VHA Infection Control Intervention Significantly Reduces MRSA in Veterans Living Centers

A new intervention coming from the Veterans Health Administration (VHA) has helped significantly cut down on the number of methicillin-resistant Staphylococcus aureus (MRSA) infections in a Veterans community living center (CLC) in North Carolina.

Taking a dual-headed approach—active surveillance and decolonization—the staff was able to achieve control of the environment, which resulted in a whopping 89% reduction in MRSA infections.

According to research that had been presented at the 44^th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC), this intervention also cut back on expenses. It costs about $28,000 to treat a MRSA infection, according to a recent press release. However, by averting 64 infections that had been projected to occur over the course of the three-year (2013-2016) study period, the researchers postulate that about $2.2 million had been saved in expenses.

“This research shows the positive impact that targeted infection prevention interventions can have on patient safety and healthcare costs,” 2017 APIC President, Linda Greene, RN, MPS, CIC, FAPIC, noted in the press release. “It is important that infection preventionists have the latitude and resources to design programs to address the infection risk at their facilities.”

However, this is not the first time that the healthcare workers attempted to cut back on the number of MRSA infections. In 2007, the team used a strategy that focused heavily on the use of contact precautions. These precautions consisted of isolating patients with MRSA colonization, “using dedicated equipment,” and calling for all workers to wear personal protective equipment, such as gowns, when entering patient rooms. The strategy wasn’t successful for several reasons. For one, the lengthy time that it took for healthcare workers to wear the required personal protective equipment resulted in “high rates of noncompliance.” Furthermore, the CLC patients are there for extended periods—these places become their home. Therefore, “the measures proved too restrictive for the residents.”

However, the researchers did not give up.

As MRSA incidence continued to rise, reaching a staggering 70% by 2012, the researchers decided to take another approach to tackle the problem. According to the press release, the staff at the VHA’s CLC in Salisbury, North Carolina, “moved quickly to test” all residents for MRSA. For 5 consecutive days, they decolonized all MRSA-positive individuals through “daily chlorhexidine bathing and use of intra-nasal mupirocin,” those known to be positive as well as everyone who tested positive at time of testing. Furthermore, the team took active steps to achieve control of the environment. They used an ultraviolet C (UVC) light to terminally clean every resident room, bathroom, and all common areas on a daily basis. Through these efforts, the team witnessed a 29% reduction in MRSA prevalence rates by the first fourth quarter of 2013.

The team followed up the decolonization process with a “search and destroy program,” which calls for all veterans who are admitted to the facility who have been colonized with MRSA to “immediately” undergo decolonization. The staff screens the rest of the residents for MRSA on a quarterly basis, and when someone tests positive, it is ensured that that individual undergo decolonization for 5 consecutive days.

“The cornerstone of this program was strict environmental control, decontamination, and cleaning,” lead study author Lanette Hughes, RN, BSN, infection preventionist at the Salisbury VA Community Living Center, said in the press release. She continued, “In addition to the substantial monetary savings from using less personal protective equipment, this initiative also fostered a better environment for residents and staff, improving the overall workflow of the living centers.”