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Methicillin-Resistant Staphylococcus aureus: HELP
Articles by Julia A. Moody
Based on 11 articles published since 2008
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Between 2008 and 2019, Julia Moody wrote the following 11 articles about Methicillin-Resistant Staphylococcus aureus.
 
+ Citations + Abstracts
1 Guideline Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. 2014

Calfee, David P / Salgado, Cassandra D / Milstone, Aaron M / Harris, Anthony D / Kuhar, David T / Moody, Julia / Aureden, Kathy / Huang, Susan S / Maragakis, Lisa L / Yokoe, Deborah S / Anonymous5450796. ·Weill Cornell Medical College, New York, New York. ·Infect Control Hosp Epidemiol · Pubmed #24915205.

ABSTRACT: -- No abstract --

2 Clinical Trial Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial. 2019

Huang, Susan S / Septimus, Edward / Kleinman, Ken / Moody, Julia / Hickok, Jason / Heim, Lauren / Gombosev, Adrijana / Avery, Taliser R / Haffenreffer, Katherine / Shimelman, Lauren / Hayden, Mary K / Weinstein, Robert A / Spencer-Smith, Caren / Kaganov, Rebecca E / Murphy, Michael V / Forehand, Tyler / Lankiewicz, Julie / Coady, Micaela H / Portillo, Lena / Sarup-Patel, Jalpa / Jernigan, John A / Perlin, Jonathan B / Platt, Richard / Anonymous12331162. ·Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA. Electronic address: sshuang@uci.edu. · Clinical Services Group, HCA Healthcare, Houston, TX, USA; Division of Infectious Diseases, Texas A&M College of Medicine, Houston, TX, USA; Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA. · Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA. · Nashville, TN, USA. · Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA. · Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA. · Division of Infectious Diseases, Rush Medical College, Chicago, IL, USA. · Division of Infectious Diseases, Rush Medical College, Chicago, IL, USA; Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, USA. · Office of HAI Prevention Research and Evaluation, Centers for Disease Control and Prevention, Atlanta, GA, USA. ·Lancet · Pubmed #30850112.

ABSTRACT: BACKGROUND: Universal skin and nasal decolonisation reduces multidrug-resistant pathogens and bloodstream infections in intensive care units. The effect of universal decolonisation on pathogens and infections in non-critical-care units is unknown. The aim of the ABATE Infection trial was to evaluate the use of chlorhexidine bathing in non-critical-care units, with an intervention similar to one that was found to reduce multidrug-resistant organisms and bacteraemia in intensive care units. METHODS: The ABATE Infection (active bathing to eliminate infection) trial was a cluster-randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in non-critical-care units. The trial was done in hospitals affiliated with HCA Healthcare and consisted of a 12-month baseline period from March 1, 2013, to Feb 28, 2014, a 2-month phase-in period from April 1, 2014, to May 31, 2014, and a 21-month intervention period from June 1, 2014, to Feb 29, 2016. Hospitals were randomised and their participating non-critical-care units assigned to either routine care or daily chlorhexidine bathing for all patients plus mupirocin for known methicillin-resistant Staphylococcus aureus (MRSA) carriers. The primary outcome was MRSA or vancomycin-resistant enterococcus clinical cultures attributed to participating units, measured in the unadjusted, intention-to-treat population as the HR for the intervention period versus the baseline period in the decolonisation group versus the HR in the routine care group. Proportional hazards models assessed differences in outcome reductions across groups, accounting for clustering within hospitals. This trial is registered with ClinicalTrials.gov, number NCT02063867. FINDINGS: There were 189 081 patients in the baseline period and 339 902 patients (156 889 patients in the routine care group and 183 013 patients in the decolonisation group) in the intervention period across 194 non-critical-care units in 53 hospitals. For the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures (figure 2), the HR for the intervention period versus the baseline period was 0·79 (0·73-0·87) in the decolonisation group versus 0·87 (95% CI 0·79-0·95) in the routine care group. No difference was seen in the relative HRs (p=0·17). There were 25 (<1%) adverse events, all involving chlorhexidine, among 183 013 patients in units assigned to chlorhexidine, and none were reported for mupirocin. INTERPRETATION: Decolonisation with universal chlorhexidine bathing and targeted mupirocin for MRSA carriers did not significantly reduce multidrug-resistant organisms in non-critical-care patients. FUNDING: National Institutes of Health.

