Winning the battle against community-acquired MRSA
James Patrick, RN, CIC
Martin Army Community Hospital
Fort Benning, GA
Fort Benning, Georgia, is a microbe’s dream. Hot and humid 8 months of the year. Teeming with hundreds of new recruits weekly. Sweat, dirt, open sores, and dirty clothing crammed into crowded, communal living spaces with little time for personal hygiene.
Fortunately, the trainees and staff at this basic training facility had a tireless soldier battling their infectious bugs for more than 17 years.
James (Jim) Patrick, RN, CIC, waged a relentless pursuit for zero hospital - and community -acquired infections during his time at Fort Benning’s Martin Army Community Hospital (MACH).
Jim served as chief, Infection Prevention and Control Service at MACH. When he went on mandatory medical leave in April 2011, Jim left a legacy of infection prevention excellence – a demonstration of how one determined, passionate professional can have a positive and lasting impact on patient care.
Throwing away the red bucket
In 1993 - after serving successfully as MACH’s ICU ward master for three years – Jim was due for a promotion, but didn’t want to leave his hospital. When the MACH infection preventionist retired, Jim eagerly stepped into the position.
With no prior IP experience, Jim immediately identified resources to help with the task of self-education. He joined APIC, and completed several infection prevention courses at the University of North Carolina. Despite his relative inexperience, Jim soon realized that the IP practices at MACH were not up to par.
“We were really starting from ground zero,” said Jim. “We had an 18th century infection control and surveillance program.”
Jim discovered, for example, that his predecessor used an old, red wash basin to collect fluids. “He told me, ‘We wait and culture them all at the end of the month,’” said Jim. “I said to myself, ‘I haven’t been doing this for very long, but I know that’s no way to do surveillance.’ I immediately threw away the red bucket.”
Operation MRSA: Taking no prisoners
Throughout his professional career, Jim launched multiple, successful offensives against a wide range of hospital- and community-acquired infections. His greatest achievement – and the best example of his ingenuity and determination – was Fort Benning’s community-acquired (CA) MRSA surveillance and prevention program.
In 2000, Jim collected MACH’s first case of CA-MRSA. Lacking a computer-based surveillance system, Jim improvised, creating an Excel spreadsheet that he updated daily. The scope of this task magnified as MRSA spread nationally, and traveled in with recruits arriving from all parts of the country. One particular summer month generated close to 160 MRSA-positive cultures.
While single-handedly tracking and reporting all suspected CA-MRSA cases, Jim worked to reduce the prevalence of this virulent bug among trainees and staff.
“MRSA leads to a huge amount of lost work and training time,” said Jim. “This creates huge logistical challenges when new soldiers are arriving each week, and we have limited instructors and staff.”
One trainee, for example, presented at MACH with nine different sores – eight of which tested positive for MRSA. Weeks of isolation resulted in him spending months longer at Fort Benning than originally planned.
Having been through basic training, Jim understood - and was therefore in a good position to address - the unique IP challenges that Fort Benning presented.
“Hygiene isn’t the highest priority in basic training,” said Jim. “If you have an hour, you’re going to eat and sleep. You’re probably not going to shower.”
Trainees are also reluctant to report health issues because it could delay their graduation.
“You want to get out of that drill sergeant’s face as soon as possible,” said Jim. “So you ignore a sore or wound for as long as you can.”
Jim attacked these challenges at multiple levels. He implemented a skin and soft-tissue infection (SSTI) education program throughout the hospital and military community, beginning with command-level and working down to training companies.
“The key is getting patients involved in their own care,” said Jim. “IPs need to be role models, setting an example for other staff. Infection control happens by walking around. You’ve got to take the time to educate patients first-hand.”
To reduce MRSA transmission in the barracks and field, Jim had alcohol hand gel dispensers installed in common areas and ensured all trainees received first aid bags and alcohol hand gel. Jim’s supervisor personally spoke with drill sergeants to emphasize the importance of SSTI prevention, education and identification.
“The most problematic thing was getting believable hand hygiene data,” said Jim. “I tried a number of processes until I found something that worked.”
Indicative of his commitment to IP and his community, Jim proactively expanded his MRSA surveillance to include military family members. “Because everyone in a military family is registered under the same Social Security number, we had an opportunity to look at familial MRSA spread,” he said. Jim maintained a separate Excel spreadsheet tracking familial and non-active military MRSA cases, compiling about 200 per year.
Jim’s comprehensive MRSA program attracted attention from the infection prevention community. In May 2010, the CDC and Infectious Disease Clinical
Research Program at the Uniformed Services University of the Health Sciences (USUHS) initiated a 20-month study at Fort Benning to evaluate MRSA reduction methods among military trainees. As part of the study, the base received updated testing equipment and the opportunity to serve as a test site for a potential MRSA vaccine.
Track record of success
In addition to his dogged and effective MRSA campaign, Jim had a significant impact on other HAIs. Programs that he and his colleagues created at MACH:
- Decreased surgical site infections (SSIs) by 48 percent between 2007 and 2010: Jim worked with the Department of Surgery chief to conduct a thorough review of SSI reduction efforts. Using surveillance data, he convinced the Surgical Services Committee to recommend pre-op showers with chlorhexidine gluconate (CHG) prior to all routine non-EENT surgeries. He also facilitated documentation of patient SSI education in the EMR.
- Decreased catheter-associated urinary tract infections by 74 percent and in-dwelling catheter utilization by 48 percent: Jim increased ICU staff education, with frequent reminders to remove indwelling catheters as soon as they were no longer clinically indicated. He also conducted rounds, visiting patients with indwelling urinary catheters and asking staff about the catheter necessity.
- Achieved 0 CLABSI in the past three years.
- Achieved 0 VAP in the past six years (down from five in the preceding five years).
A tradition of excellence
The level of success that Jim was able to achieve – particularly given the challenges presented by a military base – doesn’t happen without tremendous passion and personal dedication.
Throughout his career, Jim balanced his commitment to his wife and four children with his patients’ needs. In January 2007, when he was diagnosed with terminal brain cancer, he managed his own medical issues while maintaining his commitment to MACH IP. After his first major surgery, Jim returned to work within a week.
When Jim’s doctor finally forced him into medical retirement in April 2011, it was extremely difficult for him to stop doing the job he loved.
“Jim is extremely passionate about this job,” said Linda Brannan, RN, Jim’s successor. “I plan to maintain his standards and become as passionate about infection control as he was.”
Jim retired from infection prevention with the respect and gratitude of many colleagues, as well as an impressive list of accolades – the Military Medal of Medical Honor and RN of the Year among them. He was most proud of what he left to the base and hospital he called home for more than 20 years. “We turned our 18th century infection control program into a 21st century program,” he said. “I’m proud to have had a hand in modernizing infection control at Fort Benning to keep trainees, staff and their families healthy and safe.”
From the foothills of Columbus, Georgia, the lifework of one soldier yielded a tradition of clinical excellence for those who follow in his bootsteps. His mission will continue in the hands of those he helped train. Jim Patrick epitomizes the APIC Heroes of Infection Prevention. We salute him, his work, and his life.
James (Jim) Patrick passed away in February 2012.