Cluster of methicillin-resistant Staphylococcus aureus (MRSA) on an oncology unit: Identification, investigation, and correction

BACKGROUND: This 450-bed acute care facility in Portland, Oregon, was alerted to a significant increase in hospital-associated MRSA isolates resistant to clindamycin from various sources from May through June 2004. OBJECTIVES: Identify processes putting patients at risk, correct process breakdowns, and share information for future prevention with other clinical staff. Prevent this organism from becoming endemic on the oncology unit. METHODS: Data-mining services are provided to the hospital. Monthly reports are generated to detect unsuspected patterns of infection within the hospital and community. In June 2004, infection control (IC) received an alert describing the emergence of non-duplicate hospital-associated, clindamycin-resistant MRSA isolates from multiple sources in patients on the oncology unit. Following receipt of the pattern, the staff and manager of this unit were notified of the emerging trend. The IC team discovered one additional patient on oncology with clindamycin-sensitive MRSA. Suggested interventions were presented, concurrently with a graph demonstrating the MRSA increase. The full staff was scheduled for mandatory inservices, including a review of isolation precautions. Bimonthly updates of MRSA incidence were generated electronically and presented to the staff for review. RESULTS: Continuing electronic surveillance for hospital-associated MRSA isolates revealed only one isolate every 2 months in the subsequent 8 months following the implementation of corrective measures. CONCLUSION: Investigation of a cluster of clindamycin-resistant MRSA isolates yielded opportunities for staff to improve their processes for MRSA precautions. Providing suggestions for interventions at the same time that an issue is pointed out facilitates active staff participation in resolution.