3 Clinical Trial Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates in the REDUCE-MRSA Trial. 2016

Hayden, Mary K / Lolans, Karen / Haffenreffer, Katherine / Avery, Taliser R / Kleinman, Ken / Li, Haiying / Kaganov, Rebecca E / Lankiewicz, Julie / Moody, Julia / Septimus, Edward / Weinstein, Robert A / Hickok, Jason / Jernigan, John / Perlin, Jonathan B / Platt, Richard / Huang, Susan S. ·Department of Medicine (Infectious Diseases), Rush University Medical Center, Chicago, Illinois, USA mhayden@rush.edu. · Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA. · Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA. · Hospital Corporation of America, Nashville, Tennessee, USA. · Division of Internal Medicine, Texas A&M Health Science Center College of Medicine, Houston, Texas, USA. · Department of Medicine (Infectious Diseases), Rush University Medical Center, Chicago, Illinois, USA. · Cook County Health and Hospitals System, Chicago, Illinois, USA. · Office of HAI Prevention Research and Evaluation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. · Division of Infectious Diseases, University of California-Irvine School of Medicine, Orange, California, USA. ·J Clin Microbiol · Pubmed #27558180.

ABSTRACT: Whether targeted or universal decolonization strategies for the control of methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to decolonizing agents is unresolved. The REDUCE-MRSA trial (ClinicalTrials registration no. NCT00980980) provided an opportunity to investigate this question. REDUCE-MRSA was a 3-arm, cluster-randomized trial of either screening and isolation without decolonization, targeted decolonization with chlorhexidine and mupirocin, or universal decolonization without screening to prevent MRSA infection in intensive-care unit (ICU) patients. Isolates from the baseline and intervention periods were collected and tested for susceptibility to chlorhexidine gluconate (CHG) by microtiter dilution; mupirocin susceptibility was tested by Etest. The presence of the qacA or qacB gene was determined by PCR and DNA sequence analysis. A total of 3,173 isolates were analyzed; 2 were nonsusceptible to CHG (MICs, 8 μg/ml), and 5/814 (0.6%) carried qacA or qacB At baseline, 7.1% of MRSA isolates expressed low-level mupirocin resistance, and 7.5% expressed high-level mupirocin resistance. In a mixed-effects generalized logistic regression model, the odds of mupirocin resistance among clinical MRSA isolates or MRSA isolates acquired in an ICU in intervention versus baseline periods did not differ across arms, although estimates were imprecise due to small numbers. Reduced susceptibility to chlorhexidine and carriage of qacA or qacB were rare among MRSA isolates in the REDUCE-MRSA trial. The odds of mupirocin resistance were no different in the intervention versus baseline periods across arms, but the confidence limits were broad, and the results should be interpreted with caution.

4 Article Effect of body surface decolonisation on bacteriuria and candiduria in intensive care units: an analysis of a cluster-randomised trial. 2016

Huang, Susan S / Septimus, Edward / Hayden, Mary K / Kleinman, Ken / Sturtevant, Jessica / Avery, Taliser R / Moody, Julia / Hickok, Jason / Lankiewicz, Julie / Gombosev, Adrijana / Kaganov, Rebecca E / Haffenreffer, Katherine / Jernigan, John A / Perlin, Jonathan B / Platt, Richard / Weinstein, Robert A / Anonymous7390850. ·Division of Infectious Diseases, University of California Irvine School of Medicine, Orange, CA, USA. Electronic address: sshuang@uci.edu. · Clinical Services Group, Hospital Corporation of America, Houston, TX; Division of Infectious Diseases, Texas A&M Health Science Center College of Medicine, Houston, TX, USA. · Division of Infectious Diseases, Rush Medical College, Chicago, IL, USA. · Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA. · Nashville, TN, USA. · Division of Infectious Diseases, University of California Irvine School of Medicine, Orange, CA, USA. · Office of HAI Prevention Research and Evaluation, Centers for Disease Control and Prevention, Atlanta, GA, USA. · Division of Infectious Diseases, Rush Medical College, Chicago, IL, USA; Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, USA. ·Lancet Infect Dis · Pubmed #26631833.

