increased to >95.0%. The mean admission MRSA prevalence was 38.6% ± 19.1%. Monthly HAI rates declined 81% from 1.217 per 1,000 patient-days to 0.237 per 1,000 patient-days ( P < .001). Bloodstream infections declined by 100% ( P = .002), skin and soft-tissue infections by 60% ( P = .007), and urinary tract infections by 33% ( P = .07). Conclusion Universal surveillance, contact precautions, hand hygiene, and an institutional culture change was associated with significant declines in MRSA HAIs in a setting with a high prevalence of MRSA colonization and a high risk for infection.</description><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Bacteremia - prevention & control</subject><subject>Bacterial diseases</subject><subject>Biological and medical sciences</subject><subject>Cerebrospinal fluid. Meninges. Spinal cord</subject><subject>Cross Infection - prevention & control</subject><subject>Discharge</subject><subject>Epidemiology. Vaccinations</subject><subject>Female</subject><subject>General aspects</subject><subject>Hospital Units</subject><subject>Hospitals, Veterans</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infection Control</subject><subject>Infectious Disease</subject><subject>Infectious diseases</subject><subject>Intensive Care Units</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medical screening</subject><subject>Methicillin Resistance</subject><subject>Methicillin-Resistant Staphylococcus aureus</subject><subject>Middle Aged</subject><subject>MRSA</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Risk</subject><subject>Risk factors</subject><subject>Spinal Cord Injuries</subject><subject>Staphylococcal Infections - prevention & control</subject><subject>Staphylococcal infections, streptococcal infections, pneumococcal infections</subject><subject>Staphylococcus infections</subject><subject>United States</subject><subject>United States Department of Veterans Affairs</subject><subject>Veterans</subject><issn>0196-6553</issn><issn>1527-3296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkk1r3DAQhkVpaDZp_0APxVAKudgdSbZsQQmUkH5AoIXkrmrlEZHrlbaSHdh_Hzm7bSCHktOM4HlHM_MOIW8pVBSo-DhUenCmYkBZBaICEC_IijasLTmT4iVZAZWiFE3Dj8lJSgMASC6aV-SYcVpL6NoV-fUz4h36yQVfBFtscLp1xo2j82XE5NKk_VRcT3p7uxuDCcbMqdBzxByct2gW4ZIWaeu8HgsTYp-fwxx3xezdlF6TI6vHhG8O8ZTcfLm8ufhWXv34-v3i81VpGtFNpQTWAm25ZV3uvRV6DW1vwXKzFrbvBHRSGqpZjbWWFpnmVKKuUViUICQ_JWf7stsY_syYJrVxyeA4ao9hTormwWXHmKyfgdYty0tjC_r-CTqEOeY5H6iOigYeCrI9ZWJIKaJV2-g2Ou4UBbU4pQa1OKUWpxQIlZ3KoneH0vN6g_0_yV9rMvDhAOhk9Gij9salR67lAE29cJ_2HObt3jmMKhmH3mDvYvZH9cH9v4_zJ3KTzXf5x9-4w_Q4r0pZo66Xm1pOirJ8TUxQfg9_LcYw</recordid><startdate>20130501</startdate><enddate>20130501</enddate><creator>Evans, Martin E., MD</creator><creator>Kralovic, Stephen M., MD, MPH</creator><creator>Simbartl, Loretta A., MS</creator><creator>Obrosky, D. Scott, MS</creator><creator>Hammond, Margaret C., MD</creator><creator>Goldstein, Barry, MD, PhD</creator><creator>Evans, Charlesnika T., MPH, PhD</creator><creator>Roselle, Gary A., MD</creator><creator>Jain, Rajiv, MD</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Mosby-Year Book, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope></search><sort><creationdate>20130501</creationdate><title>Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units</title><author>Evans, Martin E., MD ; Kralovic, Stephen M., MD, MPH ; Simbartl, Loretta A., MS ; Obrosky, D. Scott, MS ; Hammond, Margaret C., MD ; Goldstein, Barry, MD, PhD ; Evans, Charlesnika T., MPH, PhD ; Roselle, Gary A., MD ; Jain, Rajiv, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c568t-90270173f2829676ab07df0f3cb6fd860899c1a24e4a9fe2a319ea4e6fe90693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Bacteremia - prevention & control</topic><topic>Bacterial diseases</topic><topic>Biological and medical sciences</topic><topic>Cerebrospinal fluid. Meninges. Spinal cord</topic><topic>Cross Infection - prevention & control</topic><topic>Discharge</topic><topic>Epidemiology. Vaccinations</topic><topic>Female</topic><topic>General aspects</topic><topic>Hospital Units</topic><topic>Hospitals, Veterans</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Infection Control</topic><topic>Infectious Disease</topic><topic>Infectious diseases</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medical screening</topic><topic>Methicillin