A Unit-Based Council Develops a Team Approach To Reduce Methicillin-Resistant Staphylococcus aureus Infections in the Intensive Care Unit

ISSUES: Data-mining surveillance detected an increase of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the intensive care unit (ICU) from February to April 2003. Statistical process control chart analysis of non-duplicate patients with MRSA after hospital day 2 revealed 3.6 new MRSA patients/week occurring over a 30-week pre-intervention period. PROJECT: The goal was to reduce the spread of MRSA among ICU patients. Infection Control (IC) provided MRSA findings to the ICU Unit Based Council (UBC) in May 2003. The key objectives were 1) educating staff and physicians, 2) peer monitoring of contact isolation practices, 3) reinforcing policies, and 4) providing weekly IC outcome data to all levels of ICU staff and team members. RESULTS: An aggressive team approach reduced the weekly average of new nosocomial MRSA patients from 3.6 (108 patients/30 weeks) to 0.47 (14 patients/30 weeks), an 87% reduction. During the post-intervention phase, an average of three MRSA infections were prevented each week versus the baseline. A concurrent decrease in vancomycin-resistant Enterococci (VRE) hospital-wide was also noted. The cost avoidance is estimated to be $3,183,030. A decrease in length of stay of 2 days was also noted on this unit during the post-intervention period. LESSONS LEARNED: Three factors facilitated this improvement: 1) the Unit Based Council, 2) an Infection Control Surveillance System, and 3) physician support. The council met weekly to review surveillance data and develop actionable plans to consistently maintain compliance. IC surveillance outcome data was generated from a computerized surveillance system, allowing for weekly updates to the UBC. This allowed IC more time to focus on intervention and education. Physician buy-in was critical, as processes of change would be vulnerable without their support.