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Tennessee hospital reduces MRSA in long-term care patients


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At Blount Memorial Hospital in Maryville, TN, a team effort reduced MRSA rates among patients admitted from nursing homes. That effort resulted in patients being discharged an average of 2.2 days faster.

“Blount Memorial is a terrific example of an institution that examined their MRSA risk and then created an individualized set of strategies to address that risk,” says Janet E. Frain, RN, CIC, CPHQ, CPHRM, APIC’s 2008 president and director of Integrated Services at Sutter Medical Center in Sacramento, CA.

The intervention began in 2002 when staff members noted that an increasingly large number of long-term care residents being treated at the hospital were positive for MRSA.

Although the long-term care facilities assumed patients picked up the organism while being treated at the hospital, hospital officials suspected the opposite: that patients were coming to them with MRSA because of multiple hospital admissions and repeated antibiotic use, says Sherry Hillis, MT, MPH, CIC, the hospital’s infection control professional.

An investigation confirmed the hospital’s suspicions, and it began an intervention that has succeeded in nearly halving its MRSA infection rate.

A team was formed to tackle the initiative, including the following members:

  • Infectious disease physician
  • Infection preventionist
  • Nursing home representatives
  • Performance improvement representative
  • Nursing staff members and supervisors
  • Medical director (administration)
  • Environmental services representative
  • Microbiologist
  • Case manager or social worker
  • Materials management representative
  • Facilities management representative

Combating MRSA misconceptions

As its first step, the team began performing nasal screens on high-risk individuals. They also put all nursing home patients on contact precautions immediately upon admission, says Hillis.

When the intervention began, there was a lot of misinformation about MRSA. Physicians were often trying to “treat” MRSA colonization by regularly decolonizing patients, a strategy that is not medically proven to be effective, Hillis says.

Nursing homes also didn’t want patients back until they had negative cultures, which sometimes reinforced inappropriate antibiotic use. Patients’ families were often upset when a patient was put on contact precautions. And the microbiology lab was using conventional techniques with tests that took between 48–72 hours because no rapid screening versions were available, says Hillis.

Using educational outreach

Education was a critical component of the team’s plan, so information about MRSA was provided to physicians, nursing homes, and staff members.

Staff members then created printed materials such as brochures and signs to educate staff members, physicians, patients, and families.

Hospital officials also took steps to make it easier for staff members to comply with contact precautions and gain access to supplies by purchasing more isolation carts, monitors, and additional personal protective equipment.

Communicating is critical

By reporting information about MRSA trends to physicians, staff members, and nursing homes on a regular basis, the infection control (IC) team kept the topic at the forefront of people’s minds. This information also helped nursing homes with their prevention efforts. These efforts were important because the hospital discovered that compliance tends to decline over time if IC leaders don’t keep the issue fresh.

Another tactic that helps drive the issue home for staff members is to link trends. For example, if your hand hygiene monitoring shows a drop in compliance and your MRSA rate goes up at the same time, share this information with staff members to show them that their actions do make a difference, says Hillis.

To ensure communication lines remain open, Blount officials hold a lunch meeting with nursing home managers twice per year.

Winning the fight

The MRSA effort resulted in more rapid discharge rates at the facility, says Hillis. This freed up beds at the hospital and got nursing home residents back to their homes quickly. “This is a win for the resident and the nursing homes, which are paid by patient day,” says Hillis. Success depended on several factors.

“They had the support of top leadership, involved a multidisciplinary team, integrated prevention measures across the system, provided frequent communication and feedback, and educated all parties. Their work is a wonderful demonstration of what can be accomplished when there is an organizational focus and drive for patient safety and risk reduction,” Frain says.