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Acute Myocardial Infarction	Medication Reconciliation (ADE)
Boards on Board	Pressure Ulcers
Catheter-Associated UTI	Rapid Response Teams
Central Line Infections	Surgical Complications
Congestive Heart Failure	Surgical Safety Checklist
High-Alert Medications	Surgical Site Infections
MRSA	Ventilator-Associated Pneumonia

Use this table to quickly find a mentor for the prevention of MRSA with demographics similar to your own, or use 'ctrl+f' in your web browser to search for specific key words on this page.

Beth Israel Medical Center – New York, NY
Availability Status: Available to answer requests
Licensed Beds: 1374
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: August 2006
Mentor Contact Name: Brian Koll, MD
Mentor Contact Email: bkoll@chpnet.org
Mentor Contact Phone: 212-420-2853

Additional Information:

Beth Israel Medical Center built on it success with the CLABs and VAP bundles to launch the MRSA bundle.
Because hand hygiene compliance, use of contact precautions, and compliance with CLABs and VAP bundle are 90+%, a system to ensure compliance with the decontamination of the environment and equipment component of the bundle was emphasized through work with environmental services, transporters and radiology.
Active surveillance cultures were also instituted in areas of the hospital where there is a high prevalence of MRSA such as the ICU and also select surgical populations.

There has been a 60% decrease in hospital acquired MRSA infections as well as decreases in the rate of other drug resistant organisms.
Our hospital acquired MRSA rate decreased from 4.0 to 1.0 per 1,000 patient discharges.
Active surveillance has identified that 15% of patients admitted are admitted with MRSA.  These patients are placed on contact precautions.
Environmental cultures from high touch areas are obtained for MRSA after a room is cleaned.  To date, none have been positive.
Control of MRSA and other drug resistant organisms has saved the hospital $1.5 million in avoided costs.

[3/13/07]

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Blount Memorial Hospital – Maryville, TN
Availability Status: Available to answer requests
Licensed Beds: 194
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: January 2004
Mentor Contact Name: MRSA contact - Sherry Hillis, Infection Control Practitioner; Marie Fox, Director of Quality Management
Email: shillis@bmnet.com; mfox@bmnet.com
Mentor Contact Phone: Hillis - 865-980-4860; Fox - 865-981-2476

Additional Information:

Aim:  Reduce Methicillin Resistant Staphylococcus aureus transmission in long-term care facility (LTCF) patients admitted to our hospital. This effort involved creating a MRSA project team, creating protocols for handling LTCF patients, targeted MRSA staff & patient education, ongoing communications with LTCF leaders, increased data collection and monitoring, and most important, leadership commitment to support the project.

Interventions included:

• Developed and implemented a new MRSA protocol that involved empiric contact precautions (ECP) and active surveillance cultures (ASC) for patients admitted from LTCF. Treated all patients admitted from LTCF as “MRSA-positive until proven innocent” by placing them automatically on ECP while awaiting results from ASC for MRSA. Required a negative MRSA culture to discontinue ECP.
• Met with individual LTCF administrators and staff to discuss and educate on MRSA recommendations and new hospital policies. 
• Conducted daily infection control rounds for surveillance of compliance with ECP and ASC protocols the first six months of the project and intermittently as needed thereafter.  Addressed observed protocol compliance failures immediately by meeting with clinical supervisors and their respective unit staff within 24 hours of occurrence.  Conducted targeted follow-up surveillance on all reported compliance failures.
• Purchased additional isolation carts and revised isolation cart package contents to more efficiently and economically provide care for patients in ECP.
• Implemented a concomitant hand hygiene program throughout the hospital.
• Developed new easy-to-understand patient and family educational brochures on MRSA and ECP.

