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Reduction in Hospitalwide Incidence of Infection or Colonization with Methicillin-Resistant Staphylococcus aureus With Use of Antimicrobial Hand-Hygiene Gel and Statistical Process Control Charts

Published online by Cambridge University Press:  02 January 2015

Glenys Harrington ,
Kerrie Watson ,
Michael Bailey ,
Gillian Land ,
Susan Borrell ,
Leanne Houston ,
Rosaleen Kehoe ,
Pauline Bass ,
Emma Cockroft  and
Caroline Marshall
...Show all authors
Glenys Harrington*
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Kerrie Watson
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Michael Bailey
Affiliation:
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Gillian Land
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Susan Borrell
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Leanne Houston
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Rosaleen Kehoe
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Pauline Bass
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Emma Cockroft
Affiliation:
Infectious Diseases Unit, Alfred Hospital, Bayside Health, Melbourne, Australia
Caroline Marshall
Affiliation:
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia Centre for Clinical Research Excellence in Infectious Diseases, University of Melbourne, Melbourne, Australia
Anne Mijch
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia Infectious Diseases Unit, Alfred Hospital, Bayside Health, Melbourne, Australia
Denis Spelman
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia Infectious Diseases Unit, Alfred Hospital, Bayside Health, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
*
Infection Control and Hospital Epidemiology Unit, Alfred Hospital, Commercial Rd., Melbourne, Victoria 3004, Australia ([email protected])
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Abstract

Objective.

To evaluate the impact of serial interventions on the incidence of methicillin-resistant Staphylococcus aureus (MRSA).

Design.

Longitudinal observational study before and after interventions.

Setting.

The Alfred Hospital is a 350-bed tertiary referral hospital with a 35-bed intensive care unit (ICU).

Interventions.

A series of interventions including the introduction of an antimicrobial hand-hygiene gel to the intensive care unit and a hospitalwide MRSA surveillance feedback program that used statistical process control charts but not active surveillance cultures.

Methods.

Serial interventions were introduced between January 2003 and May 2006. The incidence and rates of new patients colonized or infected with MRSA and episodes of MRSA bacteremia in the intensive care unit and hospitalwide were compared between the preintervention and intervention periods. Segmented regression analysis was used to calculate the percentage reduction in new patients with MRSA and in episodes of MRSA bacteremia hospitalwide in the intervention period.

Results.

The rate of new patients with MRSA in the ICU was 6.7 cases per 100 patient admissions in the intervention period, compared with 9.3 cases per 100 patient admissions in the preintervention period (P = .047). The hospitalwide rate of new patients with MRSA was 1.7 cases per 100 patient admissions in the intervention period, compared with 3.0 cases per 100 patient admissions in the preintervention period (P < .001). By use of segmented regression analysis, the maximum and conservative estimates for percentage reduction in the rate of new patients with MRSA were 79.5% and 42.0%, respectively, and the maximum and conservative estimates for percentage reduction in the rate of episodes of MRSA bacteremia were 87.4% and 39.0%, respectively.

Conclusion.

A sustained reduction in the number of new patients with MRSA colonization or infection has been demonstrated using minimal resources and a limited number of interventions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 7 , July 2007 , pp. 837 - 844
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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