Establishing a Research Agenda for Preventing Transmission of Multidrug-Resistant Organisms in Acute-Care Settings in the Veterans Health Administration

A notable example is the 2007 MRSA directive that mandated that all acute-care units adopt a specific bundle of interventions to prevent the transmission of MRSA.2 The bundle consists of nasal surveillance testing for MRSA for all patients on admission, in-hospital transfer and discharge; contact pr...

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Bibliographic Details
Published in:Infection control and hospital epidemiology 2018-02, Vol.39 (2), p.189-195
Main Authors: Perencevich, Eli N, Harris, Anthony D, Pfeiffer, Christopher D, Rubin, Michael A, Hill, Jennifer N, Baracco, Gio J, Evans, Martin E, Klutts, J Stacey, Streit, Judy A, Nelson, Richard E, Khader, Karim, Reisinger, Heather Schacht
Format: Article
Language:English
Subjects:
Automation
Cohort analysis
Cost analysis
Hospitals
Hygiene
Medical personnel
Multidrug resistant organisms
Nursing
Organisms
Orthopedics
Pathogens
Patients
Personal hygiene
Prevention
Quasi-experimental methods
Staphylococcus infections
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Summary:A notable example is the 2007 MRSA directive that mandated that all acute-care units adopt a specific bundle of interventions to prevent the transmission of MRSA.2 The bundle consists of nasal surveillance testing for MRSA for all patients on admission, in-hospital transfer and discharge; contact precautions (CP) for MRSA colonized or infected patients; hand hygiene; and a change in the institutional culture that included institutional leadership with ground-level innovation along with hiring an MRSA coordinator at each facility. A summary of the existing knowledge base, research recommendations and how needs fit within the VA Quality Enhancement Research Initiative (QUERI) 6-step model are provided in Table 1.5TABLE 1 Proposed Veterans Healthcare Administration (VHA) Research Agenda for Transmission Prevention Research Topic Current Evidence Research Needs (QUERI Step Model) Hand hygiene surveillance All hand hygiene opportunities are considered equal risk. Develop, test, and validate sustainable interventions through cluster-randomized controlled trials, well-designed quasi-experimental studies; consider behavioral (eg, peer comparison) or behavioral economic interventions (steps 4, 5, and 6) Existing hand hygiene preparation are short acting and must be reapplied before and after each opportunity. Examine approaches for including active surveillance in the existing CDI bundle across care settings (eg, ICU); perform multicenter cohort or quasi-experimental studies to determine VHA-specific parameter estimates and inform power calculations prior to modeling or large-scale cluster-randomized trials (steps 4, 5, and 6) Active surveillance is pathogen specific and will identify many patients colonized with pathogens they are not likely to transmit.
ISSN:0899-823X
1559-6834
DOI:10.1017/ice.2017.309