Weill Cornell Medicine, New York, New York (D.P.C.).
Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.D., A.J.R.).
Ann Intern Med. 2019 Oct 1;171(7_Suppl):S66-S72. doi: 10.7326/M18-3535.
Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most common causes of health care-associated infection (HAI).
To evaluate the effect of education and a tiered, evidence-based infection prevention strategy on rates of hospital-onset MRSA bloodstream infection (BSI).
Prospective, national, nonrandomized, interventional, 12-month, multiple cohort, pre-post observational quality improvement project.
Acute care, long-term acute care, and critical access hospitals with a disproportionate burden of HAI.
All patients admitted to participating facilities during the project period.
A multimodal infection prevention intervention consisting of recommendations and tools for prioritizing and implementing evidence-based infection prevention strategies, on-demand educational videos, Internet-based live educational presentations, and access to content experts.
Rates of hospital-onset MRSA BSI, overall and stratified by hospital type, during 12-month baseline and postintervention periods. Variation in outcomes across hospital types was examined.
Between November 2016 and May 2018, 387 hospitals in 23 states and the District of Columbia participated, 353 (91%) submitted MRSA data, and 172 (49%) indicated that MRSA prevention was a priority. Unadjusted overall rates of hospital-onset MRSA BSI were 0.075 (95% CI, 0.065 to 0.085) and 0.071 (CI, 0.063 to 0.080) per 1000 patient-days in the baseline and postintervention periods, respectively.
The intervention period was short. Participation and adherence to recommended interventions were not fully assessed. Baseline rates of hospital-onset MRSA BSI were relatively low. Prevention of MRSA was a priority in a minority of participating hospitals. Patient characteristics and other MRSA risk factors were not assessed.
In hospitals with a disproportionate burden of HAIs, access to tools to assist with implementation of evidence-based prevention strategies and education resources alone may not be sufficient to prevent MRSA BSI.
Centers for Disease Control and Prevention.
耐甲氧西林金黄色葡萄球菌（MRSA）仍然是医疗保健相关感染（HAI）最常见的原因之一。
评估教育和分层、基于证据的感染预防策略对医院获得性 MRSA 血流感染（BSI）发生率的影响。
前瞻性、全国性、非随机、干预性、12 个月、多队列、前后瞻性观察性质量改进项目。
急性护理、长期急性护理和具有不成比例的 HAI 负担的危急通道医院。
参与设施项目期间入院的所有患者。
一种多模式感染预防干预措施，包括针对优先实施基于证据的感染预防策略的建议和工具，按需教育视频、基于互联网的实时教育演示，以及获取内容专家。
12 个月基线和干预后期间，医院获得性 MRSA BSI 的发生率，按医院类型分层和总体情况。还检查了医院类型之间的结果变化。
2016 年 11 月至 2018 年 5 月，23 个州和哥伦比亚特区的 387 家医院参与了研究，353 家（91%）提交了 MRSA 数据，172 家（49%）表示 MRSA 预防是优先事项。未调整的医院获得性 MRSA BSI 总体发生率分别为 0.075（95%CI，0.065 至 0.085）和 0.071（CI，0.063 至 0.080）/1000 患者日在基线和干预后时期。
干预期短。未充分评估参与情况和对建议干预措施的遵守情况。医院获得性 MRSA BSI 的基线发生率相对较低。参与医院中只有少数将预防 MRSA 作为优先事项。未评估患者特征和其他 MRSA 危险因素。
在 HAI 负担不成比例的医院中，仅获得实施基于证据的预防策略的工具和教育资源可能不足以预防 MRSA BSI。
疾病控制和预防中心。