Results:

• The HO-MRSA incidence trend moved from an upward quarterly trend (+0.048) to a sustained downward trend (-0.024)

• The HO-MRSA rate has decreased 50%

• The MRSA reportable isolate rate has decreased 75%

• Average length of stay among hospitalized LTCF residents has decreased by 2.2 days

[4/18/08]

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Centra Health – Lynchburg, VA
Availability Status: Available to answer requests
Licensed Beds: 403
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: October 2006
Mentor Contact Name: Kathy Bailey, RN, CIC
Mentor Contact Email: kathy.bailey@centrahealth.com
Mentor Contact Phone: 434-947-7780

Additional Information:

In 2004, Centra Health realized a 28% reduction in critical care MRSA infections by implementing contact precautions, appropriate disinfection and hand hygiene and selectively performing active surveillance cultures (ASC) on admissions noted to be at high risk for MRSA. In October 2006, we made the decision to do ASC on ALL admissions to our medical intensive care unit to further reduce infections and we will add our surgical intensive care unit in May 2007.

Our MRSA infection rate has been 0.00 in our medical intensive care unit for 5 consecutive months

[4/30/07]

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Evanston Hospital, NorthShore University HealthSystem—Evanston, Illinois
Availability Status: Available to answer requests
Licensed Beds:  476
Teaching/ Non-Teaching Status:  Teaching
Setting:  Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Donna M. Hacek, MT (ASCP)
Mentor Contact Email: dhacek@northshore.org
Mentor Contact Phone: 847-570-1731

Additional Information:

The Evanston Hospital, Evanston Northwestern Healthcare MRSA Prevention Program has been able to design and deploy a universal surveillance program for detecting patients carrying MRSA

We were able to roll out the program with excellent compliance for MRSA admission screening within a few months of the program's beginning.

The successful program rapidly detected new patients with MRSA on admission so that they could be appropriately placed in contact isolation to prevent MRSA being spread to other patients, thus preventing infections in patients not already harboring MRSA.

The program also successfully decolonized the newly recognized MRSA patients so that they did not return in the future with a MRSA infection.

The MRSA Prevention Program saved enough money on the prevented MRSA infections that it paid for itself in the first year of operation.

By the end of the first year there was a sustainable rate of performing surveillance on all new admissions exceeding 90%.

In the first year there was a 50% reduction of MRSA nosocomial bloodstream infections hospital-wide.

In the first year there was a 75% reduction of MRSA nosocomial respiratory infections hospital-wide.

By the end of the first year the cost of the program was $600,000 and the excess healthcare costs avoided from preventing MRSA infection were determined to be cost-saving to the organization by our finance department.
[3/13/07]

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Glenbrook Hospital, NorthShore University HealthSystem—Glenview, IL
Availability Status: Available to answer requests
Licensed Beds:  143
Teaching/ Non-Teaching Status:  Teaching
Setting:  Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Donna M. Hacek, MT (ASCP)
Mentor Contact Email: dhacek@northshore.org
Mentor Contact Phone: 847-570-1731

Additional Information:

The Glenbrook Hospital, Evanston Northwestern Healthcare MRSA Prevention Program has been able to design and deploy a universal surveillance program for detecting patients carrying MRSA

We were able to roll out the program with excellent compliance for MRSA admission screening within a few months of the program's beginning.

The successful program rapidly detected new patients with MRSA on admission so that they could be appropriately placed in contact isolation to prevent MRSA being spread to other patients, thus preventing infections in patients not already harboring MRSA.

The program also successfully decolonized the newly recognized MRSA patients so that they did not return in the future with a MRSA infection.

The MRSA Prevention Program saved enough money on the prevented MRSA infections that it paid for itself in the first year of operation.
By the end of the first year there was a sustainable rate of performing surveillance on all new admissions exceeding 90%.

In the first year there was a 50% reduction of MRSA nosocomial bloodstream infections hospital-wide.

In the first year there was a 75% reduction of MRSA nosocomial resipratory infections hospital-wide.

