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Learning Objective 1: The learner will be able to identify best practice recommendations regarding MRSA control and prevention in the acute care setting.
Learning Objective 2: The learner will be able to identify the expected outcomes related to implementation of best practice recommendations for the control and prevention of MRSA.
To determine MRSA prevalence and reduce hospital-acquired MRSA rates in one small Northwest Arkansas community hospital through the implementation of aggressive control strategies, and to highlight the role of the Clincal Nurse Specialist in implementing evidence-based care and improving outcomes through student involvement in this project.
Significance
Infection with MRSA has been shown to be associated with higher mortality rates, increased length of stay, and higher healthcare costs.
Background/Rationale
Since colonized patients are a major source of MRSA transmission in hospitals, the Institute for Healthcare Improvement recommends routine screening for all patients admitted to a hospital unit with a vulnerable population (e.g. ICU), or in units known to have a high prevalence of drug-resistant organisms. (IHI, 2008)
Description
Routine screening using the traditional method, of all patients admitted to the intensive care unit began in August, 2008. Patients who test positive are placed in contact isolation until hospital discharge.
Outcome
One-hundred and twenty-one ICU patients were screened for MRSA during the study period. Of these, twelve patients were found to be colonized on admission. In addition, one patient who was MRSA negative on admission developed an active MRSA infection prior to discharge. These results highlighted the necessity for the purchase and use of rapid screening laboratory equipment which will decrease the time to result from days to hours and allow for timelier implementation of contact precautions for those infected/colonized. Rapid screening is scheduled to begin the year and the protocol will be expanded to include other hospital departments with vulnerable populations.
Interpretation
The preliminary results of this ongoing clinical improvement project suggest that without the use of active surveillance many MRSA colonized/infected patients may be missed, placing other medically vulnerable patients at risk for exposure to this prevalent and resistent microorganism.