During the next several months, BWH will begin two initiatives aimed to make it easier for staff to prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) to patients.
I. Discontinuation of MRSA/ VRE Precautions Initiative
The new initiative has been created to remove patients who are no longer colonized or infected with MRSA or VRE from Contact Precautions. A pilot study at BWH showed that about 40 percent of a group of inpatients on precautions for three or more months were no longer positive for MRSA/VRE.
Advantages include making it easier for staff to adhere to infection control precautions by limiting the patients on precautions to those most likely to serve a reservoir for transmission, improving the quality of care by making it easier for staff to enter patient rooms, improving patient satisfaction by avoiding long stays in the Emergency Department due to delays in availability of private rooms, reducing hospital costs by avoiding delays in transfers to extended care facilities, and improving the utilization of beds by requiring fewer private rooms for patients on precautions.
For all BWH inpatients and ambulatory patients who have been on MRSA and/or VRE precautions for at least three months and are not receiving antibiotics active against the organism (e.g., vancomycin for MRSA, linezolid or synercid for VRE), the following protocol should be followed:
- order three sets of screening cultures obtained on separate days;
- if feasible, order three sets of cultures from the original infection site (e.g., open wound); and
if all cultures are negative, e-mail the Infection Control Department (ICprecautions@partners.org). Infection Control staff will review the information and remove the patient from the precaution list if appropriate.A new MRSA/VRE pop-up screen will appear on BICS that will include a reminder, and “rule out MRSA” and “rule out VRE” order sets will be available in the Order Entry system to make it easier to order the appropriate screening cultures.
II. Clean Hands=Patient Safety Initiative
This initiative will make it easier for health care workers to disinfect their hands before and after each patient contact by providing an alcohol-based, waterless hand gel.
Hand gel is better and faster at killing bacteria, is not as abrasive as soap and water to the skin, is more convenient (no sink needed) and saves time.
Distribution of the wall-mounted pumps of waterless hand gel to various hospital areas will be completed in stages.