Michelle Vignari

Targeting MRSA and CLABSI

Michelle Vignari

Michelle Vignari, RN, CIC
Rochester General Hospital
Rochester, NY

In mid-2007, Michelle Vignari committed to eliminate central line-associated bloodstream infections (CLABSI) and methicillin-resistant Staphylococcus aureus (MRSA) in specific departments of her hospital. Just a few years later, the work of Vignari and her team earned Rochester General Hospital (RGH) a spot among 37 hospitals acknowledged by the Department of Health and Human Services for sustained reduction in HAIs.

Vignari presented summaries of her hospital’s successful battles against CLABSI and MRSA at the APIC 2011 Annual Conference.

CLABSIs are costly, represent a major cause of increased morbidity and mortality, and increase average hospital stays. Reducing the baseline rate in the RGH ICU from 4.7 per 1,000 line days (13 infections / 2791 line days) to zero would be a challenge.

Vignari took a comprehensive approach. She and her team standardized equipment, created insertion and line care protocols, and encouraged staff to change high-risk lines every 24 hours. She emphasized multidisciplinary staff involvement and accountability.

“We began proactively asking physicians whether central lines could be removed,” Vignari said. Together, these steps decreased the number of line days by 50 percent. The current CLABSI infection rate at RGH is 0 infections/1912 line days (p=0.012).

Vignari also focused on MRSA – the cause of 60 percent of the orthopedic infections at RGH. MRSA infection of a joint prosthesis poses a significant problem, costing upwards of $50,000 per incident.

Vignari’s MRSA and surgical site infection (SSI) programs tackled presence and colonization in multiple ways:

  1. MRSA nasal screening of all patients before surgery
  2. Full body washes with chlorhexidine prior to surgery
  3. Intra-nasal mupirocin administration for all patients day of surgery and five days post-surgery.
  4. Vancomycin administration to MRSA-positive patients en route to the operating room, in addition to standard antibiotic prophylaxis
  5. Standardization of skin prep

Other efforts were environmental – strict hand hygiene, disinfectant wipes, and patient-dedicated equipment. Today, RGH overall MRSA rates are down 90 percent, and orthopedic SSI rates have decreased more than 60 percent.

Which virulent bug is next on Vignari’s list? “Well,” she says, “our job is to be ready for anything.” Given the RGH track record, it appears they are.