NY Hospital Targets Zero MRSA Cases in Unit

Matt Phillion , April 14, 2009

When Rochester (NY) General Health System determined to cut down on Methicillin resistant Staphylococcus aureus (MRSA) in its cardiothoracic unit, the organization didn't just see the number of cases shrink—there has not been a MRSA case in the unit since January of 2008.

"It's all about execution," says Linda Greene, RN, MPS, CIC, director of infection prevention and control for the New York hospital system.

The organization pursued this goal as part of the Association for Professionals in Infection Control and Epidemiology's (APIC) Targeting Zero campaign.

"Since 2006, APIC has been promoting a Targeting Zero philosophy," says Liz Garman, the association's director of communications. "In keeping with APIC's mission and vision for 2012, Targeting Zero is the philosophy that every healthcare institution should be working toward a goal of zero (healthcare-associated infections) HAIs. While not all HAIs are preventable, APIC believes that all organizations should set the inspirational goal of elimination and strive for zero infections."

The primary reason behind targeting MRSA for a zero infection rate is and was patient safety. But the secondary factors are hard to ignore: Average length of stay jumps from 7.6 days to 25.6 days for a MRSA patient, and the average case costs $40,000 more to treat than a non-infected patient.

"That's not the driving force for from a quality perspective, but this information is important," says Greene. "When you're doing a risk assessment, you're looking at those things—what is the end result and what are opportunities for improvement."

The question was: Were these infections inevitable, or preventable? A large amount of infections are preventable, says Greene. In fact, targeting MRSA in one unit had an interesting fringe benefit.

"What we did in 2008 drove all our infection rates down," says Greene. Implementing and hardwiring improved practices caused an across-the-board lowering of infection rates in the cardiothoracic unit.

The facility looked at infections from the perspective of the science of epidemiology.

"Infections are preventable. We know they're not all preventable, but how many are? Have we done enough?" says Greene.

Bi-directional change
"One of the reasons we chose this population—which is a high risk population—is that the people working in this area are innovators," says Greene. "At the beginning it is important to engage key people."

Because MRSA is such a high-profile topic, it was also easier to engage and leverage administrative support.

"We needed some early wins," says Greene. "While it's a really high-performing unit anyway, we found that it's all about execution—incorporating changes into the routine standard of care."

This sort of change is bi-directional, Greene says.

"Top down and bottom up—we need the executives on our side but also the stakeholders," she says.

To this end, they made it a point to drive home individual consequences. For example, education was provided to environmental services staff to demonstrate how their actions could eventually have an effect on the patient.

Rochester's MRSA efforts fit in with its overall accreditation activities because Targeting Zero falls in line with the Joint Commission's National Patient Safety Goals and new governmental regulations (e.g., CMS regulations reducing reimbursement if an infection occurs during a hospital stay)

"There are institutions that have managed to greatly reduce and even eliminate certain infections—showing that zero is possible," Garman says. "It's changing a mindset that these are the inevitable consequence of more complicated care to one where these can be avoided in many cases."

Visit www.apic.org/AM/Template for more information on this program.

Matt Phillion, CSHA, is senior managing editor of Briefings on The Joint Commission  and senior editorial advisor for the Association for Healthcare Accreditation Professionals. He may be reached at mphillion@hcpro.com.

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