Controlling methicillin-resistant Staphylococcus aureus:: A feedback approach using annotated statistical process control charts

OBJECTIVES: To investigate the benefit of a hospitalwide feedback program regarding methicillin-resistant Staphylococcus aureus (MRSA), using annotated statistical process control charts. DESIGN: Retrospective and prospective analysis of MRSA rates using statistical process control charts. PARTICIPANTS: Twenty-four medical, medical specialty, surgical, intensive care, and cardiothoracic care wards and units at four Glasgow Royal Infirmary hospitals. METHODS: Annotated control charts were applied to prospective and historical monthly data on MRSA cases from each ward and unit during a 46-month period from January 1997 through September 2000. Results were fed back from December 1999 and then on a regular monthly basis to medical staff, ward managers, senior managers, and hotel services. RESULTS: Monthly reductions in the MRSA acquisition rate started 2 months after the introduction of the feedback program and have continued to the present time. The overall MRSA rate currently is approximately 50% lower than when the program began and has become more consistent and less variable within departments throughout Glasgow Royal Infirmary. The control charts have helped to detect rate changes and manage resources more effectively. Medical and nursing staff and managers also report that they find this the most positive form of MRSA feedback they have received. CONCLUSIONS: Feedback programs that provide current information to front-fine staff and incorporate annotated control charts can be effective in reducing the rate of MRSA.