ABSTRACT: BACKGROUND: Urinary tract infections (UTIs) are common health-care-associated infections. Bacteriuria commonly precedes UTI and is often treated with antibiotics, particularly in hospital intensive care units (ICUs). In 2013, a cluster-randomised trial (REDUCE MRSA Trial [Randomized Evaluation of Decolonization vs Universal Clearance to Eradicate MRSA]) showed that body surface decolonisation reduced all-pathogen bloodstream infections. We aim to further assess the effect of decolonisation on bacteriuria and candiduria in patients admitted to ICUs. METHODS: We did a secondary analysis of a three-group, cluster-randomised trial of 43 hospitals (clusters) with patients in 74 adult ICUs. The three groups included were either meticillin-resistant Staphylococcus aureus (MRSA) screening and isolation, targeted decolonisation (screening, isolation, and decolonisation of MRSA carriers) with chlorhexidine and mupirocin, and universal decolonisation (no screening, all patients decolonised) with chlorhexidine and mupirocin. Protocol included chlorhexidine cleansing of the perineum and proximal 6 inches (15·24 cm) of urinary catheters. ICUs within the same hospital were assigned the same strategy. Outcomes included high-level bacteriuria (≥50 000 colony forming units [CFU]/mL) with any uropathogen, high-level candiduria (≥50 000 CFU/mL), and any bacteriuria with uropathogens. Sex-specific analyses were specified a priori. Proportional hazards models assessed differences in outcome reductions across groups, comparing an 18-month intervention period to a 12-month baseline period. FINDINGS: 122 646 patients (48 390 baseline, 74 256 intervention) were enrolled. Intervention versus baseline hazard ratios (HRs) for high-level bacteriuria were 1·02 (95% CI 0·88-1·18) for screening or isolation, 0·88 (0·76-1·02) for targeted decolonisation, and 0·87 (0·77-1·00) for universal decolonisation (no difference between groups, p=0·26), with no sex-specific reductions (HRs for men: 1·09 [95% CI 0·85-1·40] for screening or isolation, 1·01 [0·79-1·29] for targeted decolonisation, and 0·78 [0·63-0·98] for universal decolonisation, p=0·12; HRs for women: 0·97 [0·80-1·17] for screening and isolation, 0·83 [0·70-1·00] for targeted decolonisation, and 0·93 [0·79-1·09] for universal decolonisation, p=0·49). HRs for high-level candiduria were 1·14 (0·95-1·37) for screening and isolation, 0·99 (0·83-1·18) for targeted decolonisation, and 0·83 (0·70-0·99) for universal decolonisation (p=0·05). Differences between sexes were due to reductions in men in the universal decolonisation group (HRs: 1·21 [95% CI 0·88-1·68] for screening or isolation, 1·01 [0·73-1·39] for targeted decolonisation, and 0·63 [0·45-0·89] for universal decolonisation, p=0·02). Bacteriuria with any CFU/mL was also reduced in men in the universal decolonisation group (HRs 1·01 [0·81-1·25] for screening or isolation, 1·04 [0·83-1·30] for targeted decolonisation, and 0·74 [0·61-0·90] for universal decolonisation, p=0·04). INTERPRETATION: Universal decolonisation of patients in the ICU with once a day chlorhexidine baths and short-course nasal mupirocin could be a potential preventive strategy in male patients because it significantly decreases candiduria and any bacteriuria, but not for women. FUNDING: HAI Program from AHRQ, US Department of Health and Human Services as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program, CDC Prevention Epicenters Program.

