American journal of infection control · 2026
Implementation strategies for sustainability of mupirocin decolonization across adult ICUs in an urban safety net hospital.
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Cramer Angela L, Bartkus Mary, Nelson Alison L, Rudel Rebecca, Steiner Jacqueline, Green Patricia, Barnard Astride, Henry Sherine, Betances Michelle, Pierre Cassandra M, Drainoni Mari-Lynn, Barlam Tamar F
Аннотация
BACKGROUND: Our hospital observed a significant increase in nosocomial methicillin-resistant Staphylococcus aureus bacteremia with half of these cases occurring in the adult intensive care units (ICUs). We tested a set of implementation strategies to improve the mupirocin ordering rate for universal decolonization within the adult ICUs.
METHODS: There were 3 implementation phases followed by a washout phase and a final fourth phase. The desired goal was ≥ 85% of eligible patients ordered for mupirocin within 48 hours of admission; 2 consecutive weeks below this goal prompted movement to the next phase. The first phase utilized a top-down method of education. Educational outreach was conducted during phase two. Direct messaging was utilized in phase three. Following the washout, mupirocin was added to the daily ICU rounds checklist in phase four.
RESULTS: Across all ICUs, we did not reach the desired goal during the first 2 phases. Phase three was well above the desired goal every week. During the washout, there were 3 consecutive weeks where all ICUs were below 85%. Phase four met the desired goal for all 16 weeks.
CONCLUSIONS: Direct messaging and adding mupirocin to the ICU rounds checklist proved to be the most effective strategies for sustainable implementation.
METHODS: There were 3 implementation phases followed by a washout phase and a final fourth phase. The desired goal was ≥ 85% of eligible patients ordered for mupirocin within 48 hours of admission; 2 consecutive weeks below this goal prompted movement to the next phase. The first phase utilized a top-down method of education. Educational outreach was conducted during phase two. Direct messaging was utilized in phase three. Following the washout, mupirocin was added to the daily ICU rounds checklist in phase four.
RESULTS: Across all ICUs, we did not reach the desired goal during the first 2 phases. Phase three was well above the desired goal every week. During the washout, there were 3 consecutive weeks where all ICUs were below 85%. Phase four met the desired goal for all 16 weeks.
CONCLUSIONS: Direct messaging and adding mupirocin to the ICU rounds checklist proved to be the most effective strategies for sustainable implementation.