Mluti-faceted interventions to prevent bloodstream MRSA infections

Abstract

Issue: From 1st Jan until 31st Dec 2007, there were 31 MRSA Bacteremias at our NHS trust. 22 were defined as HAI. It was discovered during Root Cause Analysis that the source of the MRSA bacteremias in 12 (54%) of the patients was due to PIVD (Peripheral Intravascular Device). These lines were not always inserted using full aseptic technique and their maintenance was poorly documented. Project: The introduction of a sequence of interventions targeted at reducing MRSA bacteremias by a newly expended infection control team, after analysis of existing policies and procedures. 1. The use of MRSA antimicrobials in the Trust's formulary was optimized according to an assessment of published efficacy data. Teicoplanin was substituted with daptomycin in medical and surgical wards. In Intensive Care vancomycin by continuous infusion was introduced. 2. Introduction of MRSA screening of all emergency admissions to adult medical, surgical and orthopaedic wards and subsequent decolonization of patients found to be positive. 3. A new PIVD policy, insertion record and on-going care tool was launched. Skin preparation prior to cannulation was changed from a non-sterile 70% alcohol 0.5% chlorhexidine swab, to a sterile pre packaged application device product containing 70% alcohol and 2% chlorhexidine. No other interventions likely to impact HAI MRSA bacteremias were introduced during the period of study. Results: Monthly rates of HAI MRSA bacteremias were relatively low and too variable therefore cumulative rates were calculated. Introductions of these 3 interventions were plotted chronologically against the cumulative MRSA bacteremia rates and calculated per 10,000 bed days. Lessons Learned: The expansion of the infection control team, triggered a review of procedures in our trust. 3 interventions were instituted to comply with best practice. Each intervention could not be shown to be effective individually, partly as the monthly rates of bacteremias were consistently low and partly as each new intervention was introduced in quick succession. The cumulative MRSA bacteremia data does however suggest the combined trio of interventions resulted in a reduction in the rate of MRSA bacteremias.