By the end of the first year the cost of the program was $600,000 and the excess healthcare costs avoided from preventing MRSA infection were determined to be cost-saving to the organization by our finance department.
[3/13/07]

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Highland Park Hospital, NorthShore University HealthSystem - Highland Park, IL
Availability Status: Available to answer requests
Licensed Beds:  239
Teaching/ Non-Teaching Status:  Teaching
Setting:  Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Donna M. Hacek, MT (ASCP)
Mentor Contact Email: dhacek@northshore.org
Mentor Contact Phone: 847-570-1731

Additional Information:

The Glenbrook Hospital, Evanston Northwestern Healthcare MRSA Prevention Program has been able to design and deploy a universal surveillance program for detecting patients carrying MRSA

We were able to roll out the program with excellent compliance for MRSA admission screening within a few months of the program's beginning.

The successful program rapidly detected new patients with MRSA on admission so that they could be appropriately placed in contact isolation to prevent MRSA being spread to other patients, thus preventing infections in patients not already harboring MRSA.

The program also successfully decolonized the newly recognized MRSA patients so that they did not return in the future with a MRSA infection.

The MRSA Prevention Program saved enough money on the prevented MRSA infections that it paid for itself in the first year of operation.
By the end of the first year there was a sustainable rate of performing surveillance on all new admissions exceeding 90%.

In the first year there was a 50% reduction of MRSA nosocomial bloodstream infections hospital-wide.

In the first year there was a 75% reduction of MRSA nosocomial resipratory infections hospital-wide.

By the end of the first year the cost of the program was $600,000 and the excess healthcare costs avoided from preventing MRSA infection were determined to be cost-saving to the organization by our finance department.
[3/13/07]

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Mercy Medical Center – Cedar Rapids, IA
Availability Status: Available to answer requests
Licensed Beds: 445
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: September 2003
Mentor Contact Name: Stacy DeMoss
Mentor Contact Email: sdemoss@mercycare.org
Mentor Contact Phone: 319-398-6696

Additional Information:

• Developed protocols for screening patients upon admission to identify MRSA carriers. Educated staff about the rising MRSA prevalence in the community, the anticipated benefits of the screening program, and how to handle the anticipated increase in isolation cases on each unit.

• Changed the contact isolation protocol to include gown, gloves, and mask as the personal protective equipment required for every person entering the room, visitors included.   Every person who enters a patient's room performs hand hygiene before coming in contact with the patient and then performs hand hygiene again before exiting the room.
 
• Nursing home residents or persons transferred from acute care facilities are placed into contact isolation and nasal swabs are collected. The patient remains in contact isolation until nasal swab is ruled negative for MRSA.  Persons with skin and/or soft tissue infections are also placed into contact isolation, the wound opened by the physician, if appropriate, and a culture collected to rule out MRSA.

• Beginning in January 2005, total joint patients have been screened for MRSA nasal carriage during pre-surgical teaching and evaluation sessions.  Cardiologists and vascular surgeons have now agreed to use the total joint protocol for persons scheduled for CABG or ICD or pacer implants. This program is under development.
 
• Every admission is reviewed to ensure that cultures are collected and appropriate isolation precautions are established.

• Support of the nurse managers has been important to the initiation and maintenance of the change.  Members of the patient care team, including physical therapists, speech and occupational therapists and social workers, are staunch supporters of the process and assist visitors to understand the purpose of the precautions and encourage visitor involvement in reducing the spread of multidrug-resistant organisms.

• Prevention costs money.  Infections cost money and increase morbidity and mortality.

Reduction in MRSA HCAI rates from an average of 0.67 (per 1000 pt days) from January 2004 through December 2005 to 0.33 (per 1000 pt days) from January 2006 through March 2007.
[6/5/07]

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Mission Hospital – Asheville, NC
Availability Status: Available to answer requests
Staffed Beds: 600
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: September 2006
Mentor Contact Name: Wilma Barnes, Infection Control Specialist; Amy Hearing, Quality Resource Specialist
Mentor Contact Email: Wilma.Barnes@msj.org; Amy.Hearing@msj.org
Mentor Contact Phone: Barnes: 828-213-5461; Hearing: 828-213-3522

Additional Information:

Mission Hospital is a tertiary care center in Asheville, North Carolina.  We are the regional referral center for western North Carolina and the surrounding region.  We have 40,000 annual inpatient admissions and perform 40,000 annual surgeries.  

