Methicillin-resistant Staphylococcus aureus (MRSA) Guide to Patient Safety (GPS)
About the GPS
The methicillin-resistant Staphylococcus aureus (MRSA) Guide to Patient Safety (GPS) is a brief troubleshooting tool to aid infection prevention teams in reducing MRSA in their hospital or unit. Modeled after the validated catheter-associated urinary tract infection (CAUTI) GPS developed by researchers at Veterans Affairs Ann ArborHealthcare System and University of Michigan, the MRSA GPS* is designed to help teams re-examine their MRSA data and prevention activities, and direct them toward specific strategies and resources to overcome barriers and challenges.
The MRSA GPS is a brief self-administered assessment of yes/no questions. Multidisciplinary MRSA prevention teams should either, thoughtfully as a group, or independently followed by group review, answer the 13 questions that comprise the assessment. When done this way, the guide can stimulate discussion and uncover barriers that may be impeding MRSA reduction progress. For more information on Tier 1 and 2 MRSA prevention strategies, review the MRSA Prevention resources on the CDC/STRIVE Infection Control Training website.
Instructions for Use
To accurately assess the team’s MRSA prevention efforts, it is recommended that:
The MRSA GPS is a brief self-administered assessment of yes/no questions. Multidisciplinary MRSA prevention teams should either, thoughtfully as a group, or independently followed by group review, answer the 13 questions that comprise the assessment. When done this way, the guide can stimulate discussion and uncover barriers that may be impeding MRSA reduction progress. For more information on Tier 1 and 2 MRSA prevention strategies, review the MRSA Prevention resources on the CDC/STRIVE Infection Control Training website.
Instructions for Use
To accurately assess the team’s MRSA prevention efforts, it is recommended that:
- The team working on MRSA prevention at the hospital or unit-level completes the MRSA GPS assessment. This can be done independently or as a group.
- The responses are reviewed as a team as a means to uncover strengths and barriers to reducing MRSA.
- For questions that were answered with a “No,” the team should click on the link below the question or reference the indicated section to review approaches, advice, and tools and resources to better implement the indicated MRSA prevention strategy.
- If you answered “Yes” to all the questions and your MRSA rates are not where you want them to be, consider viewing the Enhanced Interventions to Prevent MRSA module (MRSA 202) on the CDC/STRIVE Infection Control Training website.
This tool was developed as part of the STRIVE collaboration. Funding was provided by the Centers for Disease Control and Prevention, STRIVE Program (contract number 200-2015-88275), and project support was provided by the Health Research & Educational Trust, Department of Veterans Affairs, and the University of Michigan.
A full, PDF copy of all the information available in this Guide is available (also linked at the bottom of this page, below the questions section).
* Note. While this guide focuses on MRSA prevention, these strategies can be applied to the prevention of other multidrug-resistant organisms (MDROs)
* Note. While this guide focuses on MRSA prevention, these strategies can be applied to the prevention of other multidrug-resistant organisms (MDROs)
Question 1: Do you currently have a well functioning team (or work group) focusing on MRSA prevention?
Yes
You have a well-functioning team focusing on MRSA prevention. This is very helpful since this team is vital in developing a MRSA prevention program and assisting with program implementation. Be sure to use your team to its full capacity.
No
You indicated that either you don’t have a team or work group or the one you have does not function well. A key aspect of implementing a MRSA prevention initiative is to identify an implementation team at your site. This team plays a critical role in developing the initiative and assisting with implementation. Key responsibilities of this team are education, data collection and evaluation.
Question 2: Do you have a team leader with dedicated time to coordinate your MRSA prevention activities?
Yes
You have a project manager who has dedicated time to work on the MRSA prevention efforts. This is important to keep the project moving forward in a timely manner and to recognize and address barriers and challenges as they come up. As s/he becomes involved with other projects make sure that time on this project remains protected.
No
You indicated that either you do not have a team leader or that the one you have does not have appropriate time for the initiative. The team leader is responsible for coordinating MRSA prevention efforts and integrating MRSA prevention practices into daily workflow and collaborating with the various initiative champions. In other words, the details of the MRSA prevention initiative fall to the team leader. It is their responsibility to keep the infection prevention efforts moving forward and coordinate the moving pieces, including people, data and implementation. It is unlikely that the MRSA prevention initiative is the only responsibility of the team leader, and because of this, there may not be enough time to devote to the prevention efforts. Creating that dedicated time is imperative to a successful initiative.
Question 3: Do you have an effective nurse champion for your MRSA prevention activities?
