Veterans Health Administration Cuts Healthcare Associated Blood Infections with Preventive Initiative

Nearly a decade ago, 130 Veterans Health Administration (VHA) facilities around the country introduced their methicillin-resistant Staphylococcus aureus (MRSA) Preventive Initiative to reduce transmission of the “superbug” in their hospitals and health centers. Now a new study outlines how these preventive measures decreased the incidence of several other healthcare-associated infections in the VHA.

Published in the journal Clinical Infectious Diseases, this new study adds to the growing body of evidence on the significant role of prevention in cutting healthcare associated infections.

According to a report by the Centers for Disease Control and Prevention, there are nearly 722,000 healthcare associated infections in the United States each year. In 2007 the VHA began their initiative targeting MRSA, the drug-resistant pathogen plaguing healthcare centers around the world. Although individuals can carry the staph bacteria without infection, it can lead to life-threatening infections such as sepsis, pneumonia, and bloodstream infections.

The new initiative at the VHA facilities implemented comprehensive evidence-based measures to prevent MRSA transmission. These included active screening and isolation for MRSA carriers, emphasis on hand hygiene, expanded educational activities, and an increase in human resources for infection prevention staff.

As noted by the authors of the study, the implementation of this initiative offered an opportunity to look at how efforts to prevent the spread of one pathogen could have beneficial side effects on infections from other pathogens. “The nationwide expansion of infection control programs through implementation of this initiative provided the unique opportunity to explore and quantify the initiative’s horizontal effect on transmission of healthcare-acquired pathogens beyond MRSA, which were not directly targeted,” write the authors.

The retrospective observational cohort study took place at 130 VHA hospitals in 48 states, the District of Columbia, and Puerto Rico, from January 2003 to December 2013. The study included 11,196 veterans who were admitted to acute care wards and units during that time with positive blood cultures for Escherichia coli, Klebsiella species, or Pseudomonas aeruginosa, the three organisms that make up the majority of blood infections caused by gram-negative rods (GNR).

The researchers analyzed data on hospital-onset GNR bacteremia, while also analyzing data on community-acquired GNR bacteremia as a nonequivalent dependent control group. Each VHA facility participating in the study received funding to carry out the prevention interventions, including funding for the creation of a new MRSA Prevention Coordinator position at each setting.

Over the course of the study, the researchers studied more than 30 million patient-days and saw a total of 47,480 episodes of GNR bacteremia from Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa. While there was a small change in the rate of community-acquired GNR bacteremia during the study period, the researchers observed a significant decrease in hospital-onset GNR blood infections with a 43.3% relative reduction.

“We demonstrated that the nationwide infection control program expansion contained with the MRSA Prevention Initiative was strongly associated with a sustained and statistically significant decline in hospital-onset GNR bacteremia rates. Similar declines were not seen in our nonequivalent dependent controls,” write the authors, noting the significance of their findings since these pathogens were not directly targeted by the initiative. “These results strongly suggested that the horizontal components of the initiative, including increased infection control staffing, emphasis on hand hygiene compliance, cultural transformation, and leadership support, had collateral benefits on the epidemiology of hospital-onset GNR bacteremia.”