The MRSA IHI Committee formed in 2006 as one of several initiatives launched as a result of the 5 Million Lives Campaign.  It is a multi-disciplinary team with representation from Infectious Disease, Infection Control, Nursing, Performance Improvement, Public Health, Microbiology, Materials Management, and Environmental Services. 

In early 2006, we saw that our nosocomial MRSA infection rate was steadily increasing and had peaked at 8.0 per 10,000 patient days of care.  The team set an aim to reduce nosocomial MRSA infections by 50%.

The team decided to pilot active surveillance in the ICUs beginning in September 2006.  Specifically, we started to identify patients colonized with MRSA and place them on contact isolation in a timely manner.  The team quarterly reviewed the nosocomial MRSA infection rate and incidence by unit to decide where screening should occur.  It was expanded to the NICU and floors with highest incidence of MRSA throughout 2007. 

We chose to use PCR (polymerase chain reaction) testing because of its high sensitivity, efficacy, and fast results.  The faster PCR test produces results in as soon as two hours and makes putting patients on preemptive isolation unnecessary.  It may also reduce risk of transmission because patients with positive results can be identified and placed on isolation sooner.  Negative patients are re-screened every seven days.  The decision was made not to decolonize patients prior to discharge based on current evidence.

Infection control specialists educate staff on how to do nasal swabs and educate patients and families about MRSA.  Infection control specialists also report to the MRSA team on % MRSA-positive patients and infection data. 

PCR testing is done on admission in four adult ICUs, NICU, seven high-incidence units, and pre-admissions for heart surgery.  This has amounted to 22,000 annual screens and 50% of all inpatient admissions.  Eight percent of patients have asymptomatic MRSA colonization and are placed on isolation to prevent nosocomial spread.

We reached the goal of reducing nosocomial MRSA infections by 50% by the end of 2007.  The team conducted a cost-benefit analysis to help decide whether to expand screening hospital-wide:

- The annual cost of PCR screening is roughly $600,000. 
- We spent roughly $100,000 in 2007 to purchase stocked isolation carts.  Patient isolation days have increased over 60% since screening began and the total increased annual isolation cost attributed to MRSA screening is roughly $500,000.  (This does not include additional nursing time spent for isolated patients.)
- We estimate over $2 million annual cost savings based on the nosocomial MRSA infection rate at the end of 2007 and an estimated $26,000 cost savings per avoided MRSA infection.
- Net annual cost savings are approximately $925,000.

It was decided that the benefits did not justify the costs of expanding screening hospital-wide.  Any expanded screening would require a significant investment in resources.  Also there was concern about the impact of increased isolation both on nursing workload and patients. 

Barriers and Lessons Learned:

- Although it was decided to stop PCR screening in the NICU, this change has not yet been implemented.  The lab is preparing to offer the Chromagar test instead, which costs less and has 24-48 hours turnaround time.  PCR testing will continue until the Chromagar test is available.  Although the NICU has the lowest positive MRSA colonization rate, it has the highest nosocomial MRSA colonization rate.  There was also a large outbreak just prior to the start of PCR screening and none since then, so there was evidence that PCR screening was effective.  
- The % MRSA-positive rate combined with nosocomial MRSA infection rate are important measures and should be continually monitored to make informed decisions.
- Monitor cost-benefit from the beginning.  Increased isolation has a profound organizational impact that is easily overlooked. 
- Educating staff, patients, and families takes continuous effort.  Because of the incremental implementation, Infection Control is constantly educating staff.  Also, since only certain units do screening, floating nurses must be trained.  It can be difficult at first for nurses to explain to patients and their families what it means to be colonized with MRSA, why they are on contact isolation, and why we do not decolonize them.  They need to be trained and provided with educational materials. 

