2. MRSA: A Learning and Networking Session Program Overview July 30, 2007 Paula Griswold, Executive Director pgriswold@macoalition.org www.macoalition.org

3.  Context for today’s MRSA program  Goals and agenda for the day  Survey results  Program materials

4. Context for Today’s MRSA Program  Prevention of hospital-acquired infections identified as top priority of Coalition members  MA DPH & Betsy Lehman Center Expert Panel on Healthcare Associated Infections  APIC MRSA Survey

5. MA Coalition Members  State and federal licensure/oversight agencies  Professional associations for hospitals, physicians, nurses, nurse-executives and long-term care organizations  Accreditation organizations  Individual health care providers  Professional liability insurance organizations  Clinical researchers  Consumer organizations  State legislator  Purchasers/health plans

6. To improve patient safety and eliminate medical errors in Massachusetts To leverage the capabilities of its members through specific change initiatives with measurable outcomes to make healthcare safe in Massachusetts. Change Agent - Improvement Initiatives Achieve measurable results on specific topics State-wide Agenda Setting Agreeing on key patient safety priorities for improvement Information Source Educate & foster information sharing, including learning from innovation Forum for Aligning Efforts Align member activities to achieve goals Mission Vision

7. Identified as Priority: Preventing Hospital-Acquired Infections $1 million in 2007 MA State Budget for DPH to develop MA infection reporting project, including public reporting. MA DPH and Betsy Lehman Center – Infection Expert Panel MHA Patients First recommended hospitals report infection measures JCAHO National Patient Safety Goals: hand hygiene and manage serious outcomes from infections as sentinel events IHI 5 Million Lives Campaign: MRSA, CLABSI, VAP, SSI CMS plan to eliminate higher payments for DRGs when infections occur – staph aureus septicemia & CAUTI - and SCIP PA Study: Cases with infections cost six times more than cases without Michigan Keystone Project saved 1,578 lives, $165.5 million in healthcare costs and 81,020 hospital days from March 2004 to June 2005

8. Previous Hospital Learning Collaboratives  With MHA and MA DPH and AHRQ funding  Reconciling Medications:  Systematic approach to reduce medication errors at admission, transfers within the hospital, and discharge  Communicating Critical Test Results:  Ensuring timely and reliable communication of critical test results to clinician responsible to take action  Support for hospital teams working to improve performance on these aims

9. APIC MRSA Survey Prevalence survey – one day fall 2006 from 1200 facilities in 50 states 46 out of 1,000 patient either infected or colonized (infections - 34 per 1,000 patients) 8-11 times higher than previous (incidence) data Massachusetts results: 59.9 out of 1,000 patients from 24 facilities responding

10. APIC MRSA Survey Results suggest majority of isolates were HA-MRSA 63% at sites other than skin/soft tissue <30% clindamycin susceptible, <20% levofloxacin susceptible

11. Goal for Today  Facilitate sharing among hospitals of lessons learned and strategies for successful implementation of MRSA infection control  Beginning of ongoing learning: upcoming invitation to participate in Collaborative  Listserve, sharing sessions, conference calls

12. MA Survey Results: Current Practice ( 35 Responses)  Active Culture Surveillance Screening  42.9% not activated  28.6% unit-specific  25.7% population-specific  2.9% (1) housewide  Technology used  6.3% (2) Rapid molecular testing  56.3% Culture  37.5% Does not apply

13. MA Survey Results: Current Practice ( 35 Responses)  Isolate Patients  29.4% while awaiting results  35.3% only after results received  35.3% doesn’t apply  Issues with isolating patients  20.6% Yes  38.2% No  41.2 % Does not apply

14. MA Survey Results: Interested in/have lessons to share Most interested in learning (34): 73.5% Active Surveillance Culture 70.6% Hand Hygiene All others 41-58% - Patient Engagement Have interesting lesson/important progress to share (11) (7) Hand Hygiene Nothing else above 3!!

15. Today Agenda Materials Presentations Resources Evaluation – listserve Thanks