Hostname: page-component-745bb68f8f-f46jp Total loading time: 0 Render date: 2025-02-11T17:51:51.021Z Has data issue: false hasContentIssue false
  • English
  • Français

Controlling Methicillin-Resistant Staphylococcus aureus: A Feedback Approach Using Annotated Statistical Process Control Charts

Published online by Cambridge University Press:  02 January 2015

Evonne T. Curran ,
James C. Benneyan  and
John Hood
Evonne T. Curran*
Affiliation:
Glasgow Royal Infirmary Hospitals, Glasgow, United Kingdom
James C. Benneyan
Affiliation:
Northeastern University, Boston, Massachussetts
John Hood
Affiliation:
Glasgow Royal Infirmary Hospitals, Glasgow, United Kingdom
*
Evonne Curran, Bacteriology Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 OSF , United Kingdom
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To investigate the benefit of a hospitalwide feedback program regarding methicillin-resistant Staphylococcus aureus (MRSA), using annotated statistical process control charts.

Design:

Retrospective and prospective analysis of MRSA rates using statistical process control charts.

Participants:

Twenty-four medical, medical specialty, surgical, intensive care, and cardiothoracic care wards and units at four Glasgow Royal Infirmary hospitals.

Methods:

Annotated control charts were applied to prospective and historical monthly data on MRSA cases from each ward and unit during a 46-month period from January 1997 through September 2000. Results were fed back from December 1999 and then on a regular monthly basis to medical staff, ward managers, senior managers, and hotel services.

Results:

Monthly reductions in the MRSA acquisition rate started 2 months after the introduction of the feedback program and have continued to the present time. The overall MRSA rate currently is approximately 50% lower than when the program began and has become more consistent and less variable within departments throughout Glasgow Royal Infirmary. The control charts have helped to detect rate changes and manage resources more effectively. Medical and nursing staff and managers also report that they find this the most positive form of MRSA feedback they have received.

Conclusions:

Feedback programs that provide current information to front-line staff and incorporate annotated control charts can be effective in reducing the rate of MRSA.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 1 , January 2002 , pp. 13 - 18
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Barrett, SP, Mummery, RV, Chattopadhyay, B. Trying to control MRSA causes more problems than it solves. J Hosp Infect 1998;39:85–93.CrossRefGoogle ScholarPubMed
2.Pittet, D, Waldvogel, FA. To control or not to control colonisation with MRSA that is the question. Q J Med 1997;90:239–241.CrossRefGoogle ScholarPubMed
3.Nettleman, MD, Fredrickson, M, Pfaller, M. Assigning responsibility: using feedback to achieve sustained control of MRSA. Am J Med 1991;91(suppl 3B):228s–232s.Google Scholar
4.Sheriden, RL, Weber, J, Benjamin, J, Pasternack, MS, Tomkins, RG. Control of methicillin resistant Staphylococcus aureus in a pediatric burn unit. Am J Infect Control 1994;6:304–305.Google Scholar
5.Martin, MA. Methicillin-resistant Staphylococcus aureus: the resistant nosocomial pathogen. Curr Clin Top Infect Dis 1994;14:170–191.Google ScholarPubMed
6.Benneyan, JC. Statistical quality control methods in infection control and hospital epidemiology: Part 1. Introduction and basic theory. Infect Control Hosp Epidemiol 1998;19:194–214.CrossRefGoogle Scholar
7.Benneyan, JC. Statistical quality control methods in infection control and hospital: Part 2. Chart use, statistical properties, and research issues. Infect Control Hosp Epidemiol 1998;19:265–277.Google Scholar
8.Smyth, ETM, Emmerson, AM. Surgical site infection surveillance. J Hosp Infect 2000;45:173–185.Google ScholarPubMed
9.Reybrouck, G. Role of the hands in the spread of nosocomial infections. J Hosp Infect 1983;4:103–110.CrossRefGoogle ScholarPubMed
10.Bryan, JL, Cohran, J, Larson, E. Hand washing: a ritual revisited. Critical Care Nursing Clinics of North America 1995;7:4617–4625.CrossRefGoogle ScholarPubMed
11.Faoagali, JL, George, N, Fong, J, Davy, J, Dowser, M. Comparison of the antibacterial efficacy of 4% chlorhexidine gluconate and 1% triclosan handwash products in acute clinical ward. Am J Infect Control 1999;27:320–326.CrossRefGoogle ScholarPubMed
12.Working party report revised guidelines for the control of MRSA. J Hosp Infect 1998;39:253–290.Google Scholar
13.Vagenvoort, JHT, Sluijsmans, W, Penders, RJR. Better environmental survival of outbreak vs. sporadic MRSA isolates. J Hosp Infect 2000;45:231–234.Google Scholar
14.Beard-Pegler, MA, Stubbs, E, Vickery, AM. Observations on the resistance to drying of staphylococcal strains. J Med Microbiol 1988;26:251–255.Google ScholarPubMed
15.Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;9:622–627.Google Scholar
16.Benneyan, JC. Use and interpretation of statistical quality control charts. Int J Qual Health Care 1998;10:69–73.CrossRefGoogle ScholarPubMed
17.Plsek, P. Tutorial: introduction to control charts. Quality Management in Health Care 1992;1:65–73.CrossRefGoogle ScholarPubMed
18.Grant, EL, Leavenworth, RS. Statistical Quality Control, 6th ed. New York: McGraw-Hill; 1988.Google Scholar
19.Duncan, AJ. Quality Control and Industrial Statistics. Homewood, IL: Irwin; 1986.Google Scholar
20.Montgomery, DC. Introduction to Statistical Quality Control, 2nd ed. New York: Wiley; 1991.Google Scholar
21.Wenzel, RP, Reagen, DB, Betimo, JS JrBarron, EJ, Arias, K. MRSA outbreak: a consensus panel's definition and management guidelines. Am J Infect Control 1998;26:102–110.Google ScholarPubMed
22.Haley, RW, Gaynes, RP, Aber, RC, Bennett, JV. Surveillance of nosocomial infections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections, 3rd ed. Boston: Little Brown; 1992.Google Scholar
23.Goldmann, DA, Weinstein, RA, Wenzel, RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial resistant microorganisms in hospitals. JAMA 1996;275:234–240.CrossRefGoogle ScholarPubMed
24.National Audit Office. The Management and Control of Hospital Acquired Infection in Acute NHS Trusts, in England. London: London Stationary Office; 2000.Google Scholar
25.Stone, S, Kibbler, C, How, A, Balestrini, A, Feedback is necessary in strategies to reduce hospital-acquired infection. BMJ 2000;321:302–303.Google ScholarPubMed
26.Benneyan, JC. Geometric based g-type statistical control charts for infrequent adverse events. Institute of Industrial Engineers (HE) Society for Health Systems Conference Proceedings. Norcross, GA: Institute of Industrial Engineers; 1999:175–186.Google Scholar
27.Benneyan, JC. Performance of number-between g-type statistical quality control charts for monitoring adverse events. Health Care Manag Sci 2001;4:319–336.CrossRefGoogle ScholarPubMed