The nosocomial MRSA infection rate has been reduced from 7.5 infections per 10,000 patient days in the Q2 2006 (pre-PCR screening) to 1.5 infections per 10,000 patient days in the Q2 2008. The nosocomial MRSA infection rate ranged from 4.6 to 8.2 in the years previous to implementing PCR screening, three to five times higher than the current rate.

Other quality initiatives may have contributed to the decline in the infection rate.  For example, a comprehensive hand hygiene campaign was launched at the beginning of 2007, and compliance reached 90% in early 2008.  However, the team is fairly confident that screening made the largest impact because the sharpest decline in the infection rate occurred after MRSA screening began in the ICUs and most of the decrease in infections occurred only in the units participating in screening.

Total nosocomial MRSA infections decreased by 50% from 2006 to 2007, with a 67% decrease in the units participating in PCR screening and 10% decrease in all other areas not participating in PCR screening.  In addition, 93% of total potentially avoided nosocomial MRSA infections occurred in participating units.
[10/23/08]

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Newark Beth Israel Medical Center – Newark, NJ
[Adult & Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds:  567
Teaching/ Non-Teaching Status:  Teaching
Setting:  Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Jeremias L. Murillo, MD, Hospital Epidemiologist
Mentor Contact Email: jmurillo@sbhcs.com
Mentor Contact Phone: (973) 926-7329

Additional Information:

Newark Beth Israel Medical Center is a 600-bed tertiary care medical center that serves both an inner city (predominantly African-American) and a suburban patient population. In recent years, we've had a significant increase in the number of admitted patients colonized with MRSA. This has resulted in an overall increase in both community-associated and health care-associated MRSA infections.

In our neonatal intensive care unit (NICU), babies were being admitted colonized with MRSA at birth and we have shown that mothers were also colonized at the time of delivery. Because of these findings, we instituted MRSA screening for nasal colonization for all admissions to our NICU.

The systematic process for implementation included the following:

The problem identified was the increasing incidence of MRSA infections in premature infants in July 2005. A team was formed consisting of representatives from Neonatology, Nursing, Microbiology Laboratory, Housekeeping, Infection Control and Epidemiology. The purpose of the team was to implement infection control measures including surveillance, identification of infected and colonized patients, use of cohort methods and isolation techniques, intensive environmental sanitation and health care worker education.

The steps in the process were:

• Verification of the diagnosis and confirmation of MRSA infection in the babies
• Surveillance and search for additional infected cases
• Use of isolation techniques to prevent the spread of MRSA to other babies
• Convening the team to address the problem and sustain the control measures
• Initiating aggressive environmental cleaning procedures
• Testing other babies for nasal colonization with MRSA
• Cohorting of infected and colonized babies
• Discovering that babies were being admitted already colonized with MRSA
• Initiating MRSA screening for all admissions and decolonizing positive babies with topical mupirocin
• MRSA screening of health care workers with direct patient contact (one-time only)
• Weekly team meetings to monitor results
• Introducing state-of-the-art MRSA screening using PCR-based technology
• Repeating the risk assessment to identify the next unit to apply the methodology
• Duplicating the same methodology in the adult ICU in September 2006 

Lessons learned: 

• Perform a risk assessment for MRSA in your own institution to identify the high-risk areas. (We found variations from unit to unit.)

• Develop a methodology to identify the previously unrecognized cases of MRSA colonization being admitted to the hospital.

To date, we have identified 22 babies positive at birth. As a result of our ability to identify and decolonize positive babies, we have not seen a single MRSA infection in our NICU for 15 consecutive months. The previous year, we had 20 MRSA infections.

