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Infection prevention and control issues continue to weigh heavily on hospitals.

National Patient Safety Goals focus on healthcare-acquired infections in 2009, providing consistent challenges in identification and prevention for hospitals preparing for Joint Commission surveys. Some states have targeted specific infections for education and prevention.

In Kentucky, a collaborative has targeted methicillin-resistant Staphylococcus aureus (MRSA) as a focus point for improvement.  

Initially, the plan was to focus on rural hospitals, using funding through a rural grant, explains Elizabeth Cobb, MPH, vice president of health policy with the Kentucky Hospital Association. As discussions continued, however, the University of Louisville School of Public Health and Information Sciences was brought into the loop, and funding from emergency preparedness grants came into play.

"The timing was right in that we were able to leverage work done as part of emergency preparedness training grants and submit for some additional funding that was targeted toward emerging infections and healthcare worker training," says Ruth Carrico, PhD, RN, CIC, assistant professor and health promotion and behavioral sciences director with the school.

The organizations decided to pool their resources and target MRSA across the state.

"We decided from the beginning that this needed to be bigger than just hospitals or healthcare," says Cobb. "It's a community problem, not just a hospital or healthcare problem."

"I once worked with a state epidemiologist who would say, 'There's no such thing as a leak on your side of the canoe,'" says Carrico. "We're all impacted by the actions of others."

This concept drove the collaborative to not only target MRSA in hospitals, but build in a range of components to the program, particularly providing resources to nursing homes, home health, first responders, correctional institutions, schools, and athletics groups.

"We are really reaching out to all types of organizations where these infections are of concern," says Cobb.

Among the key targets: Hot topic (and NPSG) hand hygiene.

"We're encouraging everyone to educate visitors to your facilities about hand hygiene, and how that is so key to stopping the spread of MRSA and infections in general," says Cobb. "While we've built a MRSA toolkit, [MRSA prevention] really goes across borders."

Legislation requiring the reporting of infection rates was introduced at the state level in Kentucky in 2008. This legislation arrived early on in the development of the toolkit, prompting the collaborative to take a different approach demonstrating whether the program was making progress.

"How can we approach this at a statewide level and not be led by the drumbeat of mandatory reporting?" says Carrico. "We really wanted to lead instead of be led. We wanted to be very transparent, look at our issues, bring in concepts like standardization and social networking where improvements begin at the ground level."

The data collected will be applied directly as a method tracking process improvement.

"We wanted to do some data collection so we could share successes of the collaborative's efforts, but also if we find some components are not working, this will allow us to go back and modify the toolkit to get better results," says Cobb. "It will also help identify hospitals that are really excelling so that we can share those processes."

This will also provide an opportunity to improve through example.

"We will be able to identify facilities [that] are high performers, and also enable those who are not doing as well to make appropriate changes and figure out what is different about those facilities," says Carrico. "You can't do that if you're mired in mandatory regulations."