October 25, 2007

Purdue researchers involved in study to help reduce drug-resistant hospital infections

According to an article published this month in the Journal of the American Medical Association, drug-resistant staph infections result in more than 18,000 deaths a year in the United States, and about a quarter of those people become infected while in the hospital.

Heather Woodward-Hagg, an assistant professor of industrial technology and a researcher at Purdue's Regenstrief Center for Healthcare Engineering, is the implementation director of a study that is looking at whether a prevention model can help reduce the transmission of methicillin-resistant Staphylococcus aureus, known commonly as MRSA, in a hospital setting.

Brad Doebbeling, director of the Indiana University Center for Health Services and Outcomes Research and the Veterans Affairs Center for Implementing Evidence-Based Practice, and Paul Dexter, Regenstrief Institute scientist and Indiana University physician, are leading the study.

Drug-resistant staph infections can cause skin and soft tissue infections, and severe and sometimes fatal invasive disease.

This model involves implementation of three main clinical practices to reduce hospital-acquired transmissions of MRSA:

* Development of a strict hand hygiene program, requiring hand hygiene for health-care professionals prior to and following patient contact.

* Active culturing of every patient upon admission and just prior to discharge to determine if the patients are carriers of drug-resistant bacteria.

* Isolating patients determined to be carriers and requiring health-care professionals to wear gloves, gowns and sometimes masks before having contact with those patients.

Hagg said the research team is working to implement these procedures with health-care professionals in the six hospital systems in Indianapolis: Clarian Health (IU and Methodist Hospitals), St. Francis Hospitals, Community Health Network, St. Vincent Health, Wishard Health Services and the Roudebush Veterans Affairs Medical Center.

The team is meeting with health-care professionals, including physicians, nurses, pharmacists and environmental services specialists, in two critical care units in each hospital system to apply methods of systems engineering and systems redesign to facilitate implementation of these practices into their daily routines.

"Our faculty is working closely with front-line staff teams from each health-care facility in the study to examine issues, obstacles and solutions in the implementation of these procedures," Hagg said. "Through staff engagement, application of systems engineering methodologies, and ongoing measurement and feedback of adherence, we are assisting these facilities in creating sustained organizational change that we hope will result in a reduction of the spread of the antibiotic-resistant bacteria."

Hagg said that though results won't be available until after the study is complete in March, adherence to clinical practice guidelines in participating study units has been strong. She said some of the issues identified and addressed by the project teams include visibility of isolation signs, availability of contact isolation supplies and equipment, and redesign of clinical processes to ensure admission and discharge active culture surveillance is completed in a timely manner.

"We've also found that major redesigns of patient transportation and environmental services, as well as a change in daily and discharge cleaning processes, were required in most units," she said.

Hagg said health-care organizations that have implemented a similar model have fewer problems with the transmission of drug-resistant infections.

"These three components are what many European hospitals use, and they have significantly less occurrences of these antibiotic-resistant staph infections," she said. "The Pittsburgh Veterans Affairs hospital system, which uses this three-step model, has reduced the rate of MRSA infections by 85 percent. We think this model could lead to very favorable results within Indianapolis-area hospitals."

An additional component of this study is the use of the Indiana Network for Patient Care, developed by the Regenstrief Institute, to electronically link emergency rooms and hospitals throughout central Indiana. This system covers more that 95 percent of all inpatient care in the city and has created one of the most wired health-care settings in the country, Hagg said. Through the use of the network, the project researchers have created an information sharing system that allows participating hospitals to communicate, share and track MRSA infections. This data provides infection control officers and clinicians with identification of MRSA-infected patients when they first contact a new institution, which is critical to stopping the spread of the superbug.

"This study has provided a mechanism for collaboration among IU, Purdue, Regenstrief Institute, VA researchers and local hospital systems to make important strides in transforming the health-care system in Indiana," Doebbeling said. "Our success is based on a collaborative partnership among hospital leaders, providers and staff, informaticists, engineers and implementation scientists."

Also involved are Matthew Stephens, a professor of industrial technology at Purdue who is the team facilitator at St. Vincent's; Laura Lucas, a visiting assistant professor of building construction management at Purdue who is the team facilitator at Wishard; Jamie Workman-Germann, an associate professor of mechanical engineering technology at Indiana University-Purdue University Indianapolis who is the implementation director for Community and Wishard; and Eugenia Fernandez, an associate professor of computer technology at IUPUI who is the team facilitator at Community Heart Hospital.

The 18-month, $400,000 study is being funded by the Agency for Healthcare Research and Quality, a division of the U.S. Department of Heath and Human Services. The study is being coordinated by the Indiana University Center for Health Services and Outcomes Research, a program of the IU School of Medicine and the Regenstrief Institute Inc., and the VA Center of Excellence in Implementing Evidence-based Practice.

Writer: Kim Medaris, (765) 494-6998, kmedaris@purdue.edu

Source: Heather Hagg, (317) 514-5219, heatherhagg@purdue.edu

Purdue News Service: (765) 494-2096; purduenews@purdue.edu

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