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Reduction of Hospital-Onset Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia in an Acute Care Hospital: Impact of Bundles and Universal Decolonization

Adriana Jimenez, MPH, MLS(ASCP), CIC – Infection Control Manager, Jackson Health System, Infection Prevention and Control Department

Kathleen Sposato, RN MSN CIC – Senior Director, Infection Prevention, Jackson Health System, Infection Prevention and Control Department

Alicia de Leon-Sanchez, RN, MSN, MBA – Regional Manager, Patient Experience, Broward Health Medical Center

Regina Williams, BSN – Infection Preventionist, Jackson Health System, Infection Prevention and Control Department

Reynande Francois, RN, BSN,MSN – Nurse Manager, Jackson North Medical Center

Juliana Wilson, RN, BSN, MSN. – Nurse Manager, Jackson North Medical Center

Benjamin Lisondra, RN, BSN, BSA, MBA, MSN. – Director of Patient Care Services Critical Care Division, Jackson North Medical Center

Lilian Abbo, MD, FIDSA – Professor of Infectious Diseases; Chief Infection Control & Antimicrobial Stewardship, University of Miami Miller School of Medicine & Jackson Health System


Background :

MRSA is a major concern for hospitalized patients in the United States. Hospital-Onset (HO) MRSA bacteremia is used as a proxy measurement of MRSA healthcare acquisition, exposure, and infection burden. HO MRSA bacteremia standardized infection ratio (SIR) is used by several national agencies as a quality report metric. Our institution had more than expected HO MRSA bacteremia cases despite several interventions. We describe the impact of a bundle of interventions aimed to decrease HO MRSA bacteremia in an acute care facility.

Methods :

This quality improvement project was implemented in a 380-bed community hospital in Miami, FL from January 2015 to March 2019. HO MRSA bacteremia was defined as non-duplicate MRSA isolated from a blood culture collected >3 days after admission. SIR was calculated dividing the number of observed events by the number of predicted events; predicted events were obtained from the NHSN report.

During baseline period (Figure1 Phase 1 January 2015 - August 2016) all adult patients  in the intensive care unit (ICU) were screened for MRSA nasal colonization on admission and weekly thereafter, ICU  patients received daily Chlorhexidine (CHG) bathing, and colonized/infected patients with MRSA were placed in contact precautions. In  Phase 2 (September 2016 – June 2017)daily CHG bathing was switched from 2% wipes to 4% soap foam and expanded to all adult patients; ICU patients also received nasal decolonization with mupirocin. Nasal mupirocin in ICU was replaced with alcohol-based nasal sanitizer for all adult units in July 2017 (Phase 3). In April 2017 we discontinued using contact precautions for MRSA patients; nasal surveillance cultures were discontinued in October 2017. In May 2018 (Phase 4) we introduced alcohol-based wipes for patient hand hygiene at bedside.

SIR were compared by exact binomial test.

Results :

We observed 48 HO MRSA bacteremia cases during the study period. The SIR decreased from 3.66 to 0.97 from baseline to postintervention periods (P  .003). The largest decrease in cases and SIR was attained using combined hospital wide daily CHG bathing, alcohol-based nasal sanitizer, and alcohol wipes for patient hand hygiene during Phase 4 (Table1).

Conclusion :

Our bundle of interventions for universal decolonization was successful in decreasing HO MRSA bacteremia.

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