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Rusty Silk, health care technician in the SICU, disinfects his hands when he goes from one patient’s room to another. The placement of hand sanitizing gel pumps in public areas is just one of several solutions that the MRSA Champions came up with in order to prevent the spread of MRSA bacteria.

Getting to Zero – VAMHCS Staff Implement Strategies to Reduce MRSA Infections

by Suzan Holl

In January 2007, the VA Maryland Health Care System (VAMHCS) initiated the national VA Methicillin-resistant Staphylococcus Aureus or MRSA prevention program, Getting to Zero, and was selected as one of several pilot sites to implement the four primary strategies used to eliminate MRSA. MRSA is an antibiotic resistant bacterium that is highly contagious and easily transmitted from one person to another through physical contact. Anyone can get a MRSA infection, but they occur most frequently in hospitals and health care facilities among persons who have weakened immune systems.

The VAMHCS has initiated the national MRSA prevention program in an effort to wipe out MRSA infections among hospitalized patients. The four primary strategies that are being utilized to eliminate MRSA include obtaining nasal specimens from all patients when they are admitted, transferred or discharged; isolating all patients who test positive for MRSA; emphasizing the importance of thorough hand washing for everyone; and applying the positive deviance method for cultural transformation to make infection control a primary goal.

“MRSA is now common in the community where it mostly causes boils or abscesses,” says Dr. Mary Claire Roghmann, epidemiologist with the VAMHCS. “Although these community infections are not often serious, this makes our job harder because more veterans are colonized (the bug is present, but not causing infection) with MRSA when they are admitted. These patients can transmit MRSA to others in the hospital.”

patients and are primarily transmitted through patient-to-patient contact via the hands of health care workers and through environmental contamination.

According to the Centers for Disease Control, ease of transmission and antibiotic resistance has made MRSA one of the most rapidly growing and virulent health care associated infections in the United States. It is responsible for more than 100,000 U.S. hospitalizations each year with significant lengths of stay and financial burdens of at least $36,000 per episode.

“Getting to Zero is about educating veteran patients and staff on preventing the spread of MRSA by the safest and most efficient way possible,” said Dr. Roghmann. The VAMHCS has been tackling the issue of MRSA prevention since 2000 with much success. It was this positive track record that led Kathy Agnes, RN, MSN, director of Infection Control and Supply Processing & Distribution (SPD) for the VAMHCS, to contact the national VA office and request the VAMHCS to participate as a test site for using positive deviance.

Gail Heiss, RN, MSN, MRSA prevention coordinator for the VAMHCS, says the positive deviance model encourages employee-led change. “We’ve been applying the positive deviance model to try to find some solutions from within the staff,” said Heiss. “The program is taking shape depending on where people are finding the problems. Some units have identified a need to educate the patients and staff, so we are working on developing some educational materials. Another unit identified the need for an emphasis on hand hygiene, so we are working on the placement of hand gel in very public places.”

A very passionate and dedicated group of employees, consisting of nursing staff, housekeepers, supply technicians, ward clerks and others, meet on alternate Friday mornings to discuss and implement innovative MRSA prevention ideas. This group of individuals, who call themselves the MRSA Champions, have already come up with several of their own ideas for MRSA prevention in their work areas.

For instance, when nurses in the intensive care unit (ICU) requested isolation gowns from SPD, they frequently ran out before the end of each shift. When they requested gowns from SPD they received one package that consisted of 10 gowns. It wasn’t until someone took the time to count how many times they needed to change gowns over a 24-hour period did they realize exactly how many they needed to request. It turns out approximately 67 gowns were needed per patient for every 24 hours. Now SPD fills the isolation carts to maximum capacity and works in unison with the nurses in the ICU to make sure they always stay full.

Another staff intervention is the use of Cavacide wipes. Cavacide commonly comes in a spray form, which is not easy to use on items such as blood pressure cuffs and stethoscopes. Medical technicians, nurses and doctors now use the wipes instead of the spray.

“The solutions may differ from unit to unit, but that’s okay,” says Heiss. “What is important is that every unit comes up with a solution for MRSA prevention that works best according to the specific needs of the area.”

She adds that surveillance cultures are the real nuts and bolts of MRSA prevention. With help from clinical informatics, a list was developed that keeps track of all inpatients that are MRSA positive. If any of these patients are scheduled for an appointment, their name is flagged and staff members working in the areas where they are being treated know at a glance that certain precautions need to be followed. A second list, accessible to the nursing units, identifies all patients who have had a nasal culture and those who have been missed. Nasal swabs are one of the program’s major strategies. They are used to test each patient when they are admitted, transferred or discharged from a health care facility in order to identify if they are colonized with MRSA.

“Each nursing unit is briefed every fourth Friday of the month on how they are doing with their nasal swab compliance and how many transmissions they have had,” said Heiss. “We are now nearing 100 percent compliance for culturing each patient on admission and discharge to determine their MRSA status.”

VAMHCS employees can take part in MRSA prevention by simply practicing good hand hygiene and adhering to contact precautions. “Employees are encouraged to get involved on their unit by participating in discovery and action groups to identify issues and to create change,” said Heiss. “For example, if a unit is having a problem with discharged patients leaving the hospital prior to having a nasal culture, the staff on the unit can brainstorm to come up with a way to correct the issue.”

For more information on the MRSA prevention program or to become a MRSA Champion, please contact Gail Heiss at (410) 605-7000, ext. 4884.