VHA initiative reduces MRSA in veterans' living center

An initiative led by the Veterans Health Administration (VHA) reduced methicillin-resistant Staphylococcus aureus (MRSA) infections by 89 percent over four years in a veterans' community living center (CLC) in North Carolina.

Active surveillance and decolonization with strict control of the environment contributed to the significant reduction, according to research. At an estimated cost of $28,000 to treat each MRSA infection, researchers projected that the initiative saved roughly $2.2 million by preventing an otherwise expected 64 infections over the study period of 2013-2016.

Results of the research were presented at the 44^th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC) June 14-16 in Portland, Ore.

“This research shows the positive impact that targeted infection-prevention interventions can have on patient safety and health care costs,” says Linda Greene, R.N., APIC president. “It is important that infection preventionists have the latitude and resources to design programs to address the infection risk at their facilities.”

The aggressive intervention was put into place because an earlier attempt in 2007 to stop the spread of MRSA proved unsuccessful. The previous effort relied on contact precautions — isolating colonized residents, using dedicated equipment and requiring health care workers to don gowns before entering rooms.

These stipulations applied to the majority of rooms in the CLC, often leading to inefficiencies in the system and high rates of noncompliance due to the time required to don and doff personal protective equipment. The measures also proved to be too restrictive for residents because this was their permanent home.

As a result, MRSA prevalence rose to 70 percent by 2012, leading researchers to consider additional actions outside of contact precautions to address the increase in bacteria present in the CLC environment.

Beginning in 2012, at the VHA’s 120-bed CLC in Salisbury, N.C., staff moved quickly to test all MRSA-negative residents and then decolonize all known positives, plus everyone who tested positive at that time for five consecutive days. Decolonization consisted of daily chlorhexidine bathing and use of intranasal mupirocin.

In addition, environmental services staff performed daily terminal cleaning of each resident room, bathroom and all common areas, including utilization of ultraviolet C light to achieve control of the environment. The MRSA prevalence rates decreased from 45 percent of residents in the first quarter 2013 to 16 percent in the fourth quarter 2013. 

“The cornerstone of this program was strict environmental control, decontamination and cleaning,” says lead study author Lanette Hughes, R.N., infection preventionist at the Salisbury VA Community Living Center.

“In addition to the substantial monetary savings from using less personal protective equipment, this initiative also fostered a better environment for residents and staff, improving the overall workflow of the living centers,” she says.

The Salisbury VA CLC is designed as a community, with communal areas, a downtown center, movie theaters and even a town hall with a mayor. Prior to the start of the initiative, researchers presented their case to the town council, comprising veterans living in the community, to obtain approval. The program achieved full buy-in as support grew with the program’s success.

The initial decolonization was followed by a search-and-destroy program. With the new procedures in place, any veteran admitted who is already colonized with MRSA undergoes full decolonization immediately. All residents are screened quarterly and those who test positive for MRSA are decolonized for five consecutive days.

Researchers noted that MRSA decolonization efforts play out differently in acute care, as patients only stay for short periods and are confined to their rooms. By contrast, in CLCs, patients are admitted for long periods and many live there permanently.