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Epidemiological Study of Methicillin-Resistant Staphylococcus aureus
Among Patients in a Burn ICU Bayless Drum, MS21 and Pranavi Sreeramoju, MD, MPH1,2
1. UT Southwestern Medical Center; 2. Department of InfecEon PrevenEon, Parkland Health and Hospital System, Dallas, TX
Background
Infec'ons caused by an'bio'c resistant bacteria including methicillin-‐ resistant Staphylococcus aureus (MRSA) are associated with an increased morbidity and mortality in hospitalized pa'ents. Ac've surveillance culture (ASC) programs that involve iden'fying asymptoma'cally colonized pa'ents and placing them on contact precau'ons have been promoted to control the spread of hospital-‐onset bacterial infec'ons. Burn pa'ents are par'cularly suscep'ble to staphylococcal infec'on, and a complete understanding of the effec'veness of ASCs in preven'ng hospital onset infec'ons among burn pa'ents is limited. The objec've of this retrospec've observa'onal study is to describe the epidemiology of MRSA among pa'ents in an academic medical center burn unit including the impact of removal of ASCs on hospital-‐onset (HO) blood stream infec'ons (BSI) in order to inform MRSA control efforts in this popula'on
1980s 2011 2012 2013 2014 2015
ASC Began
Start of Study Period
Feb-‐Jun Outbreak
ASC Ended
Follow-‐Up No ASC
Timeline
Aim Statement
The aim of this project is to retrospec'vely determine the effec'veness of ac've surveillance cultures (ASC) in controlling hospital-‐onset (HO) MRSA bloodstream infec'ons (BSI) in the Burn Intensive and Burn Acute Care Units of Parkland Health and Hospital system by comparing the rate during December 2011-‐August 2014 when ASC were used with the rate during September 2014-‐August 2015 when ASC were discon'nued. This is important in order to understand whether established best prac'ces for MRSA preven'on in the burn popula'on must include ASC.
PDSA: ASC IntervenEon
• Organize and analyze infec'on rate data.
• 1980s ASC Began
• How do results affect future prac'ce?
ACT PLAN
DO STUDY
Measures
Measures: Admission Surveillance Adherence
% screened for colonizaEon in BICU
% screened for colonizaEon in BACU
ASC period 20.90% 12.50% ASC w/o outbreak period 18.21% 6% outbreak period 82.88% 41.80%
Measures: Hospital-‐onset Blood Stream InfecEons
Measures: Community-‐onset ColonizaEon
ColonizaEon of Admits
Range of Monthly Rate
ASC period 1.35% 0-‐18.75% ASC w/o outbreak period 0.94% 0-‐7.32% outbreak period 10.81% 3.85-‐18.75%
BICU BACU
YES
NO
End ASC Study BSI rates
Did removing ASC increase HO
BSI significantly?
Recommend to reestablish ASC
Recommend to con'nue without
ASC
ColonizaEon of Admits
Range of Monthly Rate
ASC period 1.89% 0-‐17.1% ASC w/o outbreak period 1% 0-‐2.9% outbreak period 5.3% 0-‐17.1%
Decision Flow Chart
Conclusions and Next Steps
Team Members
Results Removal of the ASC led to an increase in HO BSI that was not sta's'cally significant.
Impact
Karla Voy-‐Hacer, RN, MPH, MHA, CIC Katherine Collinsworth, MSN Steven Wolf, MD Brec Arnoldo, MD Pranavi Sreeramoju, MD, MPH
Recommend con'nuing MRSA preven'on without ASC in Parkland Burn Unit. Monitor BSI rates and focus on other widely accepted infec'on preven'on measures.
BICU and BACU Combined BICU BACU
ASC period 1.23 2.59 0.31 ASC w/o outbreak period 1.16 2.39 0.36 outbreak period 1.66 3.59 0 follow-up period 1.56 3.72 0.25
HO-‐BSI Incidence (Rate) = Number of HO-‐BSI/ Number of PaEent-‐Days *1000
Rate RaEo (95% Confidence Interval) P-‐value
BICU and BACU Combined
1.26 (0.57,2.68) 0.54
BICU
1.43 (0.61, 3.19) 0.39
BACU
0.81 (0.03, 7.57) 0.92
HO-‐BSI Rate: Follow-‐Up Period vs. ASC Period
Was there a significant increase in the HO-‐BSI rate from ASC period to follow-‐up period? NO
