Hospital Policies and Hospital-onset Methicillin-resistant Staphylococcus aureus Infections: A Mixed Method Evaluation

Abstract

MRSA continues to spread in hospitals, despite modest recent success. Gaps exist regarding how hospital policies impact MRSA transmission in hospitals. Characterization of the policy environment has been useful in approaching other public health issues including alcohol control. Our goals were to develop a tool to identify measurable and modifiable hospital policy components designed to prevent MRSA, then utilize this tool to evaluate policies to examine the relationship between policies and MRSA incidence. We developed a tool to systematically evaluate hospital policies that included instructional and implementation elements. Each policy element was evaluated for its presence and thoroughness. Four hospital policy types were evaluated from five hospitals in Minnesota: hand hygiene, multidrug-resistant organism (MDRO)/isolation, influenza vaccination, and whistleblower (corporate compliance). Results demonstrated that the policies varied in comprehensiveness and thoroughness across hospitals and topics. Most policies included purpose and policy statements. Most policies lacked consequences for noncompliance, accountability, responsibility, monitoring and enforcement of policy expectations; when included, components scored low for thoroughness. Of the policies, influenza vaccination was the most complete while hand hygiene policies scored highest for thoroughness, followed by MDRO/Isolation. Upon evaluation of policy scores and MRSA incidence rates, we found an indication of a negative correlation between the MDRO/Isolation policy score and MRSA incidence: the higher the mean score of the MDRO/Isolation policy, the lower the MRSA rate. We found a similar indication of a negative correlation between the mean hand hygiene policy score and MRSA incidence. As we begin to characterize policy, endogenous in nature, as a potential exposure it is important that we develop rigorous measurement; we provided a first step in developing such an approach. The work of this dissertation will contribute to the field of epidemiology by gaining insight into organizational policy – including how we measure, analyze, and draw inferences with the results.