775. Horizontal Effects of Implementing a Vertical MRSA Prevention Bundle:     Experiences of a Large Community Hospital System and Sustained Reduction of Healthcare Associated (HA) Central Line Associated Bloodstream Infections (CLABSI) and Ventilator Associated Pneumonia (VAP) in Adult ICUs   
Session: Oral Abstract Session: Staph aureus: Screening and Prevention
Friday, October 21, 2011: 3:45 PM
Room: 157ABC
Background: Evidence-based infection prevention protocols are proven to reduce HA-infections and improve patient safety.  HCA continuously implemented improvements starting in 2006, to the creation and deployment of HCA MRSA specific practice bundles in 3Q 2007, thru the 2008 SHEA Compendium.   Reduction in MRSA CLABSI and VAP were previously reported.  This report is on the effect of enhanced attention to infection prevention basic practices which lowered infection due to all causes.  HCA Inc. is one of the largest US healthcare systems with 160 acute care hospitals in 20 states with over 1.7 million adult admissions annually.

Methods: MRSA bundles included basic infection prevention practices of increasing hand hygiene access, active MRSA surveillance of high-risk patients and contact precautions.   In 2006, infection preventionists voluntarily reported NHSN surveillance defined cases into an internal database and in 2007 with a structured approach to MRSA, case reporting was required and hand hygiene and gown use monitored.  

Results: 90% of 142 hospitals reporting adult ICU rates were community nonteaching acute care hospitals.   HA-CLABSI and HA-VAP were reported for 230 NHSN adult ICUs comprised of 60% Medical Surgical, 20% Surgical or Cardiothoracic, 11% Medical or Medical Cardiac and 9% other (burn and trauma).  From 3Q 2007 to 4Q 2010, all causes of HA-CLABSI and HA-VAP were reduced over 50% from 2.65 to 1.2 and 3.65 to 1.49 per 1000 device days (NHSN pooled means are 1.5 and 1.9); hand hygiene and gown use increased from 20 to 114 ounces and 55 to 100 units per adjusted patient day respectively.    The most common microbes associated with HA-CLABSI were coagulase-negative staphylococci, Candida yeast, gram negative bacilli and enterococci.

Conclusion: A vertical MRSA prevention bundle with greater emphasis on basic infection control practices (e.g. hand hygiene and contact precautions), resulted in improvement of not just MRSA infections but horizontally for all microbial causes of HA-CLABSI and HA-VAP across a diverse system of community hospitals.   Actionable performance and hardwiring behaviors sustain excellence and engage shared accountability for highly reliable practices resulting in improved patient safety.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Jason Hickok, MBA, Julia Moody, MS, Jane Englebright, RN PhD, Jonathan Perlin, MD and Edward Septimus, MD, FIDSA, Clinical Services Group, HCA Inc, Nashville, TN


J. Hickok, None

J. Moody, None

J. Englebright, None

J. Perlin, None

E. Septimus, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.