5 Article Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery. 2015

Schweizer, Marin L / Chiang, Hsiu-Yin / Septimus, Edward / Moody, Julia / Braun, Barbara / Hafner, Joanne / Ward, Melissa A / Hickok, Jason / Perencevich, Eli N / Diekema, Daniel J / Richards, Cheryl L / Cavanaugh, Joseph E / Perlin, Jonathan B / Herwaldt, Loreen A. ·University of Iowa Carver College of Medicine, Iowa City2Iowa City VA Health Care System, Iowa City3University of Iowa College of Public Health, Iowa City. · University of Iowa Carver College of Medicine, Iowa City. · Hospital Corporation of America, Nashville, Tennessee5Texas A&M Health Science Center, College of Medicine, Texas A&M University Houston. · Hospital Corporation of America, Nashville, Tennessee. · The Joint Commission, Oakbrook Terrace, Illinois. · University of Iowa Carver College of Medicine, Iowa City2Iowa City VA Health Care System, Iowa City. · University of Iowa College of Public Health, Iowa City. · University of Iowa Carver College of Medicine, Iowa City3University of Iowa College of Public Health, Iowa City7University of Iowa Hospitals and Clinics, Iowa City. ·JAMA · Pubmed #26034956.

ABSTRACT: IMPORTANCE: Previous studies suggested that a bundled intervention was associated with lower rates of Staphylococcus aureus surgical site infections (SSIs) among patients having cardiac or orthopedic operations. OBJECTIVE: To evaluate whether the implementation of an evidence-based bundle is associated with a lower risk of S. aureus SSIs in patients undergoing cardiac operations or hip or knee arthroplasties. DESIGN, SETTING, AND PARTICIPANTS: Twenty hospitals in 9 US states participated in this pragmatic study; rates of SSIs were collected for a median of 39 months (range, 39-43) during the preintervention period (March 1, 2009, to intervention) and a median of 21 months (range, 14-22) during the intervention period (from intervention start through March 31, 2014). INTERVENTIONS: Patients whose preoperative nares screens were positive for methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus (MSSA) were asked to apply mupirocin intranasally twice daily for up to 5 days and to bathe daily with chlorhexidine-gluconate (CHG) for up to 5 days before their operations. MRSA carriers received vancomycin and cefazolin or cefuroxime for perioperative prophylaxis; all others received cefazolin or cefuroxime. Patients who were MRSA-negative and MSSA-negative bathed with CHG the night before and morning of their operations. Patients were treated as MRSA-positive if screening results were unknown. MAIN OUTCOMES AND MEASURES: The primary outcome was complex (deep incisional or organ space) S. aureus SSIs. Monthly SSI counts were analyzed using Poisson regression analysis. RESULTS: After a 3-month phase-in period, bundle adherence was 83% (39% full adherence; 44% partial adherence). Overall, 101 complex S. aureus SSIs occurred after 28,218 operations during the preintervention period and 29 occurred after 14,316 operations during the intervention period (mean rate per 10,000 operations, 36 for preintervention period vs 21 for intervention period, difference, -15 [95% CI, -35 to -2]; rate ratio [RR], 0.58 [95% CI, 0.37 to 0.92]). The rates of complex S. aureus SSIs decreased for hip or knee arthroplasties (difference per 10,000 operations, -17 [95% CI, -39 to 0]; RR, 0.48 [95% CI, 0.29 to 0.80]) and for cardiac operations (difference per 10,000 operations, -6 [95% CI, -48 to 8]; RR, 0.86 [95% CI, 0.47 to 1.57]). CONCLUSIONS AND RELEVANCE: In this multicenter study, a bundle comprising S. aureus screening, decolonization, and targeted prophylaxis was associated with a modest, statistically significant decrease in complex S. aureus SSIs.

6 Article Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial. 2014

Huang, Susan S / Septimus, Edward / Avery, Taliser R / Lee, Grace M / Hickok, Jason / Weinstein, Robert A / Moody, Julia / Hayden, Mary K / Perlin, Jonathan B / Platt, Richard / Ray, G Thomas. ·Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Orange, California. ·Infect Control Hosp Epidemiol · Pubmed #25222894.

