Highlighting Veterans Affairs’ “War” on MRSA

In previous blogs I’ve tried to highlight some of the issues surrounding attitudes on MRSA prevention and the utility of interventions aimed at dealing with this problem. One of the great recent stories in MRSA and infection control comes from the US army, and specifically the steps that Veterans Affairs hospitals are taking to ensure safe care of their own.

Among other services, the US Department of Veterans Affairs (VA) offers healthcare and related services to some 23 million veterans. This organization spent $43.4 billion on medical programs in 2009,1 and operates 155 hospitals across the country. This network represents that largest integrated healthcare system in the United States. However, the VA hospital system hasn’t escaped criticism in the past regarding high infection rates and equipment sterilization issues. This year, VA sent warning letters to 1800 individuals who underwent dental treatments in a St. Louis VA Medical Center in 2009 after an inspection found that equipment was being improperly disinfected between patients. These and other similar smaller incidents within VA hospitals in the last decade have prompted calls for increased oversight and revised procedures for infection control.

Another area of infection control, however, in which VA Hospitals have made great strides is in prevention of the spread of MRSA within its institutions. Perhaps in an attempt to uphold the VA’s public image, and certainly with the intent of delivering the best care possible to patients, a pioneering infection control clinician in Pittsburgh introduced a pilot program in 2002 that would soon have far-reaching effects across the VA healthcare system. The four basic pillars of this program were: 1) sampling admitted, transferred, or discharged patients for nasal carriage of MRSA, 2) isolating identified MRSA carriers from the rest of the patient population, 3) emphasizing handwashing as standard practice, and 4) elevating infection control to a primary goal at the hospital. If you’ve been reading my previous posts, you’ll be unsurprised to hear that this program was extremely successful in Pittsburgh. Within that institution they were able to decrease MRSA infections in surgical wards by 60% and overall hospital infections by 75% over a 3-year period.2

On the heels of this success, the VA made an unprecedented decision to roll out the “MRSA Prevention Initiative” across all of its 155 hospitals. Starting in mid-2007, all VA hospitals were required to adopt the same “bundle” of MRSA control procedures that proved successful at the pilot site in Pittsburgh. Two years later, the Director of this initiative, Dr. Rajiv Jain, announced that nationwide the VA had been able to cut the overall infection rate by about 30% and intensive care (ICU) infections by up to 50%.3 Given the extra costs associated with an ICU infection, these levels of reductions would represent tens of millions of dollars in savings for the VA healthcare system. Although specific numbers aren’t readily available to the public, these savings would undoubtedly far surpass the costs involved in rolling the initiative out nationwide.

So what do the VA’s actions show us about MRSA prevention and control? From a healthcare delivery standpoint this case study certainly suggests that integrated healthcare systems like VA are very efficient at rolling out new standard practices. While VA hospitals on the other side of the country were replicating Pittsburgh’s successes within a couple years, I very much doubt that the private hospital across the street has done so even to this day. Say what you like about “Privatized Healthcare”, but standardization of care does not rank among its advantages. Most obviously, the MRSA Prevention Initiative seems to demonstrate beyond a doubt that the adoption of specific infection control measures in a hospital leads to measurable reductions in MRSA infection rate. Hard to believe that even today the debate goes on as to whether identifying and addressing the problem leads to better outcomes than ignoring it and hoping it goes away. The amazing part of this from my point of view is that the VA still hasn’t gone as far as it can go in MRSA prevention. Screening and isolation are important in preventing the spread of pathogens, but new treatment paradigms are emerging that allow proactive decolonization of MRSA carriers upon admission to the hospital. Imagine what will be achieved in the near future when healthcare systems like VA incorporate decolonization therapies into practice and attack not just the spread, but the introduction of MRSA into their facilities.

1 Source: US Census Bureau, statistic found at http://www.infoplease.com/spot/veteranscensus1.html

2 Muder RR, Cunningham C, McCray E, et al. (2008) Implementation of an Industrial Systems-Engineering Approach to Reduce the Incidence of Methicillin-resistant Staphylococcus aureus Infection. Infection Control and Hospital Epidemiology 29:702-708.

3 Infectious Disease News, June 1 2009: http://www.infectiousdiseasenews.com/article/40908.aspx

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3 Responses to “Highlighting Veterans Affairs’ “War” on MRSA”

  1. […] Highlighting Veterans Affairs' “War” on MRSA | MRSA Topic Dec 3, 2010. Among other services, the US Department of Veterans Affairs (VA). who underwent dental treatments in a St. Louis VA Medical Center in Highlighting Veterans Affairs' “War” on MRSA | MRSA Topic […]

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