Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units

Martin E. Evans*, Stephen M. Kralovic, Loretta A. Simbartl, D. Scott Obrosky, Margaret C. Hammond, Barry Goldstein, Charlesnika T. Evans, Gary A. Roselle, Rajiv Jain

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Background: Methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) are a concern in the 22 acute care Veterans Affairs (VA) spinal cord injury units where patients with unique rehabilitation and medical needs and a high risk of infection are treated. Methods: A bundle was implemented in VA spinal cord injury units consisting of nasal surveillance for MRSA on admission/in-hospital transfer/discharge, contact precautions for patients colonized or infected with MRSA, an emphasis on hand hygiene, and an institutional culture change where infection control became everyone's responsibility. Results: From October 2007, through June 2011, there were 51,627 admissions/transfers/discharges and 816,254 patient-days of care in VA spinal cord injury units. The percentage of patients screened increased to >95.0%. The mean admission MRSA prevalence was 38.6% ± 19.1%. Monthly HAI rates declined 81% from 1.217 per 1,000 patient-days to 0.237 per 1,000 patient-days (P <.001). Bloodstream infections declined by 100% (P =.002), skin and soft-tissue infections by 60% (P =.007), and urinary tract infections by 33% (P =.07). Conclusion: Universal surveillance, contact precautions, hand hygiene, and an institutional culture change was associated with significant declines in MRSA HAIs in a setting with a high prevalence of MRSA colonization and a high risk for infection.

Original languageEnglish (US)
Pages (from-to)422-426
Number of pages5
JournalAmerican Journal of Infection Control
Issue number5
StatePublished - May 2013


  • MRSA

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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