TOPLINE

An educational quality improvement program focused on evidence-based practices was associated with a 65% reduction in hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia events among the participating hospital units, along with significant decreases in all-cause hospital-onset bacteremia (HOB) and central line-associated bloodstream infections (CLABSIs).

METHODOLOGY

• A quality improvement study evaluated the Agency for Healthcare Research and Quality Safety Program for MRSA Prevention in ICUs and non-ICUs in US acute care hospitals between April 2022 and September 2023.
• A total of 94 hospitals completed the program, including 106 ICUs and 87 non-ICUs; the participating hospitals included 31 academic medical centers (33%), 42 nonacademic medical center teaching hospitals (45%), and 21 nonteaching community hospitals (22%).
• The 18-month implementation program included 22 educational webinars and provided durable educational content, focusing on two objectives: cultivating a stronger safety culture and building unit-level capacity to carry out quality improvement activities as well as the adoption of evidence-based practices to interrupt MRSA transmission and prevent MRSA infection.
• The primary outcome was the rate of laboratory-identified MRSA HOB events; the secondary outcomes were rates of all-cause HOB (defined as a positive blood culture growing any organism from any cause), MRSA-positive cultures from hospital day 4 or later, and CLABSI events.
• Researchers compared clinical outcomes between the 12-month baseline period and the 18-month implementation period.

TAKEAWAY

• Compared with the baseline period, laboratory-identified MRSA HOB events decreased by 2.3 events per 10,000 patient-days (P < .001) during the implementation period for the combined ICU and non-ICU cohorts, representing a 65% reduction (P < .001).
• The implementation period was associated with significantly lower rates of MRSA-positive cultures from hospital day 4 or later (-5.6 events per 10,000 patient-days; P < .001) and lower rates of all-cause HOB in both ICU and non-ICU settings (-10.5 events per 10,000 patient-days; P < .001).
• CLABSI events also decreased by 3.5 events per 10,000 central line days (P < .001), representing a 31% reduction (P < .001).
• Over half of the observed decline in HOB rates per 10,000 patient-days between the baseline and implementation periods, across both ICU and non-ICU settings, was driven by reductions in MRSA, methicillin-susceptible S aureus, and coagulase-negative Staphylococcus species.

IN PRACTICE

"Participation in the program by ICU and non-ICU units was associated with significant improvements in their MRSA prevention practices, including the use of MRSA decolonization and active monitoring of the quality of environmental cleaning,″ the authors wrote. ″Although COVID complicated recruitment and implementation, the program was associated with reduced MRSA infections at a time when national MRSA infection rates recovered more slowly from pandemic-related increases."

SOURCE

The study was led by Lisa L. Maragakis, MD, MPH, Johns Hopkins University School of Medicine in Baltimore. It was published online on August 27, 2026, in JAMA Network Open.

LIMITATIONS

The COVID pandemic constrained both recruitment and facility resources, resulting in a reduced participant pool that affected the ability to assess rare events and conduct subgroup analyses. The before-and-after evaluation might have been affected by volunteerism and secular trends. Several clinical outcomes declined before the commencement of the formal implementation, which might reflect increased awareness of MRSA prevention among the participating units before the intervention period and/or improved availability of resources as the pandemic-related pressures eased.

DISCLOSURES

The study was funded by the Agency for Healthcare Research and Quality. Maragakis reported serving as the president of the Society for Healthcare Epidemiology of America. One author reported being an employee of the Agency for Healthcare Research and Quality during the conduct of the study. Few authors reported receiving personal fees or an antiseptic product and a disinfectant and having other ties with various companies unrelated to this work. Full disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.