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BACKGROUND: MRSA has been a burden for acute-care facilities for many years due to the higher morbidity and cost of treatment then the more susceptible Staphylococcus aureus. To address MRSA burden, legislation was passed in 2007 in NJ requiring acute-care hospitals to report MRSA bloodstream infections and implement MRSA active surveillance. The Centers of Disease Control and Prevention (CDC) and the New Jersey Department of Health (NJDOH) are concerned for MRSA healthcare-associated infections; in 2011 facility-wide laboratory identified MRSA (LabID event) isolates were required to be entered into the CDC’s NHSN surveillance system in NJ. All of New Jersey’s 72 acute care facilities report to NHSN. The LabID events have never been validated in NJ and the only state to have validated such events has been California. In addition to reporting LabID events, NJ hospitals are required to perform active surveillance testing (AST) for MRSA colonization on admission to at least one of their intensive care units (ICUs) via nasal swab cultures.
METHODS: Voluntary participation was used to recruit hospitals into this validation study. Data is in the process of being validated by an individual trained by CDC using a standardized medical chart abstraction tool developed by CDC. By the completion of this study, each LabID event from 2011and 2012 will be validated. If hospitals have more than 60 LabID events per year, then 60 events will be selected for validation based on the following ratio: 20 first events to 40 second events. The AST data will be validated with a form developed by NJDOH. Four months from 2011-2012 will be evaluated by matching laboratory test data to ICU admissions to see the number of patients actually tested.
RESULTS: Of the 72 acute care facilities in NJ, 30 (42%) volunteered to participate in this study. The median bed size for participating hospitals is 223 (range 142 - 675). Over the two year period (2011 and 2012) the 30 participating hospitals had a combined 1,730 MRSA LabID Events reported to NHSN (range 15-213, median 44).
CONCLUSIONS: MRSA legislation has made NJ uniquely qualified to track MRSA prevalence in acute care facilities. NJ’s legislation added two years to the nationwide LabID Event reporting that began in 2013. Additionally, NJ is unique in requiring the implementation of AST which allows the NJDOH to track compliance with the legislation.