Case Studies

Combining Programs to Reduce MRSA Infections

The Problem

The Pitt Country Memorial Hospital leadership team decided to reduce surgical complications and infections, with a special desire to decrease MRSA infections.

The Solution

The surgical teams used theSurgical Care Improvement Project protocols. To enhance the quality improvements brought by SCIP, an organization-wide patient safety culture stresses paying attention to detail, improving handoffs, continuous reporting and increasing critical thinking skills.
The hospital uses AHRQ's Hospital Survey on Patient Safety Culture. They embrace a critical thinking strategy known as the AAA approach. AAA stands for:

  • Ask when not sure;
  • Advocate for the patient; and
  • Assert and stop work to keep patient safe.

This approach is combined with a behavior-based expectation program that goes by the acronym STAR—Stop, Think, Act, Review. For handoffs, the surgical teams and the hospital as a whole use SBAR— Situation, Background, Assessment, Recommendation. SBAR provides a framework for individuals of all professional backgrounds to communicate about a patient’s condition. Pitt County has taken a special interest in reducing MRSA for surgical patients. Preelective surgery patients are screened 10 to 14 days ahead of time so physicians have the chance to order the proper medications and materials before surgery. Everybody throughout the hospital screens for MRSA, including the emergency department, with hopes that no cases make it to patients in the operating room and become a dangerous surgical infection.
Since open communication is such a big part of the culture at Pitt County, the data that is collected every day is reported on a monthly basis. Surgeons get feedback immediately if there is a bump in infections numbers. And as part of this open communication system, if any surgeons or nurses or other staff perceive a problem they are empowered to discuss it or report it.

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