Statewide Effort Seeks to Reduce MRSA Risk

According to a 2007 article in JAMA, methicillin-resistant Staphylococcus aureus (MRSA) causes approximately 94,000 serious infections and 19,000 deaths in the United States each year. Of these, 86% are health care associated and 14% are community associated.

The Centers for Disease Control and Prevention (CDC) reports that MRSA infection as a proportion of all staph infections has gone up dramatically in the last few decades. In 1974, MRSA infections accounted for two percent of all staph infections in the U.S. In 2004, MRSA represented 63% of staph infections. This increase is alarming, given the challenges of treating antibiotic-resistant infections.

While most MRSA infections pertain to the skin, MRSA can also cause other, more serious infections – including pneumonia. Patients in health care facilities who are in a weakened immune state are at particular risk of acquiring MRSA-related infections, including the most dangerous infections.

As part of its Patient Safety Theme, the Centers for Medicare and Medicaid Services has contracted with Quality Improvement Organizations (QIOs) across the nation to help health care professionals reduce MRSA infections in their hospitals. The QIOs provide technical assistance and educational tools that providers can use to design MRSA interventions.

Since August 2008, IPRO, the QIO for New York, has been working with 60 hospitals throughout the state on MRSA – by far the largest number of participating hospitals for any state in the initiative. We are providing support to one unit in each of these hospitals, with the goal of achieving a 28% reduction in MRSA infection rates by the end of July 2011. We have met with infection control leadership at each participating hospital, conducted medical record audits and examined each hospital’s infection prevention policy, in order to help design appropriate interventions.

This effort has involved important partners from the state’s health care community, including the Greater New York Hospital Association, which helped recruit downstate participants, and has worked with IPRO to design professional education tools.

Among these tools is a MRSA “bundle.” A bundle is a group of evidence-based best practices related to a specific disease process that, when implemented together, result in better outcomes than when implemented individually. The MRSA bundle includes eight required practices — such as the development of a laboratory-based alert system, use of CDC hand hygiene guidelines, equipment disinfection, and patient education following MRSA identification – as well as four supplemental practices.

Patient and visitor education are key to this initiative, and IPRO has created additional educational tools that hospitals can use, such as fact sheets and posters. IPRO has also developed positive reinforcement tools for hospital staff, employee newsletter article templates, videos and other materials.

IPRO’s Patient Safety page has the aforementioned tools, and more, available at: http://www.ipro.org/index/patient-safety-hospitals.

This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 9SOW-NY-THM6.2-10-84