ABSTRACT: OBJECTIVE: To estimate and compare the impact on healthcare costs of 3 alternative strategies for reducing bloodstream infections in the intensive care unit (ICU): methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, targeted decolonization (ie, screening, isolation, and decolonization of MRSA carriers or infections), and universal decolonization (ie, no screening and decolonization of all ICU patients). DESIGN: Cost analysis using decision modeling. METHODS: We developed a decision-analysis model to estimate the health care costs of targeted decolonization and universal decolonization strategies compared with a strategy of MRSA nares screening and isolation. Effectiveness estimates were derived from a recent randomized trial of the 3 strategies, and cost estimates were derived from the literature. RESULTS: In the base case, universal decolonization was the dominant strategy and was estimated to have both lower intervention costs and lower total ICU costs than either screening and isolation or targeted decolonization. Compared with screening and isolation, universal decolonization was estimated to save $171,000 and prevent 9 additional bloodstream infections for every 1,000 ICU admissions. The dominance of universal decolonization persisted under a wide range of cost and effectiveness assumptions. CONCLUSIONS: A strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and likely reduce healthcare costs compared with strategies of MRSA nares screening and isolation or screening and isolation coupled with targeted decolonization.

7 Article Does chlorhexidine bathing in adult intensive care units reduce blood culture contamination? A pragmatic cluster-randomized trial. 2014

Septimus, Edward J / Hayden, Mary K / Kleinman, Ken / Avery, Taliser R / Moody, Julia / Weinstein, Robert A / Hickok, Jason / Lankiewicz, Julie / Gombosev, Adrijana / Haffenreffer, Katherine / Kaganov, Rebecca E / Jernigan, John A / Perlin, Jonathan B / Platt, Richard / Huang, Susan S. ·Hospital Corporation of America, Nashville, Tennessee. ·Infect Control Hosp Epidemiol · Pubmed #25222893.

ABSTRACT: OBJECTIVE: To determine rates of blood culture contamination comparing 3 strategies to prevent intensive care unit (ICU) infections: screening and isolation, targeted decolonization, and universal decolonization. DESIGN: Pragmatic cluster-randomized trial. SETTING: Forty-three hospitals with 74 ICUs; 42 of 43 were community hospitals. PATIENTS: Patients admitted to adult ICUs from July 1, 2009, to September 30, 2011. METHODS: After a 6-month baseline period, hospitals were randomly assigned to 1 of 3 strategies, with all participating adult ICUs in a given hospital assigned to the same strategy. Arm 1 implemented methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, arm 2 targeted decolonization (screening, isolation, and decolonization of MRSA carriers), and arm 3 conducted no screening but universal decolonization of all patients with mupirocin and chlorhexidine (CHG) bathing. Blood culture contamination rates in the intervention period were compared to the baseline period across all 3 arms. RESULTS: During the 6-month baseline period, 7,926 blood cultures were collected from 3,399 unique patients: 1,099 sets in arm 1, 928 in arm 2, and 1,372 in arm 3. During the 18-month intervention period, 22,761 blood cultures were collected from 9,878 unique patients: 3,055 sets in arm 1, 3,213 in arm 2, and 3,610 in arm 3. Among all individual draws, for arms 1, 2, and 3, the contamination rates were 4.1%, 3.9%, and 3.8% for the baseline period and 3.3%, 3.2%, and 2.4% for the intervention period, respectively. When we evaluated sets of blood cultures rather than individual draws, the contamination rate in arm 1 (screening and isolation) was 9.8% (N = 108 sets) in the baseline period and 7.5% (N = 228) in the intervention period. For arm 2 (targeted decolonization), the baseline rate was 8.4% (N = 78) compared to 7.5% (N = 241) in the intervention period. Arm 3 (universal decolonization) had the greatest decrease in contamination rate, with a decrease from 8.7% (N = 119) contaminated blood cultures during the baseline period to 5.1% (N = 184) during the intervention period. Logistic regression models demonstrated a significant difference across the arms when comparing the reduction in contamination between baseline and intervention periods in both unadjusted (P = .02) and adjusted (P = .02) analyses. Arm 3 resulted in the greatest reduction in blood culture contamination rates, with an unadjusted odds ratio (OR) of 0.56 (95% confidence interval [CI], 0.044-0.71) and an adjusted OR of 0.55 (95% CI, 0.43-0.71). CONCLUSION: In this large cluster-randomized trial, we demonstrated that universal decolonization with CHG bathing resulted in a significant reduction in blood culture contamination.

