"Improving Practice: Automated Compliance Monitoring in Infection Control"

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Title: Improving Practice: Automated Compliance Monitoring in Infection Control Anticipated Impacts on Veteran's Healthcare: Methicillin-resistant Staphylococcus aureus (MRSA) is an antibiotic-resistant bacterium that is associated with 94,000 invasive infections and 18,000 deaths annually in the United States. Since March 15, 2007 a National VA MRSA Initiative (VHA Directive 2007-002) has required all VA hospitals to screen for and isolate patients colonized with MRSA by placing them on contact precautions. The Initiative's aim is to reduce MRSA infections and related mortality by preventing MRSA from spreading from patient-to-patient in VA hospitals. This project seeks to improve the effectiveness of the MRSA Initiative by improving healthcare worker compliance with infection control best practice (hand washing and wearing gloves/gowns) and thus reduce the spread of MRSA in VA Hospitals. Project Background: The VA MRSA Initiative's potential to reduce MRSA infections will only be realized if healthcare workers are compliant with hand hygiene and contact precautions (wearing gown and glove by healthcare workers each time they enter a patient's room). Thus, if healthcare workers do not wash their hands and wear gloves/gowns when they see patients, the very expensive MRSA Initiative may be ineffective. Two factors are known to improve compliance with infection control practice: 1) Continuous monitoring of compliance and 2) Direct feedback of compliance rates to healthcare workers with a goal to get compliance up to 100%. However, direct observation of hand hygiene and glove wearing is labor intensive, expensive and rarely occurs during night shifts. Project Objectives: The objectives of this study are: (1) Develop and validate an automated method for compliance monitoring of infection control practice including hand hygiene and contact precautions. The automated method uses monthly supply-chain delivery of bottles of alcohol-based hand rub and gloves. (2) Provide sustained feedback of automated monthly supply delivery counts of alcohol-based hand rub and gloves to specific hospital wards and demonstrate improved compliance with actual directly observed compliance and reduced MRSA infections. Project Methods: This proposal contains two distinct studies. The first study that will develop and validate supply chain delivery of alcohol-based hand rub and glove use as a viable estimate of the related actual infection control compliance measure will utilize an observational cohort study, while controlling for potential confounders. The second study will test the efficacy of sustained feedback of automated monthly supply delivery counts of alcohol-based hand rub and gloves in improving compliance and reducing MRSA infections in 6 hospital intensive care units in 3 VA acute care hospitals using an interrupted time-series analysis quasi-experimental design with non-equivalent control groups.