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How one facility reduced MRSA and saved money


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Evanston first in the nation to swab every patient at admission

For those hospitals that think screening every patient for methicillin-resistant staphylococcus aureus (MRSA) is too expensive, too time-consuming, and too onerous, consider this: In one year, Evanston (IL) Northwestern Healthcare system, the first in the country to start swabbing every patient for MRSA, dramatically reduced nosocomial infections and saved money.

“Not only are you saving the hospital lots of money, you’re saving the patients lots of suffering,” says Donna M. Hacek, MT, ASCP, technical specialist of clinical microbiology and molecular epidemiology at Evanston. “It’s a good patient safety thing. That was kind of the package we needed to sell, and the CEOs bought into it.”

Evanston Northwestern Healthcare set a goal of reducing the MRSA rate within two years at its three hospitals.

But after just 12 months, the staff decided to take a peek at the data. The results were startling. In the first year, the hospital saw an 80% reduction of its bloodstream infection rate with MRSA.

“We were just floored,” Hacek says. “We had already met our goal within one year instead of two, and we were really happy to see that.”

Evanston began its journey toward MRSA reduction in 2004 when it started screening patients in the ICU. But the data showed that MRSA transmissions were still occurring. The organization decided to do a point prevalence whereby staff members throughout the entire three-hospital system on one set day swabbed everybody’s nose to determine who might have MRSA.

“To our surprise, the statistic turned out to be 8.5% of our patients on that one particular day had MRSA in their nose,” Hacek says. “And we didn’t know about two-thirds of those patients, so our ICU screening was just not doing us any justice. We were missing a lot of the patients.”

Asking questions not sufficient

Staff members from infection control, nursing, and IT got together to see whether there was a single question that they could ask patients that could identify those infected with MRSA.

They considered asking patients whether they had been hospitalized within the past two years, a commonality among many with MRSA.

But that question still wouldn’t catch 20% of the patient population.

“We just decided it was going to be a heck of a lot easier to screen everybody coming in the door rather than having a nurse ask a question or having IT build an algorithm that said, ‘Was this person in the hospital in the last two years?’ ” Hacek says.

The MedMined system the hospital used helped the staff sell the project to senior leaders. The system was able to identify nosocomial infections and put that information into the financial database to determine cost savings.

That allowed the staff to come in with a proposal that said the program would cost $1 million to implement, but they estimated the hospital would save the same amount.

And there was another big savings as well.

“You’re going to save all the hardship that goes along with patients having MRSA infections,” Hacek says.

The program ended up costing $600,000 and prevented 49 patients from acquiring MRSA while they were in the hospital.

Each MRSA case costs the hospital an estimated $24,000, so the hospital saved more than $1 million. “It shouldn’t be about the bottom line, but the reality is, these things cost money and if we can do both at the same time, that’s a really good thing,” Hacek says.

Decolonizing MRSA patients

Swabbing every patient’s nose for MRSA wasn’t the only thing Evanston did to protect its patients. It also decolonized those testing positive for MRSA for five days with Bactroban. The patients were also bathed with Chlorhexidine.

“We did a two-pronged attack,” Hacek says. “We cleaned their nose, and then we cleaned their skin.”

The hospital’s rapid screening system, which produced results in 12 hours instead of 48, also helped in the battle against MRSA.

“What’s nice about the rapid screening is that you know very, very quickly if the patients have MRSA and you get them in isolation faster,” Hacek says. “So now you don’t have those two extra days of colonized people being able to spread their MRSA around.”

The success at Evanston has not gone unnoticed. The facility is now a mentor hospital for the Institute for Healthcare Improvement’s 5 Million Lives Campaign. And at least one hospital that aims to replicate that success has modeled its program after Evanston’s.

Pampa (TX) Regional Medical Center plans to roll out a program this spring to swab every patient coming in the door at the 115-bed facility for MRSA. Sallie M. Gatlin, CPHQ, director of quality resource management for Pampa, says the effort was championed by her former CEO. The chief nursing officer also talked to Evanston when creating the program.

“She researched and found out that Evanston was a mentor hospital,” Gatlin says. “She began talking to them, and it’s actually their program that we’re adapting. Their program is simple and straightforward.”