8 Article Targeted versus universal decolonization to prevent ICU infection. 2013

Huang, Susan S / Septimus, Edward / Kleinman, Ken / Moody, Julia / Hickok, Jason / Avery, Taliser R / Lankiewicz, Julie / Gombosev, Adrijana / Terpstra, Leah / Hartford, Fallon / Hayden, Mary K / Jernigan, John A / Weinstein, Robert A / Fraser, Victoria J / Haffenreffer, Katherine / Cui, Eric / Kaganov, Rebecca E / Lolans, Karen / Perlin, Jonathan B / Platt, Richard / Anonymous5200759 / Anonymous5210759. ·University of California Irvine School of Medicine, Orange, CA 92868, USA. sshuang@uci.edu ·N Engl J Med · Pubmed #23718152.

ABSTRACT: BACKGROUND: Both targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care-associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: We conducted a pragmatic, cluster-randomized trial. Hospitals were randomly assigned to one of three strategies, with all adult ICUs in a given hospital assigned to the same strategy. Group 1 implemented MRSA screening and isolation; group 2, targeted decolonization (i.e., screening, isolation, and decolonization of MRSA carriers); and group 3, universal decolonization (i.e., no screening, and decolonization of all patients). Proportional-hazards models were used to assess differences in infection reductions across the study groups, with clustering according to hospital. RESULTS: A total of 43 hospitals (including 74 ICUs and 74,256 patients during the intervention period) underwent randomization. In the intervention period versus the baseline period, modeled hazard ratios for MRSA clinical isolates were 0.92 for screening and isolation (crude rate, 3.2 vs. 3.4 isolates per 1000 days), 0.75 for targeted decolonization (3.2 vs. 4.3 isolates per 1000 days), and 0.63 for universal decolonization (2.1 vs. 3.4 isolates per 1000 days) (P=0.01 for test of all groups being equal). In the intervention versus baseline periods, hazard ratios for bloodstream infection with any pathogen in the three groups were 0.99 (crude rate, 4.1 vs. 4.2 infections per 1000 days), 0.78 (3.7 vs. 4.8 infections per 1000 days), and 0.56 (3.6 vs. 6.1 infections per 1000 days), respectively (P<0.001 for test of all groups being equal). Universal decolonization resulted in a significantly greater reduction in the rate of all bloodstream infections than either targeted decolonization or screening and isolation. One bloodstream infection was prevented per 54 patients who underwent decolonization. The reductions in rates of MRSA bloodstream infection were similar to those of all bloodstream infections, but the difference was not significant. Adverse events, which occurred in 7 patients, were mild and related to chlorhexidine. CONCLUSIONS: In routine ICU practice, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen. (Funded by the Agency for Healthcare Research and the Centers for Disease Control and Prevention; REDUCE MRSA ClinicalTrials.gov number, NCT00980980).

9 Article A bundled approach to reduce methicillin-resistant Staphylococcus aureus infections in a system of community hospitals. 2013

Perlin, Jonathan B / Hickok, Jason D / Septimus, Edward J / Moody, Julia A / Englebright, Jane D / Bracken, Richard M. ·Clinical & Physician Services Group, HCA. Jonathan.perlin@hcahealthcare.com ·J Healthc Qual · Pubmed #23648079.

ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) infections pose a significant challenge to U.S. healthcare facilities, but there has been limited study of initiatives to reduce infection and increase patient safety in community hospitals. To address this need, a multifaceted program for MRSA infection prevention was developed for implementation in 159 acute care facilities. This program featured five distinct tools-active MRSA surveillance of high-risk patients, enhanced barrier precautions, compulsive hand hygiene, disinfection and cleaning, and executive champions and patient empowerment-and was implemented during 1Q-2Q 2007. Postintervention (3Q 2007-2Q 2008), 10.2% of patients with high-risk for infection or complications due to MRSA had nasal colonization. Volume of disposable gown and alcohol-based hand sanitizer use increased substantially following program implementation. Self-reported rates, based on NHSN definitions, of healthcare-associated central line-associated bloodstream infections and ventilator-associated pneumonia due to MRSA decreased 39% (p < .001) and 54% (p < .001), respectively. Infection rates continued to decrease during the follow-up period (1Q-4Q 2009). This sustained improvement demonstrates that reducing healthcare-associated MRSA infections in a large number of diverse facilities is possible and that a "bundled" approach that translates science into clinical and executive performance expectations may aid in overcoming traditional barriers to implementation.

