Brief report
Nationwide reduction of health care–associated methicillin-resistant Staphylococcus aureus infections in Veterans Affairs long-term care facilities

A portion of the information provided herein was presented at IDWeek 2012, San Diego, California, October 2012.
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The Veterans Affairs methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative was implemented in its 133 long-term care facilities in January 2009. Between July 2009 and December 2012, there were ∼12.9 million resident-days in these facilities nationwide. During this period, the mean quarterly MRSA admission prevalence increased from 23.3% to 28.7% (P < .0001, Poisson regression for trend), but the overall rate of MRSA health care–associated infections decreased by 36%, from 0.25 to 0.16/1,000 resident-days (P < .0001, Poisson regression for trend).

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Methods

Resources for the MRSA Prevention Initiative, training of MRSA Prevention Coordinators (MPCs) at each facility, and Institutional Review Board approval have been described previously.7 A CLC-specific MPC was added to CLCs with more than 200 beds with expansion of the initiative into CLCs.

MRSA admission prevalence was calculated as the number of CLC admissions with MRSA, either from nasal surveillance or a clinical culture within 48 hours of admission, as a percentage of the total number of

Results

During the 42-month analysis period of July 2009 through December 2012, there were a total of ∼12.9 million resident-days in VA CLCs nationwide. The mean quarterly MRSA admission prevalence increased from 23.3% to 28.7% (P < .0001, Poisson regression for trend) (Fig 1). The ratio of residents with MRSA colonization or infection who were identified by active surveillance to those identified by clinical cultures alone was 37:1. The overall MRSA HAI rate decreased by 36%, from 0.25 to 0.16/1,000

Discussion

We previously reported that a MRSA Prevention Initiative was associated with significant decreases in MRSA HAIs in acute care facilities over a 33-month period in a large health care system.7 Here we show that the initiative was also associated with decreased rates of MRSA HAIs in VA CLCs without a corresponding decrease in MRSA admission prevalence. To our knowledge, declines in MRSA HAIs such as this have not been reported in other large long-term care settings.

A recent survey of 10

Acknowledgments

The authors thank Robert A. Petzel, MD, Under Secretary for Health; Madhulika Agarwal, MD, MPH, Deputy Under Secretary for Health for Policy and Services; Christa M. Hojlo, PhD, RN, NHA, Director, VA Community Living Centers; and Lisa Minor, RN, Chief, Facility-Based Programs, Geriatrics and Extended Care Operations, for support of the VA MRSA Prevention Initiative. The authors acknowledge the efforts of Dr Suzanne Bradley, Patricia Burke, Cheryl Creen, Linda Danko, Christy Galbreath, Elizabeth

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