472. Effect of Methicillin-Resistant Staphylococcus aureus (MRSA) Targeted Interventions on Non-MRSA Multidrug-Resistant Organisms (MDROs)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Recent evaluations of MRSA-specific interventions have demonstrated decreases in MRSA incidence in hospitals; however their impact on other MDROs is unknown. In early 2007 three hospitals joined a collaborative to implement an MRSA-specific intervention including active surveillance testing for MRSA in select units, Contact Precautions for MRSA carriers, and hand hygiene promotion, using the Positive Deviance approach to group behavioral change. We sought to evaluate potential intervention-associated impact on non-MRSA MDROs at these hospitals.
Methods: Using microbiology data, combined and individual clinical incidence (first positive culture per patient per year) was calculated for vancomycin-resistant enterococcus and carbapenem-resistant organisms (K. pneumoniae, E. coli, P. aeruginosa, and A. baumannii). To evaluate the intervention-associated impact, combined non-MRSA MDRO clinical incidence was modeled using interrupted time series analyses. To determine the multicenter impact, estimates were pooled across hospitals using inverse-variance weighting.
Results: Pooled across the 3 hospitals, there was a significant intervention-associated improvement when comparing post- to pre-intervention trends in non-MRSA MDRO clinical incidence (IDR 0.96, P<0.001). However, there was heterogeneity in the post-intervention trends (one facility had a significant decrease, one facility had a significant increase, and one facility had a non-significant decrease)
Conclusion: Accounting for pre-intervention trends, the introduction of MRSA-specific interventions coupled with Positive Deviance was associated with improvement in non-MRSA MDRO rates. The intervention did not, however, prevent an increase in the post-intervention non-MRSA MDRO trend in one hospital.
F Arnold, DO1, D Borton, BSN, RN, CIC1, P Chang, MPH1, Katherine Ellingson, PhD2, L Goss, MSN, RN, CIC1, N Iverson, BSN, RN, CIC1, J Jernigan, MD, MS1, Alexander Kallen, MD, MPH, FSHEA3, C Lindberg, DMan1, J Lloyd, MD1, J Stelling, MD, MPH1, J Zuckerman, MD1 and  A. J. Kallen,
Kimberly-Clark Role(s): Independent Contractor, Received: Consulting Fee.
Vicks Role(s): Independent Contractor, Received: Consulting Fee.
Vusion Role(s): Independent Contractor, Received: Consulting Fee.
P. I. Chang, None..
N. Iverson, None..
J. Zuckerman, None..
D. Borton, None..
L. Goss, None..
F. Arnold, None..
J. Stelling, None..
C. Lindberg, None..
J. C. Lloyd, None..
K. E. Ellingson, None..
J. Jernigan, None., (1)Positive Deviance MRSA Prevention Partnership, Atlanta, GA, (2)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (3)Centers for Disease Control and Prevention, Atlanta, GA