Tier One Recommendations

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• Tier One Recommendations
• Gloves and gowns required for all HCWs entering
  patient room/area regardless of anticipated
  patient contact
• 2. For eligible patients, discontinuation of
  Contact Precautions requires a minimum of 3
  consecutive negative nares cultures and 3
  consecutive negative cultures from previously
  positive sites.

• Park Nicollet Methodist
• Before
• ? Gowns required only if coming in contact with
  patient or patients environment
• ? Required 2 consecutive negative cultures from
  nares, open wounds/tubes and previously positive
  sites.

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• Tier One Recommendations
• 3. Patients with identified risk factors are
  ineligible to be considered for discontinuation
  of Contact Precautions

• Park Nicollet Methodist
• Before
• ? Did not collect surveillance cultures if
  patient on antibiotics active against MRSA or
  acutely ill

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• Hospital errors
• ?
• Right thing to do
• ?
• Zero tolerance
• ?
• To eliminate HAI MRSA, need
• Early identification of
• MRSA carriers
• Admin support with HH
• compliance efforts

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Goal 90
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? Currently have dedicated housekeepers on each
inpatient unit, considered member of care team.
Developing checklist to ensure all tasks done
in each room.
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? Mini-RCA on every MRSA HAI, reporting findings
and recommendations to department manager(s) to
share with staff.
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ASC Program Conclusions

• Adds an average of 184 isolation days/ month
• On average, 50 new cases of MRSA colonization per
  month.
• 2.8 increase over MRSA cases previously
  identified by clinical cultures or reported
  history
• Reduction in HAI MRSA is not yet statistically
  significant. But clinical significance is
  evident.