"MRSA Bundle"!

This week NEJM has published an interesting article from Veterans Affairs (VA) system where a “MRSA bundle” was implemented in 2007 in acute care VA hospitals nationwide.

The bundle consisted of

1. universal nasal surveillance for MRSA,

2.contact precautions for patients colonized or infected with MRSA,

3. hand hygiene, and

4. a change in the institutional culture whereby infection control would become the responsibility of everyone who had contact with patients.

Method implemented was: each month, personnel at each facility entered into a central database aggregate data on adherence to surveillance practice, the prevalence of MRSA colonization or infection, and health care–associated transmissions of and infections with MRSA.

Results showed that the rates of health care–associated MRSA infections in ICUs declined with implementation of the bundle, from 1.64 infections per 1000 patient-days in October 2007 to 0.62 per 1000 patient-days in June 2010, a decrease of 62% (P value less than 0.001 for trend). During this same period, the rates of health care–associated MRSA infections in non-ICUs fell from 0.47 per 1000 patient-days to 0.26 per 1000 patient-days, a decrease of 45% (P value less than 0.001 for trend).

It was concluded that a program of universal surveillance, contact precautions, hand hygiene, and institutional culture change was associated with a decrease in health care–associated transmissions of and infections with MRSA in a large health care system.

Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections- N Engl J Med 2011; 364:1419-1430, April 14, 2011