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Guidelines on preventing MRSA and CLABSI in hospitals, how to curb readmissions, and more.

Health care groups update guidelines for preventing MRSA, CLABSI in hospitals

Several organizations recently released joint guidelines for preventing the incidence and spread of methicillin-resistant Staphylococcus aureus (MRSA) and central-line associated bloodstream infections (CLABSI) in hospitals.

Key highlights from the MRSA guidelines include:

  • Conduct a risk assessment that estimates the facility's MRSA rates of transmission and infection, and the number of MRSA carriers.
  • Implement a monitoring program that tracks MRSA rates by identifying any patient with a current or prior history of MRSA and noting hospital-onset cases of infection.
  • Track and enforce hand hygiene, as well as contact precautions for MRSA-colonized and infected patients.
  • Properly clean and disinfect hospital equipment and the environment.
  • Educate health care personnel, patients and families about MRSA, including information on risks, precautions, prevention and transmission.
  • Implement an alert system to notify when patients are identified with MRSA at the lab, or are readmitted.

Highlights from the CLABSI guidelines include:

  • Engage frontline hospital staff and senior leadership in creating an outcome improvement plan. Emphasize teamwork, technical process, and accountability.
  • Educate all personnel involved in the insertion and care of central lines, employing multiple teaching strategies to engage diverse learners.
  • Standardize the care process, and consider using quality improvement methods.
  • Bathe ICU patients over 2 months of age daily with a chlorhexidine preparation prior to central venous catheter (CVC) insertion.
  • Have a process in place to ensure adherence to infection prevention practices at the time of CVC insertion.
  • Evaluate strategies and give feedback to staff, articulating improvement goals clearly and often.

Both guidelines, updated from 2008, were published in the July Infection Control and Hospital Epidemiology and were a joint effort of the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission.

Complex interventions work best to prevent readmissions

The most effective interventions to reduce readmissions are also the most complex, a recent meta-analysis found.

Researchers examined several databases from 1990 until April 1, 2013, to determine the effect of various interventions on 30-day readmissions of adults who were hospitalized for more than 24 hours. They used a coding scheme to characterize the interventions in each trial. While blind to outcomes, the researchers noted the degree to which interventions placed extra work on patients after discharge or supported their capacity for self-care. Results were published in the July JAMA Internal Medicine.

Forty-two trials were selected, and together their interventions significantly reduced readmissions (pooled random-effects relative risk [RR], 0.82; P<0.001), including across patient subgroups. In subgroup analysis, interventions with many components were 1.4 times more effective than those with fewer (P<0.001). Interventions with more individuals involved in care delivery were 1.3 times more effective (P=0.05), as were those that supported patient capacity for self-care (P=0.04). The interventions in trials published before 2002 were 1.6 times more effective than interventions published later (P=0.01).

The most effective interventions used “a complex and supportive strategy to assess and address contextual issues and limitations in patient capacity,” the authors noted. “In particular, we found value in interventions that supported patients' capacity for self-care in their transition from hospital to home.” Many of the most successful interventions involved home visits and/or contacting the patient frequently; many also reported cost savings, they noted. The fact that more recent interventions were less effective may reflect a general improvement over time in the standard of care and/or an effort over time to test simpler and less comprehensive interventions, including those involving more technology and less human interaction, the authors added.

A separate study released in May found that unplanned readmission rates between July 2009 and June 2012 declined for pneumonia (median rates: 17.7% in 2009-2010, 17.6% in 2010-2011, 17.3% in 2011-2012), heart failure (median rates: 23.3% in 2009-2010, 23.1% in 2010-2011, 22.5% in 2011-2012), and acute myocardial infarction (median rates: 18.5% in 2009-2010, 18.5% in 2010-2011, 17.7% in 2011-2012). The study, published online May 14 in the Journal of General Internal Medicine, also found that acute myocardial infarction mortality rates declined during this time period (15.5% in 2009-2010, 15.4% in 2010-2011, 14.7% in 2011-2012), while pneumonia and heart failure mortality rates stayed more or less the same.