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Implementation of an Industrial Systems-Engineering Approach to Reduce the Incidence of Methicillin-Resistant Staphylococcus aureus Infection

Published online by Cambridge University Press:  02 January 2015

Robert R. Muder ,
Candace Cunningham ,
Ellesha McCray ,
Cheryl Squier ,
Peter Perreiah ,
Rajiv Jain ,
Ronda L. Sinkowitz-Cochran  and
John A. Jernigan
Robert R. Muder*
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Pittsburgh Regional Healthcare Initiative, Pittsburgh, Pennsylvania
Candace Cunningham
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Ellesha McCray
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Cheryl Squier
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Peter Perreiah
Affiliation:
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Rajiv Jain
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Pittsburgh Regional Healthcare Initiative, Pittsburgh, Pennsylvania
Ronda L. Sinkowitz-Cochran
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Infectious Diseases Section, VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240 (Robert.Muder@va.gov)
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Abstract

Objective.

To measure the effectiveness of an industrial systems-engineering approach to a methicillin-resistant Staphylococcus aureus (MRSA) prevention program.

Design.

Before-after intervention study

Setting.

An intensive care unit (ICU) and a surgical unit that was not an ICU in the Pittsburgh Veterans Administration hospital

Patients.

Allpatientsadmittedtothe study units

Intervention.

We implemented an MRSA infection control program that consisted of the following 4 elements: (1) the use of standard precautions for all patient contact, with emphasis on hand hygiene; (2) the use of contact precautions for interactions with patients known to be infected or colonized with MRSA; (3) the use of active surveillance cultures to identify patients who were asymptomatically colonized with MRSA; and (4) use of an industrial systems-engineering approach, the Toyota Production System, to facilitate consistent and reliable adherence to the infection control program.

Results.

The rate of healthcare-associated MRSA infection in the surgical unit decreased from 1.56 infections per 1,000 patient-days in the 2 years before the intervention to 0.63 infections per 1,000 patient-days in the 4 years after the intervention (a 60% reduction; P = .003). The rate of healthcare-associated MRSA infection in the ICU decreased from 5.45 infections per 1,000 patient-days in the 2 years before to the intervention to 1.35 infections per 1,000 patient-days in the 3 years after the intervention (a 75% reduction; P = .001). The combined estimate for reduction in the incidence of infection after the intervention in the 2 units was 68% (95% confidence interval, 50%-79%; P < .001).

Conclusions.

Sustained reduction in the incidence of MRSA infection is possible in a setting where this pathogen is endemic. An industrial systems-engineering approach can be adapted to facilitate consistent and reliable adherence to MRSA infection prevention practices in healthcare facilities.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 8 , August 2008 , pp. 702 - 708
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Klevens, RM, Edwards, JR, Tenover, FC, McDonald, LC, Horan, T, Gaynes, R. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006;42:389–391.CrossRefGoogle ScholarPubMed
2.Jernigan, JA, Clemence, MA, Stott, GA, et al.Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686–696.CrossRefGoogle Scholar
3.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:53–59.CrossRefGoogle ScholarPubMed
4.Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al.Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.CrossRefGoogle ScholarPubMed
5.Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.CrossRefGoogle ScholarPubMed
6.Blot, SI, Vandewoude, KH, Hoste, EA, Colardyn, FA. Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002;162:2229–2235.CrossRefGoogle ScholarPubMed
7.Whitby, M, McLaws, ML, Berry, G. Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust 2001;175:264–267.CrossRefGoogle ScholarPubMed
8.Melzer, M, Eykyn, SJ, Gransden, WR, Chinn, S. Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus? A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin Infect Dis 2003;37:1453–1460.CrossRefGoogle ScholarPubMed
9.Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408–411.CrossRefGoogle ScholarPubMed
10.Siegel, JD, Rhinehart, E, Jackson, M, et al. Management of multi-drug resistant organisms in healthcare settings, 2006. Available at: http://www .cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Accessed October 16, 2006.Google Scholar
11.Kim, PW, Roghmann, MC, Perencevich, EN, Harris, AD. Rates of hand disinfection associated with glove use, patient isolation, and changes between exposure to various body sites. Am J Infect Control 2003;31:97–103.CrossRefGoogle ScholarPubMed
12.Pettinger, A, Nettleman, MD. Epidemiology of isolation precautions. Infect Control Hosp Epidemiol 1991;12:303–307.CrossRefGoogle ScholarPubMed
13.Afif, W, Huor, P, Brassard, P, Loo, VG. Compliance with methicillin-resistant Staphylococcus aureus precautions in a teaching hospital. Am J Infect Control 2002;30:430–433.CrossRefGoogle ScholarPubMed
14.Pittet, D, Mourouga, P, Perneger, TV, Members of the Infection Control Program. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126–130.CrossRefGoogle ScholarPubMed
15.Jernigan, JA, Titus, MG, Groschel, DH, Getchell-White, S, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996;143:496–504.CrossRefGoogle ScholarPubMed
16.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386CrossRefGoogle ScholarPubMed
17.Farr, BM. Prevention and control of methicillin-resistant Staphylococcus aureus infections. Curr Opin Infect Dis 2004;17:317–322.CrossRefGoogle ScholarPubMed
18.Cooper, BS, Stone, SP, Kibbler, CC, et al.Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): Systematic review of the literature. BMJ 2004;329:533.CrossRefGoogle ScholarPubMed
19.Garner, JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
20.Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 2002;23(12 suppl):S3–S40.CrossRefGoogle ScholarPubMed
21.Spear, S, Bowen, H. Decoding the DNA of the Toyota Production System. Harvard Bus Rev 1999;77:97–106.Google Scholar
22.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
23.Cleveland, W, Grosse, E. Computational methods for local regression. Statistics and Computing 1991;1:47–62CrossRefGoogle Scholar
24.Haley, RW, Cushion, NB, Tenover, FC, et al.Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614–624.CrossRefGoogle ScholarPubMed
25.Struelens, MJ, Ronveaux, O, Jans, B, Mertens, R. Methicillin-resistant Staphylococcus aureus epidemiology and control in Belgian hospitals, 1991 to 1995. Groupement pour le Depistage, l'Etude et la Prevention des Infections Hospitalieres. Infect Control Hosp Epidemiol 1996;17:503–508.CrossRefGoogle ScholarPubMed
26.Murray-Leisure, KA, Geib, S, Graceley, D, et al.Control of epidemic methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 1990;11:343–350.CrossRefGoogle ScholarPubMed
27.Nicolle, LE, Dyck, B, Thompson, G, et al.Regional dissemination and control of epidemic methicillin-resistant Staphylococcus aureus. Manitoba Chapter of CHICA-Canada. Infect Control Hosp Epidemiol 1999;20:202–205.CrossRefGoogle ScholarPubMed
28.Kotilainen, P, Routamaa, M, Peltonen, R, et al.Elimination of epidemic methicillin-resistant Staphylococcus aureus from a university hospital and district institutions, Finland. Emerg Infect Dis 2003;9:169–175.CrossRefGoogle ScholarPubMed
29.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–280.CrossRefGoogle ScholarPubMed
30.Manian, FA, Meyer, PL, Setzer, J, Senkel, D. Surgical site infections associated with methicillin-resistant Staphylococcus aureus: do postoperative factors play a role? Clin Infect Dis 2003;36:863–868.CrossRefGoogle ScholarPubMed
31.Jernigan, JA. Is the burden of Staphylococcus aureus among patients with surgical-site infections growing? Infect Control Hosp Epidemiol 2004;25:457–460.CrossRefGoogle ScholarPubMed