QAPI 113 - Increasing Compliance with Hospital-wide Universal Decolonization Protocol Decreases Methicillin-resistant Staphylococcus Aureus (MRSA) Bacteremia

Background: Hospital-wide universal decolonization protocols have shown to reduce healthcare-associated infections, including those caused by Methicillin-resistant Staphylococcus aureus (MRSA). Our facility decolonization protocol consists of a daily chlorhexidine gluconate (CHG) bath and twice daily nasal antiseptic application universally. A gap analysis determined a deviation from protocol to practice; a decrease in compliance with the protocol was observed while MRSA bacteremia rates remained high. To reduce MRSA bacteremia rate, our facility implemented a multidisciplinary approach to increase universal decolonization compliance.

Methods: In February 2021, our data analytics team created CHG bathing and nasal antiseptic application compliance reports by unit. These reports were sent daily to clinical leadership teams and presented in daily leadership safety huddle by Infection Prevention. Nursing leaders addressed noncompliance (missing or refusal of either CHG bathing or nasal antiseptic applications) prior to safety huddle and reinforced during leader unit rounding. MRSA bacteremia rates were identified utilizing the National Healthcare Safety Network (NHSN) MRSA Blood LabID criteria.

Results: The 12-month pre-intervention CHG bath compliance was 53% and nasal antiseptic compliance was at 84% with a MRSA bacteremia incidence rate of 1.27 infections per 1,000 patient days. The 12-month post intervention CHG bath compliance was 81% and Nasal antiseptic compliance was at 94% with a MRSA incidence rate of 0.63 infections per 1,000 patient days (p=0.11), trending toward statistical significance. Our hospital-onset MRSA bacteremia decreased from 15 to 8 cases, reflecting almost a 50% reduction.

Conclusions: A gap analysis between protocol and practice identified a variation in performance. A multidisciplinary approach utilizing infection prevention, data analytics, nursing, and leadership was effective in improving compliance with decolonization. This study, though not statistically significant, supports decolonization protocols as an effective intervention in reducing MRSA bacteremia rates.