Hospital-Onset Methicillin-Resistant Staphylococcus aureus Prevention in Acute Care Hospitals

Importance: Methicillin-resistant Staphylococcus aureus (MRSA) infections are major contributors to morbidity and mortality among hospitalized patients. Despite evidence-based guidelines, opportunities remain to improve the implementation of MRSA infection prevention. Objective: To determine whether an educational quality improvement program is associated with improved evidence-based practices and prevention of MRSA infections among hospitalized patients. Design, Setting, and Participants: This quality improvement study evaluates the Agency for Healthcare Research and Quality's Safety Program for MRSA Prevention, which was conducted and evaluated in volunteer intensive care units (ICUs) and non-ICUs in US acute care hospitals from April 2022 through September 2023. Data analysis, which was conducted between October 2024 and January 2025, compared data from the project period to the previous 12 months of baseline data. Exposures: The program provided 22 webinars and durable educational content and assisted units with implementing evidence-based MRSA infection prevention interventions. Webinars targeted nurses, infection preventionists, physicians, nursing assistants, and environmental services personnel. The major foci were chlorhexidine bathing, nasal MRSA decolonization, environmental disinfection, and interventions to prevent person-based MRSA transmission and device-related infections. Main Outcomes and Measures: The primary outcome was the rate of laboratory-identified, MRSA hospital-onset bacteremia (HOB) events. Secondary outcomes included hospital-onset clinical cultures growing MRSA, all-cause HOB, and central line-associated bloodstream infections. The χ2 test was used to compare binary outcomes. Results: One hundred ninety-three hospital units completed the program (106 ICUs and 87 non-ICUs from 94 hospitals), including units from 31 (33%) academic medical centers, 42 (45%) non-academic medical centers teaching hospitals, and 21 (22%) nonteaching community or other hospitals. Between baseline and the end of the program, laboratory-identified MRSA HOB events decreased by -2.3 events per 10 000 patient-days (95% CI, -2.8 to -1.9 events per 10 000 patient-days; P < .001), or -65% (95% CI, -73% to -58%; P < .001). Clinical cultures growing MRSA from hospital day 4 or later decreased by -5.6 events per 10 000 patient-days (95% CI, -7.8 to -3.3 events per 10 000 patient-days; P < .001), or -39% (95% CI, -50% to -29%; P < .001). All-cause HOB decreased by -10.5 events per 10 000 patient-days (95% CI, -13.8 to -7.1 events per 10 000 patient-days; P < .001), or -37% (95% CI, -45% to -30%; P < .001). Central line-associated bloodstream infections decreased by -3.5 events per 10 000 central-line days (95% CI, -5.5 to -1.5 events per 10 000 central-line days; P < .001), or -31% (95% CI, -45% to -17%; P < .001). Conclusions and Relevance: In this quality improvement study of MRSA prevention in ICU and non-ICU hospital settings, the program was associated with significantly reduced rates of laboratory-identified MRSA HOB events and other infections among participating hospital units. The program content is publicly available and may help ICUs and non-ICUs reduce MRSA infection among hospitalized patients.