DECREASING HOSPITAL ACQUIRED METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) THROUGH ACTIVE SURVEILLANCE Confidential: For Quality Improvement Purposes Only

TEAM MEMBERS INFECTION CONTROL MICROBIOLOGY NURSING ADMINISTRATION Jorge Parada MD,MPH Janis Bartel Alexander Tomich Emie Pua Gigi Marinakos-Trulis MICROBIOLOGY Paul Schreckenberger, PhD Sandy Chakonas Colleen Jarosz NURSING ADMINISTRATION Paula Hindle Sue Flores Vada Grant PEDIATRIC INFECTIOUS DISEASES Malliswari Challipalli MD Andrew Bonwit MD INFORMATION TECHNOLOGY Laura Digangi Julie Glen Connie Giere Media John Griffin The nurses who collected the MRSA screens and made this program possible Confidential: For Quality Improvement Purposes Only

Background The incidence of MRSA colonization and infections is increasing annually. MRSA is associated with serious infections, increase hospital length of stay, patient morbidity and mortality, as well as increased cost of hospitalization. In August, 2007 Illinois law mandated active surveillance for all ICU patients as well as all high risk non-ICU patients Magnet Forces of Magnetism - Force 7,Quality Improvement: “The organization has structures and processes for the measurement of quality and programs for improving the quality of care and services within the organization” Confidential: For Quality Improvement Purposes Only

Project Aim Statement A multidisciplinary task force developed a program to screen ALL inpatients for MRSA upon admission (for the purpose of identifying them early), isolating them appropriately, and thereby limiting hospital associated MRSA transmission and infection. The goal was to decrease the incidence of hospital acquired MRSA. Confidential: For Quality Improvement Purposes Only

Prior Pilot Interventions Neonatal Intensive Care Unit (NICU) initiated active surveillance for all births, transfers in, and biweekly surveillance - January, 2005 Surgical Intensive Care Unit (SICU) initiated screening on admission and weekly surveillance for select patient populations (stay greater than 7 days, on ventilator greater than 5 days, dialysis) - June, 2005 Confidential: For Quality Improvement Purposes Only

Pilot Interventions: SICU Rates from 3.7 → 0.7 75% REDUCTION SUSTAINED OVER TIME Confidential: For Quality Improvement Purposes Only

Solutions Implemented Plan: UNIVERSAL SCREENING of ALL INPATIENTS MRSA Guidelines written, distributed and available on Loyola intranet under Policies Details screening process Decolonization treatment regimen outlined PCR rapid testing machine - decreased testing time from 48 → 2 hours Videotape on MRSA education purchased Original Loyola video developed outlining MRSA screening (from specimen collection, through lab processing to results reported) February,2008 Confidential: For Quality Improvement Purposes Only

Solutions Implemented - Timeline October 15, 2007: All ICU patients screened November 27, 2007: All hospitalized patients screened March 4th, 2008: Pre-op screening for elective surgery (PAT/SAC) Additional Infectious Disease Clinics:January,2008 Confidential: For Quality Improvement Purposes Only

Infection Control MRSA Program Nursing Grand Rounds on MRSA Surgical Grand Rounds on MRSA Nurse Managers meeting on MRSA Multiple MRSA-focused in-services, memos Loyola Patient/Family MRSA Informational Brochures developed and now available on Loyola intranet visa Employee Resources Loyola MRSA Educational Video for staff MRSA Guidelines available on Loyola intranet CD demonstrating technique for collection of MRSA nasal swab/screen Confidential: For Quality Improvement Purposes Only

Results INPATIENT: PREADMISSION TESTING Number of screens performed (Nov 27th-May 1st) >10,000 which is 88% of admissions Number of positive screens (7%) PREADMISSION TESTING Number of screens performed (March 4th-May 1st) 1168 Number positive screens (4%) Confidential: For Quality Improvement Purposes Only

68% Universal MRSA Screening ICU MRSA Screening 0.5294 REDUCTION IN (all patients admitted to hospital) ICU MRSA Screening (all patients admitted to ICU) 6-Month pre-surveillance rate 0.5294 68% REDUCTION IN NOSOCOMIAL MRSA RATES ICU surveillance rate 0.3924 Universal surveillance rate 0.1713 Confidential: For Quality Improvement Purposes Only

Next Steps Emergency Department MRSA screening for all hospital admissions Continued emphasis on prevention of infection: Hand washing, Appropriate isolation and cohorting of patients Environmental cleaning Decolonization of MRSA carriers Confidential: For Quality Improvement Purposes Only