Nationwide safety program associated with 65% reduction in hospital-onset MRSA bloodstream infections

A nationwide quality improvement initiative, spearheaded by infection prevention specialists at Johns Hopkins Armstrong Institute for Patient Safety and Quality, yielded a significant 65% decline in hospital-onset bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA) across participating hospital wards.

Published on August 27 in JAMA Network Open, these findings underscore the potential of a comprehensive strategy to integrate existing infection prevention knowledge into routine clinical practice, markedly diminishing healthcare-associated infections.

The Agency for Healthcare Research and Quality (AHRQ) Safety Program for MRSA Prevention was instituted in 106 intensive care units (ICUs) and 87 non-ICU areas spread across 94 hospitals nationwide. This effort highlighted not only the preventability of MRSA infections but also the necessity of a structured approach to translate scientific evidence into everyday clinical protocols.

Dr. Lisa Maragakis, senior author, professor of medicine and epidemiology at Johns Hopkins University School of Medicine, and a member of the Armstrong Institute for Patient Safety and Quality, emphasized that while multidrug-resistant organisms like MRSA may be perceived as inevitable, they are, in fact, preventable. She noted that the success of infection prevention hinges on meticulous implementation of evidence-based strategies.

MRSA, a type of staph bacteria resistant to antibiotics, poses a serious threat as it can lead to more challenging-to-treat infections. Hospitalized patients, particularly those with underlying conditions and invasive devices such as central venous catheters, are especially susceptible due to the breach of the body's natural defenses.

In response, the Johns Hopkins Armstrong Institute, collaborating with NORC at the University of Chicago and AHRQ, launched an 18-month program aimed at standardizing infection prevention practices across hospital units.

The program provided education and resources on essential infection prevention measures, including hand hygiene, environmental cleaning, device-associated infection prevention, chlorhexidine bathing, and nasal decolonization. It also engaged frontline healthcare workers from various disciplines to ensure consistent application of these strategies.

Comparing infection rates during the implementation period with those from the preceding 12 months, researchers observed a notable 65% reduction in hospital-onset MRSA bloodstream infections across both ICU and non-ICU settings. Additionally, there were substantial decreases in MRSA-positive clinical cultures, bloodstream infections from all causes, and central line-associated bloodstream infections.

The researchers also noted improvements in infection prevention practices. The proportion of ICUs and non-ICUs practicing nasal MRSA decolonization for all patients more than doubled, rising from 35% to 61%, and from 13% to 35%, respectively. Monitoring of environmental cleaning also increased significantly, from 50% to 75% in ICUs and from 52% to 76% in non-ICUs.

This collaborative effort, involving researchers from NORC and AHRQ, demonstrated the power of a large-scale, coordinated initiative to enhance infection prevention across healthcare settings. The AHRQ MRSA Prevention Toolkit, a resource offering educational and implementation materials, is now publicly available. It provides healthcare teams with tools to develop or strengthen their infection prevention programs, focusing on fundamental practices that can extend benefits beyond MRSA prevention to reduce the spread of other healthcare-associated infections.