847. Reduction of MRSA Infections Among Veterans
Session: Oral Abstract Session: MRSA - Epidemiological Trends
Saturday, October 22, 2011: 9:30 AM
Room: 157ABC
Background: Methicillin-resistant Staphylococcus aureus (MRSA) has undergone rapid evolutionary changes and epidemiologic expansion and has become a common cause of both healthcare associated and community-acquired infections. Methods: The Atlanta VA Medical Center is a large university - affiliated tertiary care facility. Active surveillance of MRSA infections has been in place since October 2005. All clinical MRSA cultures (outpatient and inpatient) are reviewed monthly and entered into a database if they meet a standard NHSN definition of infection. Since October 2007, all hospital admissions and transfers are screened for nasal MRSA by PCR testing and upon discharge are screened using a selective culture media. All colonization data from Oct 07 to Dec 10 was retrieved using TheraDoc. Ventilator associated pneumonia and central line care bundles were implemented in fiscal year (FY) 06. The VA MRSA Directive (active surveillance, contact precautions, and hand hygiene) was fully implemented in Oct 07. Results: Community onset (CO) infections in Atlanta peaked in FY 07 with 5.45 MRSA infections / 1000 veterans in care and subsequently declined to 3.89 MRSA infections / 1000 veterans in care in FY 10 (p< 0.0001). All infection categories demonstrated a similar decline in incidence from FY 07 to FY 10 while the distribution of infection types remained constant. Skin and skin structure infections represented 60% and genitourinary infections 10% of CO infections. MRSA healthcare associated infections declined from 1.62 infections / 1000 bed days of care (BDOC) in FY 06 to 0.73 infections / 1000 BDOC in FY 10 (p=0.0012). This finding was driven by a reduction in ICU related infections from FY 06 to FY 07 (4.19 infections / 1000 BDOC to 1.3 infections / 1000 BDOC). Rates of healthcare associated infections did not change significantly from FY 07 to FY 10 (0.79 infections / 1000 BDOC to 0.73 infections / 1000 BDOC, p=0.78) Conclusion: The epidemiology of MRSA continues to change. Infection (healthcare associated and CO) rates have declined over the past 5 years; however, in Atlanta, the MRSA Directive did not result in a significant decline in healthcare associated infections.

Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Edward Stenehjem, MD1,2, Courtney Stafford, MPH1 and David Rimland, MD1,2, (1)Atlanta VA Medical Center, Decatur, GA, (2)Emory University School of Medicine, Decatur, GA

Disclosures:

E. Stenehjem, None

C. Stafford, None

D. Rimland, None

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