Yes
You have an effective nurse champion. This is key to the success of the initiative because it depends heavily on the nursing staff, especially those on the frontline. It is important that s/he remains engaged with the project as other projects come along, and if expanding the MRSA prevention initiative to other units it is important to reassess if the current nurse champion is the best fit for these other units!
No
You indicated that either you do not have a nurse champion or that the one you have is not effective. Because daily patient care is crucial to the prevention of MRSA transmission, getting buy-in from nursing staff is key to MRSA reduction. The nurse champion is responsible for engaging nursing staff in MRSA prevention efforts and working to integrate practices into daily nursing workflow. A nurse champion plays a large role in not only bringing the initiative to the nursing staff, but also in modeling excitement for infection prevention efforts and problem-solving as challenges arise. The nurse champion often becomes the face of the initiative, especially to the people most instrumental in the initiative’s success, the bedside nurses.
Question 4: Do you have an effective physician champion for your MRSA prevention activities?
Yes
You indicated that you have an effective physician champion on your team. Despite the initiative relying heavily on nursing efforts, physician awareness, engagement, and support is key for the success of the project. Your physician champion should continue to communicate with staff so that if an issue does arise s/he is aware of it as soon as possible.
No
You indicated that either you do not have a physician champion or the one you have is not effective. The physician champion is responsible for engaging physicians in MRSA prevention efforts and coordinating MRSA prevention efforts that require physician support. A successful MRSA prevention initiative requires collaboration and cooperation with physicians and physician leadership. A physician champion is needed to bring the initiative to the other physicians, to help engage them, to be a part of problem-solving when there is resistance or another challenge from this group of providers and gain physician cooperation.
Question 5: Is senior leadership supportive of MRSA prevention activities?
Yes
You indicated that you have the support of senior leadership for your MRSA prevention activities. Having a member of the hospital executive leadership team oversee the initiative lets the hospital staff know the importance of the initiative. It is important to occasionally reassess that this support remains, as new initiatives and priorities are constantly being introduced.
No
You indicated that you do not have the support of senior leadership. Given the many competing priorities of hospitals, having the support of leadership is key to making immediate and lasting progress with your MRSA prevention initiative. Having a member of the hospital executive leadership team oversee the initiative signals the importance of the initiative to the hospital staff.
Question 6: Do you currently assess or identify the source of MRSA bloodstream infections (vascular catheter, surgical site, skin/soft tissue, etc.) to help focus MRSA prevention strategies?
Yes
You currently assess or identify the source of MRSA bloodstream infections. Assessing the source of infection is important, as it can help to target and prioritize MRSA prevention strategies.
No
You indicated that you do not currently assess the source of MRSA bloodstream infections. MRSA bacteremia can originate from a variety of source infections (e.g., surgical site, skin/soft tissue, vascular catheters). Assessing the source of infection is important, as it can help to target and prioritize MRSA prevention strategies. Since MRSA bacteremia can arise from a variety of underlying infections, MRSA bloodstream infections may be a marker for problems with other HAIs or how patients receive care. Identifying and isolating these sources are critical to preventing future MRSA infections.
Question 7: Do you currently collect MRSA-related data (e.g., incidence, prevalence, compliance with prevention practices) in the unit(s) or populations in which you are intervening to reduce infections?
Yes
You currently collect MRSA-related data. It is important to collect these measures as the project continues and once you have entered in to the sustainability phase. Discuss with the MRSA prevention team if there are other measures that would be helpful to collect.
No
You indicated that you do not currently collect MRSA related data. Collecting, measuring, analyzing and reporting information on your MRSA prevention activities is critical to ensure continued success. Outcome data, such as total MRSA bacteremia infection rate (defined below), enable you to monitor the success of your MRSA prevention initiative and allow teams to compare how they are doing in their prevention efforts to other units and hospitals. Additionally, as health care moves from fee-for-service models of care to value-based compensation, healthcare-associated infection (HAI) rates, including MRSA bacteremia rates, are important metrics for determining care reimbursement. Process measures, such as hand hygiene compliance rates, ensure that process interventions are being effectively implemented and point to areas that require continued enhancement or intervention. Lastly, sharing and highlighting data are crucial strategies to engage physicians, frontline staff and senior leaders in infection prevention efforts.
Question 8: Do you routinely feed back MRSA-related data to frontline staff and physicians? (e.g., incidence, prevalence, compliance with prevention practices)
Yes
You currently feed MRSA-related data back to frontline staff. No matter what stage of the initiative you are in, it is important to continue to provide this information. It is helpful to occasionally change how you communicate this data to the staff so that they continue to be engaged and motivated by it.
