Institute for Healthcare Improvement: Learning and Innovation Community: Reducing Hospital-Acquired Infections (MRSA, VRE, C. diff)

Overview

Available through the IMPACT network or on a direct-enroll basis, IHI’s most intensive front-line improvement work happens in Learning and Innovation Communities. These are collaborative change laboratories in which teams from a wide variety of organizations work with each other and IHI faculty to rapidly test and implement meaningful, sustainable change within a specific topic area. NOTE: This Community is for current members only; we are no longer accepting new participants in it.

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Download a brief description of this Community.

Reducing Hospital-Acquired Infections (MRSA, VRE, C. diff) is available either through membership in the IMPACT network or through direct enrollment in the Community. Learn more about IMPACT.

The Challenge

The Solution

Health care-associated infections remain a major cause of morbidity, mortality and cost despite concerted efforts of the Centers for Disease Control and Prevention (CDC) and infection control professionals for nearly a half-century. Recently, treatment of these infections has become more complex due to an alarming rise in antibiotic resistance. Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) are particularly problematic — both are associated with increased mortality, and their incidence has risen inexorably over the past decade. According to the CDC, MRSA now accounts for greater than 50% of hospital-acquired Staphylococcus aureus infections, and there have been similar increases in VRE. [1]

Not only is it becoming increasingly difficult to find effective antibiotics to treat these resistant health care-associated infections, but antibiotic therapy itself predisposes patients to another potentially life-threatening infection, C. difficile (“C. diff”) colitis. The incidence of C. diff has been increasing for years, but the recent emergence and spread of strains that produce much higher levels of a potent toxin have made control even more urgent. Overall, MRSA, VRE and C. difficile infections combined infect at least 350,000 persons, cause the death of at least 12,000, and result in at least $5 billion in excess health care costs.

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[1] Siegel JD, Rhinehart E, Jackson M, Chiarello L. Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006. The Healthcare Infection Control Practices Advisory Committee. Online information also available through the Centers for Disease Control and Prevention website.

A recently published guideline from the Hospital Infection Control Practices Advisory Committee (HICPAC) provides an excellent review of the strategies that may be useful in reducing transmission of organisms resistant to multiple drugs. [1] Subsequently, IHI has worked with clinical experts to develop a package of interventions. These evidence-based interventions include aggressive detection of carriers, rigorous isolation of colonized patients, appropriate hand hygiene, and thorough disinfection of the environment and personal equipment. Although aspects of this package may seem self-evident, the key to preventing transmission of organisms is highly reliable practice of all components — rates of compliance that greatly exceed current practice in most health care settings. In addition, infection in colonized patients can be dramatically reduced by reliable application of the central venous catheter and ventilator bundles.

There are many barriers to consistent implementation of best practices. However, infections can be significantly reduced by the implementation of known measures; through standardizing and simplifying core processes; redesigning delivery systems using proven human factors principles; partnering with patients; creating safety cultures that minimize blame and maximize communication and teamwork; and using technologies appropriately.

Areas of Focus

This Learning and Innovation Community will focus primarily on the reduction of MRSA infections. VRE and C. diff will also be targeted since some of the basic interventions that are required to control MRSA, with appropriate additional measures, also are effective in reducing transmission of these pathogens.

Teams in this Community will build upon the work reported by successful organizations and by working collaboratively to redesign processes in their own organizations. Initial focus will be in a pilot area, such as an intensive care unit, where teams will work to achieve dramatically higher reliability in all evidence-based components of the intervention package:

Active detection of MRSA carriers
Contact precautions and use of dedicated equipment
Hand hygiene
Decontamination of the environment and equipment
Central venous catheter and ventilator bundles

This work will be enhanced by a focus on changing culture, using proven techniques from previous IHI projects on patient safety. Other areas of focus may be identified by teams and faculty during the course of the Community.

Aims

The aim of this Community will be to significantly reduce health care-associated infections due to MRSA, VRE, and C. difficile.

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The Institute for Healthcare Improvement works in partnership with the Centers for Disease Control and Prevention (CDC), the Association for Professionals in Infection Control and Epidemiology (APIC), and the Society of Healthcare Epidemiology of America (SHEA) on its hospital-acquired infections initiatives.