Innovative initiatives to prevent the spread of infections

Image: Chad Neilsen, MPH, is director of infection prevention and control at UF Health Jacksonville.
Chad Neilsen, MPH, is director of infection prevention and control at UF Health Jacksonville.
Image: Kelly Gray-Eurom, MD, is chief quality officer at UF Health Jacksonville.
Kelly Gray-Eurom, MD, is chief quality officer at UF Health Jacksonville.

Treatments to combat MRSA at UF Health Jacksonville involve implementing new protocols.

Personnel in UF Health Jacksonville’s critical care units closely track hospital-acquired bloodstream infection rates in order to improve patient health, with methicillin-resistant staphylococcus aureus, or MRSA, being of particular interest.

MRSA is contagious and has several strains, making preventing this infection crucial for critically ill patients. MRSA rates in the hospital have decreased by 50 percent during the past two years. The most dramatic decrease began 18 months ago, when the hospital implemented a universal ICU MRSA decolonization protocol.

In 2015, 28 hospital-acquired MRSA blood infections were documented and treated hospitalwide. At the end of 2018, there were only 14 cases.

Chad Neilsen, MPH, director of infection prevention and control at UF Health Jacksonville, credits the dramatic decrease to the new MRSA protocol. It involves five days of nasal antibiotics for all patients upon admission to any adult critical care unit, along with strict hand-hygiene practices using improved hand sanitizer dispensers.

In addition, all patients admitted to these units receive five days of chlorhexidine gluconate, or CHG, wipes to treat MRSA. Antibiotics administered through a nasal swab, coupled with regular bathing with CHG wipes, destroy the strains coming into the hospital and reduce the spread of existing strains within the hospital.

“By implementing these steps on the front end, we are preventing instead of responding to infections,” Neilsen said.

The Duval County Department of Health designates the area where UF Health Jacksonville is located as Health Zone 1, which has the county’s highest population density per square mile. The dense population and higher-than-average poverty rates can cause increased patient volumes for the hospital. Critical care patients are more susceptible to MRSA due to weakened immune systems and comorbidities.

“Readmissions can be higher here. So if they are decolonized here and sent home, they are less likely to return with MRSA,” Neilsen said.

Kelly Gray-Eurom, MD, chief quality officer at UF Health Jacksonville, emphasizes how reducing infection rates in the hospital involves many departments working together.

“The new protocol has not only improved patient safety by reducing the number of MRSA infections, but it has also shown that a multidisciplinary team can work quickly and effectively to translate documented evidence in the literature to better clinical outcomes,” Gray-Eurom said.

Neilsen and his team continue to meticulously track the number of bloodstream infections, using funds from an awarded research grant. They hope to see continued decreases as they learn more about strains of MRSA and the most effective ways to prevent and treat the bacteria.

“It’s a good example of people coming together to implement an evidence-based intervention and make it happen in a short amount of time,” Neilsen said.

According to Gray-Eurom, the program goal has now moved from implementation to standardization to ensure lasting cultural change.

“From the patient perspective, this is yet another way our organization is evolving practices to increase patient safety,” Gray-Eurom said. “The excellent outcomes of the new process have given staff an increased trust that infection prevention and quality leadership are at the forefront of translating research into action.”

Featured Faculty

Kelly R. Gray-Eurom, MD, MMM, FACEP

Kelly R. Gray-Eurom, MD, MMM, FACEP

Chief Quality Officer, UF Health Jacksonville; Assistant Dean for Quality and Safety; Associate Chair and Director, Business Operations, Department of Emergency Medicine

Chad D. Neilsen, MPH, CIC

Chad D. Neilsen, MPH, CIC

Courtesy Assistant Professor