Danbury tackles MRSA with aggressive initiative

Danbury (CT) Hospital, named to the Solucient 100 Top Hospitals list for three years running, establishes a set of quality initiatives each year that include aggressive plans for improvement. This year one of those initiatives focuses on Methicillin-resistant Staphylococcus aureus, or MRSA.

"Here we have this disease that is remarkably prevalent — a key driver of hospital-acquired infections," notes Matthew A. Miller, MD, chief medical officer at Danbury. "The problem nationally is that no one really knows what percentage of patients are colonized with this disease, which have the highest risk, and how to prevent it from spreading from one patient to another."

There is a clear set of universal precautions, Miller notes — "so we make sure we are compliant with gowns, gloves, and so forth." However, he says, "You first have to know the patient has the disease, and then the horse is out of the barn."

The Centers for Disease Control and Prevention (CDC), he says, recommends that any staff person who goes into the room of such a patient wears gloves and gown — if they are going to touch that patient. "That will not work," says Miller. "Maybe the doctor, nurse, or phlebotomist forgets, and touches a handrail; we need to be ahead of that."

At Danbury, he says, a policy of contact isolation has been adopted. "When you think you might touch anything at all, you have to put on gloves and a gown; we have to enforce that," he says.

How does he plan to enforce compliance? "Partly by promulgating the policy and making it clear to everyone — partly by signage and partly by having the nurse manager on each floor assign someone to be the representative for patient safety," he says. These representatives do random, "blinded" audits; they might sit nearby, observe, and track compliance. These results will then be published — by specialty. "Adopting a similar approach with hand washing last year moved us from 55%-60% compliance to 80%," says Miller.

An even more difficult issue, says Miller, is what to do with patients who are colonized. "Some recent evidence says probably 5%-7% of patients who are admitted are colonized; does that mean we isolate everybody? Probably not," he concedes, adding, "Here's where technology meets careful planning."

The staff will take a couple of days doing nasal swabs to determine the percent of admitted patients who are positive, and where they come from, says Miller. "We believe — and the evidence suggests — that patients in nursing homes and chronic care facilities have the highest rate, maybe as high as 30%-50%," he asserts.

So, beginning this month, the staff will be screening three categories of patient — every nursing home admission, every transfer from other hospitals' ICUs, and every scheduled high-risk procedure (i.e., total hip replacements and cardiac cases). "Transfers will get nasal swabs on admission," he says. "We are currently testing new technology that will turn around results in 24 hours. For the first 24 hours we will isolate every one of those admissions until the test comes back negative."

As for surgical cases, says Miller, "if we have time we will treat them; if not, we will isolate them."