Published in:
01-11-2010 | Original
The role of general quality improvement measures in decreasing the burden of endemic MRSA in a medical–surgical intensive care unit
Published in: Intensive Care Medicine | Issue 11/2010
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Purpose
To determine whether any of several quality improvement interventions with none specifically targeting methicillin-resistant Staphylococcus aureus (MRSA) were associated with a decline in endemic MRSA prevalence in an intensive care unit (ICU) where active screening and contact isolation precautions for known MRSA colonised patients are not practised.
Setting
Medical–surgical ICU with 2,000 admissions/year.
Design
8.5-year retrospective time-series analysis.
Interventions
ICU re-location, antibiotic stewardship utilising computerised decision-support and infectious-diseases physician rounds, dedicated ICU infection control practitioners, alcohol-based hand rub solution (ABHRS).
Method
Regression modelling was used to evaluate trends in S. aureus prevalence density (monthly clinical isolates per 1,000 patient-days), antibiotic consumption, infection control consumables, ABHRS and their temporal relationship with MRSA prevalence.
Results
Methicillin-resistant S. aureus prevalence density decreased by 83% [95% confidence interval (CI) −68% to −91%, p < 0.001]. Rates of MRSA bacteraemia decreased 89% (95% CI −79% to −94%, p = 0.001) with no statistically significant change in methicillin-sensitive S. aureus bacteraemia. Hospital MRSA prevalence density decreased 17% (95% CI −5% to −27%, p = 0.005), suggesting that ICU was not shifting MRSA elsewhere. In ICU, broad-spectrum antibiotic use decreased by 26% (95% CI −12% to −38%, p = 0.008), coinciding with a decrease in MRSA, but time-series analysis did not show a significant association. On multivariate analysis, only ABHRS was significantly associated with a decrease in MRSA, but it was formally introduced late in the study period when MRSA was already in decline.
Conclusion
General quality improvement measures were associated with a decrease in endemic MRSA in a high-risk setting without use of resource-intensive active surveillance and isolation practices.