APIC MRSA Elimination Guideline

Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital SettingsMRSA Risk AssessmentPurposePerformance of a hospital-specific MRSA risk assessment will result in the baseline description of hospitalMRSA incidence, prevalence and transmission, and will identify patient populations that are more likely tobe colonized and/or infected with MRSA. The purpose of the MRSA assessment is to guide developmentof a surveillance, prevention and control program plan that is based on facility data and conditions. Theplan will include consideration of local resources such as laboratory capabilities, administrative support,infection prevention and control department staffing, public health support, other support elements orroadblocks, current infection prevention and control interventions (e.g., hand hygiene, contact precautions,etc.) and the measurement parameters for the current interventions.Additional interventions may be developed if the risk assessment data show that MRSA transmission ratesare not decreasing in spite of good compliance with current interventions. Therefore, an important aspectof the plan is identification of endpoints or goals. A clear picture of what will be accomplished throughimplementation of the plan must be expressed and quantified as appropriate.Examples of possible outcome measures include “decrease hospital-associated MRSA, centralline-related bloodstream infections by X% in the next six months,” and “decrease MRSAtransmission by X% in the next three quarters.”Examples of possible process measures include annual increase in compliance with hand hygienerequirements to the 90% level as measured by gel and soap use through the “Partners in YourCare Program” or “increase compliance with Contact Precautions to the 95% level as measuredby the quarterly isolation compliance monitor.”Each of these specifies an element to be measured, how it will be measured and what success will look like.Key ConceptsPast and current hospital surveillance data is at the core of the MRSA assessment. Relevant MRSAsurveillance data available from local public health departments and published MRSA data from facilitiesof similar demographic and geographic characteristics may also be helpful in a hospital MRSA assessment.Evaluation of MRSA assessment data identifies patient care units, service lines or groups of individualslikely to be colonized or infected. This information is used to drive the hospital’s surveillance, preventionand control program for the elimination of MRSA transmission.The CDC guideline “Management of Multidrug Resistant Organisms (MDRO) in Healthcare Settings,2006” recommends monitoring trends in the incidence* of a target MDRO.V.A.4.e. Monitor trends in the incidence* of target MDROs in the facility over time using appropriate statisticalmethods to determine whether MDRO rates are decreasing and whether additional interventions are needed.Category IA*number of new MDROs divided by the size of the population under consideration.10ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL AND EPIDEMIOLOGY