10 Article Infection prevention practices in adult intensive care units in a large community hospital system after implementing strategies to reduce health care-associated, methicillin-resistant Staphylococcus aureus infections. 2013

Moody, Julia / Septimus, Edward / Hickok, Jason / Huang, Susan S / Platt, Richard / Gombosev, Adrijana / Terpstra, Leah / Avery, Taliser / Lankiewicz, Julie / Perlin, Jonathan B. ·Clinical Services Group, HCA Inc, Nashville, TN 37203, USA. Julia.moody@hcahealthcare.com ·Am J Infect Control · Pubmed #22748841.

ABSTRACT: BACKGROUND: A range of strategies and approaches have been developed for preventing health care-associated infections. Understanding the variation in practices among facilities is necessary to improve compliance with existing programs and aid the implementation of new interventions. METHODS: In 2009, HCA Inc administered an electronic survey to measure compliance with evidence-based infection prevention practices as well as identify variation in products or methods, such as use of special approach technology for central vascular catheters and ventilator care. Responding adult intensive care units (ICUs) were those considering participation in a clinical trial to reduce health care-associated infections. RESULTS: Responses from 99 ICUs in 55 hospitals indicated that many evidenced-based practices were used consistently, including methicillin-resistant Staphylococcus aureus (MRSA) screening and use of contact precautions for MRSA-positive patients. Other practices exhibited wide variability including discontinuation of precautions and use of antimicrobial technology or chlorhexidine patches for central vascular catheters. MRSA decolonization was not a predominant practice in ICUs. CONCLUSION: In this large, community-based health care system, there was substantial variation in the products and methods to reduce health care-associated infections. Despite system-wide emphasis on basic practices as a precursor to adding special approach technologies, this survey showed that these technologies were commonplace, including in facilities where improvement in basic practices was needed.

11 Article Cluster randomized trials in comparative effectiveness research: randomizing hospitals to test methods for prevention of healthcare-associated infections. 2010

Platt, Richard / Takvorian, Samuel U / Septimus, Edward / Hickok, Jason / Moody, Julia / Perlin, Jonathan / Jernigan, John A / Kleinman, Ken / Huang, Susan S. ·Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA. richard_platt@harvard.edu ·Med Care · Pubmed #20473200.

ABSTRACT: BACKGROUND: The need for evidence about the effectiveness of therapeutics and other medical practices has triggered new interest in methods for comparative effectiveness research. OBJECTIVE: Describe an approach to comparative effectiveness research involving cluster randomized trials in networks of hospitals, health plans, or medical practices with centralized administrative and informatics capabilities. RESEARCH DESIGN: We discuss the example of an ongoing cluster randomized trial to prevent methicillin-resistant Staphylococcus aureus (MRSA) infection in intensive care units (ICUs). The trial randomizes 45 hospitals to: (a) screening cultures of ICU admissions, followed by Contact Precautions if MRSA-positive, (b) screening cultures of ICU admissions followed by decolonization if MRSA-positive, or (c) universal decolonization of ICU admissions without screening. SUBJECTS: All admissions to adult ICUs. MEASURES: The primary outcome is MRSA-positive clinical cultures occurring >or=2 days following ICU admission. Secondary outcomes include blood and urine infection caused by MRSA (and, separately, all pathogens), as well as the development of resistance to decolonizing agents. RESULTS: Recruitment of hospitals is complete. Data collection will end in Summer 2011. CONCLUSIONS: This trial takes advantage of existing personnel, procedures, infrastructure, and information systems in a large integrated hospital network to conduct a low-cost evaluation of prevention strategies under usual practice conditions. This approach is applicable to many comparative effectiveness topics in both inpatient and ambulatory settings.