We duplicated this process in our adult ICU in September 2006 and we have seen a colonization rate of 21% on all admissions or transfers to the ICU. Since we instituted admission screening, we have not seen a single MRSA infection in 6 months of surveillance.
[4/7/07]

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Saint Clare's Health System – Denville, NJ
Availability Status: Available to answer requests
Staffed Beds: 260
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: January 2006
Mentor Contact Name: Norma Atienza, RN Director Clinical Quality and Epidemiology and Laura Anderson, RN, Nurse Epidemiologist
Mentor Contact Email: natienza@saintclares.org; landerson@saintclares.org
Mentor Contact Phone: 973-625-6597; 973-625-6598

Additional Information:

St. Clare's Health System has one Infection Control department for three acute care campuses of varying sizes (Denville:  260 staffed beds; Dover: 50; and Sussex: 41.)  In 2003, Saint Clare’s infection rate for MRSA was 0.84. With the incoming of a new epidemiology director and staff in 2004, we looked at new ways to decrease the transmission of MRSA as well as our health care acquired infections. MRSA colonized patients had previously not been isolated so we began isolating all MRSA positive patients. In addition to standard precautions, contact precautions were also implemented.

Hand Hygiene Campaign:  Compliance rate to hand washing was 72 percent in 2004.  We heightened our hand washing awareness in 2005 and began a hand hygiene campaign. Monthly hand hygiene audits were done by actual observation. A data collection tool was revised (see appendix) and unit based “hand washing secret agents” were asked to perform 20 observations a month in a patient care unit. Secret agents are an interdisciplinary mix including RNs, LPNs, nursing assistants, unit secretaries, respiratory therapists and physical medicine staff. Results were sent to the epidemiology department for data analysis and reporting. Concurrent corrective actions were implemented for departments with low compliance rates. Compliance rate went up to 82 percent by the end of 2005. Tickets were designed in 2007 to be given to those that are caught not washing their hands as a gentle reminder to be compliant. Hand hygiene compliance was also integrated in the employee’s annual evaluation. Additional alcohol hand gel dispensers were also installed in high traffic areas to increase compliance.

Environmental cleaning:  In 2005 and 2006 all efforts continued with collaboration and emphasis on environmental services. All discharge units are terminally cleaned including changing cubical curtains for all patients that were on isolation during their stay. Environmental Staff were also evaluated on actual cleaning and went through a rigorous educational session on the importance of a clean environment to the prevention and control of infection. Policies were revised appropriately.

Infection Control Liaison:  In 2006, we began our Infection Control Liaison Program. Staff members from the nursing units were assigned to be the “Infection Control Expert” on their units. They meet regularly with the Infection Control Practitioners to review unit specific goals and health care acquired infection rates. They serve as the eyes and ears of the ICPs in the units and also as an infection control resource for their co-staff. New ideas are discussed and shared and contribute to the development of new policies and protocols.

Flagging Positive Cases:  In 2004, we worked with our IT and Admitting Departments to have a system of identifying positive cases of not only MRSA but all MDRO patients including C. Diff when they are readmitted into our acute care facilities. These are the cases that were not cleared of infection before discharge. If they are re-admitted, Admitting Staff must review the MDRO/C. Diff status on Admission Face Sheet and must notify the unit to ensure the patient is properly and timely isolated.

Education:  With the heightened awareness of MRSA, especially in the community, we have been providing multiple educational sessions on the prevention and control of infections, especially MRSA. Isolation protocols and practices are reviewed to our nursing staff in different scenarios, informal, formal, group, or one to one sessions. MRSA education is also expanded to our visitors and to the community that we serve.

