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Together, hospitals can ramp up MRSA prevention

Tuesday October 9, 2012
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Methicillin-resistant Staphylococcus aureus infections are better prevented when hospitals cooperate and coordinate their infection control procedures, according to a study.

Hospitals working alone do not achieve the same level of infection control, researchers reported in the October issue of Health Affairs.

"Unless they are associated financially or legally, hospitals often have their own separate infection control programs and procedures," Bruce Lee, MD, MBA, director of the University of Pittsburgh’s Public Health and Infectious Diseases Computational and Operations Research group, said in a news release.

"However, hospitals are rarely isolated islands and instead share patients extensively with other hospitals in their area, which can facilitate the spread of MRSA infections."

Lee and colleagues obtained real-world data from all 29 hospitals in Orange County, Calif., and developed a computer simulation of the effectiveness of contact isolation in limiting MRSA transmission. The simulation explored scenarios in which different combinations of hospitals implemented contact isolation to varying degrees.

"The more that hospitals work together and coordinate infection control efforts, the more they all benefit," said Lee, also an associate professor of medicine, epidemiology and biomedical informatics at Pitt’s School of Medicine and Graduate School of Public Health. "For example, doubling the number of hospitals that adopt contact isolation can more than double their improvement in infection control."

The simulation also found that requiring contact isolation at one hospital not only decreased MRSA at that hospital as expected, but also did so in other nearby hospitals that had not implemented the intervention.

When the simulation was run with all the hospitals in Orange County implementing contact isolation simultaneously with a 75% compliance rate, MRSA prevalence decreased an additional 3.85% over what the hospitals could have achieved on their own. Long-term acute care facilities fared even better, with a 12.13% additional decrease.

The simulation relies extensively on data regarding infection rates, annual admissions, average patient length-of-stay, hospital transfers, readmissions, number of ICUs and bed capacity at the Orange County hospitals.

MRSA is widely prevalent in U.S. hospitals. In 2006, the MRSA colonization rate was 12 per 1,000 inpatients. In 2010, the rate nearly quadrupled to 41 per 1,000 inpatients despite an overall decrease in the rates of MRSA infection.

The researchers had shown previously that hospitals in Orange County, which has a population of 3 million, are highly interconnected through patient transfers and readmission of patients to different hospitals after an intervening stay at home or elsewhere.

Some hospitals have started cooperating to control hospital-acquired infections, the researchers noted. In California, the Safety Net Initiative is building a learning collaborative among California public hospitals to reduce such infections. The Pittsburgh Regional Health Initiative has created a culture of change to improve overall patient safety. Similar programs in Iowa, Michigan, Nebraska, New York, South Dakota and Wisconsin also have successfully reduced hospital-acquired infections.

The study abstract is available at http://content.healthaffairs.org/content/31/10/2295.abstract.


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