Newark Beth Israel Medical Center (NBIMC) has renewed its status with the Institute for Healthcare Improvement (IHI) and will continue to participate in the Mentor Hospital Registry in the category of Infection Prevention – Methicillin-resistant Staphylococcus aureus (MRSA), a bacterial infection that is highly resistant to some antibiotics. This mentorship is based on the hospital’s innovative and effective management plans for the elimination of MRSA on its units.
According to the IHI, the organizations on the Mentor Hospital Registry volunteer to provide support, advice, clinical expertise, and tips to hospitals seeking help with their implementation efforts. The Mentor Hospital Registry is designed to help health care improvement professionals identify the most suitable Mentor Hospitals to contact for assistance.
“Controlling infections such as MRSA is at the heart of patient safety efforts and requires comprehensive planning and coordination of staff,” says Jeremias Murillo, MD, NBIMC Medical Staff President and Patient Safety Officer. “We are pleased to be able to share our successful techniques with other medical facilities to promote the reduction of these infections in health care settings and the community.”
When clinicians at NBIMC identified a cluster of MRSA-infected babies in the NICU in the summer of 2005, they began an initiative that substantively changed infection-control practices and made the center a pioneer in the war against drug-resistant organisms.
“This improvement was the result of intensive education of the frontline staff, streamlined laboratory processes, frequent feedback of screening data to the staff, visible infection control presence in the unit and a leadership in the NICU dedicated to make the process work,” reports Dr. Murillo.
Collaborative effort consisted of a team of representatives from Neonatology, Nursing, Microbiology Laboratory, Housekeeping, Infection Control and Epidemiology. The purpose of the team was to implement infection control measures including surveillance, identification of infected patients, use of isolation techniques, intensive environmental sanitation, and health care worker education.
According to Pat Harmon, RN, MA, CIC, the Director of Infection Prevention and Epidemiology, this process is now second nature to the frontline staff and is responsible for the sustainability over the past six years.
The steps in the process included:
- Screening all admissions for nasal colonization with MRSA
- Surveillance and search for infected cases
- Use of isolation techniques to prevent the spread of MRSA to other babies
- Aggressive environmental cleaning procedures
- Cohorting or grouping together of infected babies
“Actively looking for and isolating infected patients proved to be the most effective way to prevent transmission,” says Dr. Murillo.
While the original cost of MRSA infection in the NICU was $48,022, by preventing 24 infections in 42 months, NBIMC realized savings of $1,152,000 in 42 months or the equivalent of $329,000 per year.
While New Jersey law requires that hospitals have active surveillance testing on at least one critical care unit, NBIMC found the testing to be so cost-effective that it instituted surveillance testing on five critical care units. Using polymerase chain reaction (PCR) in rapid testing, isolation and decolonization for MRSA, the hospital greatly reduced or eliminated the number of hospital-acquired cases of the disease. In the past, MRSA infections could increase hospital stay by 4 to 14 days and increase treatment cost by $30,000 to $35,000 per patient.