Resistance</topic><topic>Methicillin-Resistant Staphylococcus aureus</topic><topic>Middle Aged</topic><topic>MRSA</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Risk</topic><topic>Risk factors</topic><topic>Spinal Cord Injuries</topic><topic>Staphylococcal Infections - prevention & control</topic><topic>Staphylococcal infections, streptococcal infections, pneumococcal infections</topic><topic>Staphylococcus infections</topic><topic>United States</topic><topic>United States Department of Veterans Affairs</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Evans, Martin E., MD</creatorcontrib><creatorcontrib>Kralovic, Stephen M., MD, MPH</creatorcontrib><creatorcontrib>Simbartl, Loretta A., MS</creatorcontrib><creatorcontrib>Obrosky, D. Scott, MS</creatorcontrib><creatorcontrib>Hammond, Margaret C., MD</creatorcontrib><creatorcontrib>Goldstein, Barry, MD, PhD</creatorcontrib><creatorcontrib>Evans, Charlesnika T., MPH, PhD</creatorcontrib><creatorcontrib>Roselle, Gary A., MD</creatorcontrib><creatorcontrib>Jain, Rajiv, MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><jtitle>American journal of infection control</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Evans, Martin E., MD</au><au>Kralovic, Stephen M., MD, MPH</au><au>Simbartl, Loretta A., MS</au><au>Obrosky, D. Scott, MS</au><au>Hammond, Margaret C., MD</au><au>Goldstein, Barry, MD, PhD</au><au>Evans, Charlesnika T., MPH, PhD</au><au>Roselle, Gary A., MD</au><au>Jain, Rajiv, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units</atitle><jtitle>American journal of infection control</jtitle><addtitle>Am J Infect Control</addtitle><date>2013-05-01</date><risdate>2013</risdate><volume>41</volume><issue>5</issue><spage>422</spage><epage>426</epage><pages>422-426</pages><issn>0196-6553</issn><eissn>1527-3296</eissn><abstract>Background Methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) are a concern in the 22 acute care Veterans Affairs (VA) spinal cord injury units where patients with unique rehabilitation and medical needs and a high risk of infection are treated. Methods A bundle was implemented in VA spinal cord injury units consisting of nasal surveillance for MRSA on admission/in-hospital transfer/discharge, contact precautions for patients colonized or infected with MRSA, an emphasis on hand hygiene, and an institutional culture change where infection control became everyone’s responsibility. Results From October 2007, through June 2011, there were 51,627 admissions/transfers/discharges and 816,254 patient-days of care in VA spinal cord injury units. The percentage of patients screened increased to >95.0%. The mean admission MRSA prevalence was 38.6% ± 19.1%. Monthly HAI rates declined 81% from 1.217 per 1,000 patient-days to 0.237 per 1,000 patient-days ( P < .001). Bloodstream infections declined by 100% ( P = .002), skin and soft-tissue infections by 60% ( P = .007), and urinary tract infections by 33% ( P = .07). Conclusion Universal surveillance, contact precautions, hand hygiene, and an institutional culture change was associated with significant declines in MRSA HAIs in a setting with a high prevalence of MRSA colonization and a high risk for infection.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>23149087</pmid><doi>10.1016/j.ajic.2012.06.006</doi><tpages>5</tpages></addata></record> |
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| subjects | Anti-Bacterial Agents - therapeutic use Bacteremia - prevention & control Bacterial diseases Biological and medical sciences Cerebrospinal fluid. Meninges. Spinal cord Cross Infection - prevention & control Discharge Epidemiology. Vaccinations Female General aspects Hospital Units Hospitals, Veterans Human bacterial diseases Humans Infection Control Infectious Disease Infectious diseases Intensive Care Units Male Medical sciences Medical screening Methicillin Resistance Methicillin-Resistant Staphylococcus aureus Middle Aged MRSA Nervous system (semeiology, syndromes) Neurology Risk Risk factors Spinal Cord Injuries Staphylococcal Infections - prevention & control Staphylococcal infections, streptococcal infections, pneumococcal infections Staphylococcus infections United States United States Department of Veterans Affairs Veterans |
| title | Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units |
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