Screening:  2007 brought mandatory MRSA nasal screening in New Jersey. By state law, all hospitals were to begin MRSA nasal screenings in a designated high risk area (such as the ICU). At Saint Clare’s, we expanded our screening population to many high risk populations. All nursing home, hemodialysis inpatients and all past positive MRSA patients are being screened. In early 2007 we identified an increase in our MRSA orthopedic surgical site infections so all pre-op orthopedic patients are also screened pre-operatively as well as all surgical patients that are being discharged to a nursing home or rehabilitation facility.  The program was rolled out in our three acute care facilities. Standing orders for MRSA nasal screening were developed. Rapid PCR testing began November 15, 2007 (initially screens were done via culture plating). In 2007, 1105 patients were screened with 123 positive (11.1 percent positive rate). By the end of February 2008, 656 patients have been screened with 131 positive (20 percent positive rate). All positive patients are immediately isolated and placed on contact precautions.

We are continuously reviewing and evaluating our program goals and outcomes. Through active participation via conferences and webinars with APIC, IHI, CDC and other related associations, new ideas and innovations are developed to further improve our prevention strategies.

Hand hygiene compliance has shown great improvement over the years and system wide, Saint Clare’s had a compliance rate of 91.4 percent in 2007. 

Through all our efforts, MRSA hospital acquired infection rates have declined from 0.84 in 2003, 0.54 in 2004, 0.48 in 2005, and 0.35 in 2006 to 0.29 in 2007 – an improvement of 35 percent over 5 years.
[5/1/08]

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Veterans Administration Pittsburgh Healthcare System (VAPHS)–Pittsburgh, PA
Availability Status: Available to answer requests
Licensed Beds:  146
Teaching/ Non-Teaching Status:  Teaching
Setting:  Urban
Start Date of Intervention Work: August 2001
Mentor Contact Name: Candace Cunningham, RN, MRSA Coordinator
Mentor Contact Email: candace.cunningham@med.va.gov
Mentor Contact Phone: (412) 688-6000, Ext. 815612

Additional Information:

(a) August 2001 to June 2005: An industrial model (Toyota Production System or TPS) was piloted on a surgical specialty nursing unit and surgical intensive care unit to enable the staff to comply with evidence-based precautions (SHEA guidelines) to prevent MRSA HAIs. TPS-trained mentors and team leaders worked with staff to standardize routines and create system changes that enabled them to implement strict hand hygiene, active surveillance and contact isolation precautions with dramatic reductions in MRSA HAIs in the two pilot units in the 125 bed acute care facility (VAPHS-UD).

(b) July 2005: VAPHS initiated hospital-wide implementation of hand hygiene, active surveillance and appropriate contact isolation precautions in its 125 bed acute care and 275 bed long term care facility.

(c) July 2005: Clinical and administrative leaders and staff representatives attend Positive Deviance (PD) workshop. PD is an approach to behavioral and cultural transformation from within an organization which enables the staff and patients to assume true ownership of the problem (MRSA HAIs) and solutions.

(d) August 2005: Orders for active surveillance culture (nares swabs) "hard wired" in to EMR on every patient on admission and discharge. Culture results reported to nursing units daily. Performance data (nares swabbing rates, MRSA transmission and infection rates) reported to nursing units weekly.

(e) August through November 2005: Discovery and action dialogs with 500 staff and patients in the two facilities to discuss their practices and ideas on how to prevent MRSA transmissions and associated infections. Volunteers emerge to work on the problem.

(f) September 2005: Weekly 15 minute stand-up briefings in each nursing unit initiated. Staff reports their performance data, successes and improvement opportunities and identify barriers which clinical and administrative leaders attending the briefings can help eliminate.

(g) August 2006: MRSA status of patients shared with support services where staff create ways of applying transmission-based precautions for MRSA colonized and infected patients.

(h) November 2006: Patients engaged in "Partners in Your Care" (Univ. Penn/Steris) to learn about the importance of hand hygiene for themselves, their families and their care givers.

(i) Oct. 2006: VAPHS system-wide celebration of success in achieving goal of 50% reduction in MRSA HAIs.

January 2007: VAPHS reports system wide: >90% nares swabbing rates, 60% increase in compliance with hand hygiene and contact isolation precautions and 50% reduction in MRSA HAI's.

[3/13/07]