No
You indicated that you do not routinely feed back MRSA-related data to frontline staff, which includes physicians. While collecting MRSA-related data is key to measuring success, it is imperative that the staff, especially those on the frontline, are aware of it. Data transparency can help motivate and engage staff at all stages of the initiative, as well as encourage them to continue the changes, promoting sustainability. Simply put, feedback improves motivation and learning. Feed back hospital intervention data, as well as data from comparable hospitals and national aggregates. Simple run charts or a MRSA scorecard are great ways to quickly display and easily communicate data to both frontline staff and senior leaders.
Question 9: Do you have a system in place for communicating confirmed MRSA-positive cultures to frontline care staff?
Yes
You currently have a system for communicating confirmed MRSA-positive cultures to frontline care staff. Early identification and notification allows for the placement of these patients into Contact Precautions and modifications to daily patient care activities.
No
You indicated that your hospital does not have a system in place, or the existing system does not function well, for communicating confirmed cases of MRSA to frontline care staff. An important component of preventing MRSA is early identification of patients with MRSA and notification of those involved in the care of that patient. Early identification and notification allows for the placement of these patients into Contact Precautions and modifications to daily patient care activities. Thus, it is imperative that frontline staff are aware of a patient’s MRSA status. Nursing champions can play a pivotal role in helping ensure a communication system is in place and properly followed.
Question 10: Do you currently place patients colonized or infected with MRSA into Contact Precautions?
Yes
You currently place patients colonized or infected with MRSA into Contact Precautions. Current guidelines from the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America recommend that both patients with active MRSA infections and those colonized with MRSA should be placed into Contact Precautions.
No
You indicated that your hospital does not use Contact Precautions, or does not effectively use Contact Precautions for patients colonized or infected with MRSA. A key aspect of preventing MRSA bacteremia is preventing MRSA transmission. MRSA from colonized and infected patients can be spread by both direct and indirect contact. Current guidelines from the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America recommend that both patients with active MRSA infections and those colonized with MRSA should be placed into Contact Precautions.
Question 11: Is staff empowered to speak up if hand hygiene is not performed effectively?
Yes
You currently empower your staff to speak up if hand hygiene is not performed effectively. Staff should be encouraged and empowered to remind colleagues about strict glove use, wearing proper PPE and performing hand hygiene.
No
You indicated that staff are not empowered to speak up to remind colleagues to perform proper hand hygiene. A key aspect of preventing MRSA infection is preventing MRSA transmission. Staff should be encouraged and empowered to remind colleagues about strict glove use, wearing proper PPE and performing hand hygiene. Consider using a facility-wide common reminder phrase to get everyone on the same page and keep reminders from feeling punitive; it’s about patient safety not punishment.
Question 12: Do frontline staff receive training about how to prevent transmission of MRSA and other multidrug-resistant organisms (MDROs)?
Yes
You currently provide training about how to prevent transmission of MDROs like MRSA to frontline staff. Buy-in and competency of nursing and frontline staff are crucial for success.
No
You indicated that you do not have training for frontline staff about how to prevent multidrug-resistant organism (MDRO) transmission or that training is ineffective. Daily patient care is crucial to the prevention of MRSA and other MDRO transmission. Thus, buy-in and competency of nursing and frontline staff are crucial for success. Frontline staff training to prevent MDRO transmission should focus on: proper hand hygiene, personal protective equipment use, Contact Precautions, cleaning and disinfection of the environment and equipment and communicating a patient’s infection status to frontline staff or during inter- and intra-hospital transfers.
Question 13: Do you have standardized processes for daily and discharge environmental cleaning/disinfection of patient rooms that includes monitoring of cleaning/disinfection quality?
Yes
You currently have standardized, cleaning/disinfection quality monitored processes for patient rooms. A key aspect of preventing MRSA and other MDRO infections lies in preventing transmission. Hospitals and units need to ensure environmental cleaning and disinfection is effectively decontaminating patient rooms and equipment.
No
You indicated that you do not have a standardized process for daily and terminal environmental cleaning of patient rooms, or that the process you do have does not work well. Transmission of MRSA is similar to that of other pathogens spread by contact; microorganisms can contaminate the patient or their environment and then be passed on to other patients via health care personnel or shared equipment, or to the next occupant of the patient room. A key aspect of preventing MRSA and other MDRO infections lies in preventing transmission. Hospitals and units need to ensure environmental cleaning and disinfection is effectively decontaminating patient rooms and equipment.