Multihospital Surveillance of Nosocomial Methicillin-Resistant Staphylococcus aureus, Vancomycin-Resistant Enterococcus, and Clostridium difficile: Analysis of a 4-Year Data-Sharing Project

BACKGROUND: In 1998, VHA East Coast infection control professionals from 32 hospitals in New Jersey and Pennsylvania initiated a data-sharing project. Standardized methodology was used for the surveillance of nosocomial infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE). A third organism, Clostridium difficile (C. diff), was added in the third quarter of 1999. Analysis was performed on data collected from 1999 to 2002. OBJECTIVE: To determine if a cohort of hospitals could impact their resistant organism rates by comparing data, establishing benchmarks, and sharing best practices. METHODS: The Centers for Disease Control and Prevention (CDC) definitions were used to standardize the methodology for obtaining rates of nosocomial acquisition per 1000 patient days. Only newly acquired nosocomial cases were counted. Data were reported as individual hospital control charts and as cohorted aggregate data. RESULTS: Pooled mean rates were established for each cohort. A statistically significant downward trend was observed for VRE and MRSA (p = 0.02 and 0.0007, respectively). A statistically significant upward trend was observed for C. diff. (p = 0.0256). CONCLUSIONS: The group established benchmarks for comparing rates of nosocomial transmission for these organisms. Through trending of data, better performers were identified and a secondary gain was achieved through sharing of best practices.