By taking a multidepartmental approach to emphasizing hand hygiene, monitoring patient safety, analyzing data, and sharing best practices with other health professionals, Nash Health Care Systems in Rocky Mount, N.C., was able to reduce its Methicillin-resistant Staphylococcus aureus (MRSA) infection rate by 84 percent over the past four years.
"Reducing the MRSA rate by 84 percent is truly an exceptional achievement that will have a major positive impact on patient safety," says Larry Chewning, president and CEO of Nash Health Care Systems.
Even more remarkable: Patients at Nash Health Care Systems remained totally free of hospital-associated MRSA infections between February and November 2010, according to the hospital.
"The positive response from our employees, particularly those in our environmental services department, has been amazing. They have all embraced this process and have participated in additional training," says Wanda Lamm, RN, BSN, CIC, infection prevention coordinator at Nash Health Care Systems. "We have continually promoted a culture of patient safety and patient and family education."
Although she doesn't know exactly how much Nash Health Care Systems has saved as a result of the reduction in MRSA infections, Lamm says between 1990 and 2000, the mean cost attributable to a MRSA infection was $35,367 (Association for Professionals in Infection Control and Epidemiology, Inc., Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital Settings, 2nd ed., 2011).
"I hope these cost savings can be used to implement additional items to improve our processes as we continue our journey," she adds.
As part of a multistep approach to reduce MRSA infections, Nash Health Care Systems reinforced the requirement that those who come in contact with patients-hospital staff, physicians, and visitors-must wash their hands before entering the rooms and follow a "wash-in" and "wash-out" approach to infection prevention.
Another initiative implemented by Nash Health Care Systems is a room quality check. After a patient is discharged, the room is thoroughly cleaned. Prior to cleaning, supervisors in the environmental services department place a florescent lotion on five predefined, high-touch surfaces. After the room is cleaned, they shine a handheld ultraviolet light onto the marked areas-such as door handles, television remotes, and bed rails-to see how clean they are. Traces of the lotion will glow in the black light on areas that weren't washed thoroughly.
In addition, infection prevention nurses also check the cleanliness of surfaces by using a handheld sampling device that can detect adenosine triphosphate (ATP), a byproduct of cellular metabolism. If detected, in predefined levels, it indicates inadequate cleaning.
Other areas of focus included:
See sidebar:How Nash Reduced MRSA Infections
Nash Health Care Systems was one of 54 hospitals that collectively reduced their MRSA infection rates as part of a VHA regional initiative that focuses on reducing the incidence of hospital-acquired infections. The 54 hospitals also saved $35.4 million in additional treatment costs since the initiative began in 2007.
"Multiple components are helping hospitals achieve success, including hospital CEO/leadership involvement, working with the participating hospitals to implement a culture of safety, monthly data collection and monitoring, best practice sharing, and customized coaching by VHA clinical improvement consultants," says Terri Bowersox, FACHE, director of clinical performance improvement at VHA's Central Atlantic office in Charlotte, N.C.
Lamm says the webinars, conference calls, and coaching calls Nash Health Care Systems staff participated in with other hospitals and health professionals were helpful in the hospital's MRSA reduction initiative.
"It was very beneficial to see and hear experts in the field discuss various things that worked in their facilities and to hear the barriers they faced and how they overcame the barriers," she states. "This gave us an opportunity to ask others about ideas that we had to see if they had been tried and if they worked."
For 2011, Nash Health Care Systems' infection prevention committee set its MRSA infection goal to be at or below 0.06 cases per 1,000 patient days.
"We would really like to strive for zero infections," Lamm says. "To do this, we have to keep information on how to prevent MRSA infections in front of the staff, management, administration, and the medical staff. We find it very important to have frontline staff from various departments participate on our team. This helps us work through specific issues and also helps us educate staff.
"In order to be successful, I think it is very important to have a leadership that is engaged in the process," she adds. "I think we are very fortunate to have this."
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