Selecting a Strategy to Stop HAI

This article appears in the August 2011 issue of HealthLeaders magazine.

This is a tale of three urban hospitals, each grappling with nosocomial infection prevention in three very different ways. It's hard to tell which one works best, but all are taking on an issue that is at the center of a national and very charged debate.

The first hospital swabs patients for colonization of methicillin-resistant staphylococcus aureus, the leading culprit of hospital-acquired infections. And it does so not just as patients are admitted to the intensive care unit, which is legislatively mandated in that state, but this hospital also screens patients as they leave the ICU. With this and other infection-reduction measures, rates of MRSA and other HAIs have dropped.

The second hospital aggressively performs MRSA swabs on all patients admitted to all hospital beds, an expensive undertaking that involves putting some patients in isolation, and coping with the issue of false positive results. Rates of infections have dramatically declined.

The third hospital has taken an entirely different approach, avoiding testing altogether, except for some patients undergoing high-risk neuro, cardiac, and joint-replacement procedures. This hospital pays graduate students to prowl the halls to observe hand-washing practices in an effort to prevent not just MRSA, but every other destructive bug a hospital might see. ICU patients receive chlorhexidine baths, and staff members work hard with central line?associated catheter bundles to make sure the devices are used safely.

The hospital saves about $1 million in lab supplies each year. At this hospital, too, rates of infection have decisively improved.

"We're not looking for any specific organism," says Michael Edmond, MD, hospital epidemiologist at hospital No. 3, Virginia Commonwealth University Medical Center, an 800-bed hospital in Richmond. "All the interventions we have implemented are effective against all organisms that are transmitted in the same way: through contact?MRSA, KPC, vancomycin-resistant enterococcus, C. difficile. You name it.

"The patient's goal when they come to the hospital is not 'I don't want to get a MRSA infection,'" Edmond says. "It's, 'I don't want to get an infection?period.'"