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Implementation of an Industrial Systems-Engineering Approach to Reduce the Incidence of Methicillin-Resistant Staphylococcus aureus Infection

Published online by Cambridge University Press:  02 January 2015

Robert R. Muder ,
Candace Cunningham ,
Ellesha McCray ,
Cheryl Squier ,
Peter Perreiah ,
Rajiv Jain ,
Ronda L. Sinkowitz-Cochran  and
John A. Jernigan
Robert R. Muder*
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Pittsburgh Regional Healthcare Initiative, Pittsburgh, Pennsylvania
Candace Cunningham
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Ellesha McCray
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Cheryl Squier
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Peter Perreiah
Affiliation:
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Rajiv Jain
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Pittsburgh Regional Healthcare Initiative, Pittsburgh, Pennsylvania
Ronda L. Sinkowitz-Cochran
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Infectious Diseases Section, VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240 ([email protected])
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Abstract

Objective.

To measure the effectiveness of an industrial systems-engineering approach to a methicillin-resistant Staphylococcus aureus (MRSA) prevention program.

Design.

Before-after intervention study

Setting.

An intensive care unit (ICU) and a surgical unit that was not an ICU in the Pittsburgh Veterans Administration hospital

Patients.

Allpatientsadmittedtothe study units

Intervention.

We implemented an MRSA infection control program that consisted of the following 4 elements: (1) the use of standard precautions for all patient contact, with emphasis on hand hygiene; (2) the use of contact precautions for interactions with patients known to be infected or colonized with MRSA; (3) the use of active surveillance cultures to identify patients who were asymptomatically colonized with MRSA; and (4) use of an industrial systems-engineering approach, the Toyota Production System, to facilitate consistent and reliable adherence to the infection control program.

Results.

The rate of healthcare-associated MRSA infection in the surgical unit decreased from 1.56 infections per 1,000 patient-days in the 2 years before the intervention to 0.63 infections per 1,000 patient-days in the 4 years after the intervention (a 60% reduction; P = .003). The rate of healthcare-associated MRSA infection in the ICU decreased from 5.45 infections per 1,000 patient-days in the 2 years before to the intervention to 1.35 infections per 1,000 patient-days in the 3 years after the intervention (a 75% reduction; P = .001). The combined estimate for reduction in the incidence of infection after the intervention in the 2 units was 68% (95% confidence interval, 50%-79%; P < .001).

Conclusions.

Sustained reduction in the incidence of MRSA infection is possible in a setting where this pathogen is endemic. An industrial systems-engineering approach can be adapted to facilitate consistent and reliable adherence to MRSA infection prevention practices in healthcare facilities.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 8 , August 2008 , pp. 702 - 708
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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