Impact of Hand Hygiene Simulation Driven by Neonatal Intensive Care Unit Multidisciplinary Team on Hospital Associated Methicillin-resistant Staphylococcus Aureus Screens

Background Hospital-associated infections (HAI) such as methicillin-resistant Staphylococcus aureus (MRSA) can have devastating consequences. The World Health Organization created the 5 moments for hand hygiene. It was identified in the neonatal intensive care unit (NICU) pod setting that health care workers did not always recognize opportunities due to workflow complexities. It was hypothesized that introducing hand hygiene simulations would increase hand hygiene awareness which would decrease prevalence of HAI MRSA screen positive NICU infants. Methods This was a pre/post study performed in a level 4 NICU with 54 beds from February 2018 through November 2019. Participants included 146 nurses, 30 physicians, 18 respiratory therapists, and 5 additional therapists. In January 2019, each discipline created a scenario which guided the participant through a clinical situation and monitored opportunities for hand hygiene. Simulations were carried out in empty pods in the NICU to closely mimic actual working conditions. MRSA screening was performed via nasal MRSA PCR or culture with testing of infants born outside the hospital on admission and routine testing of all infants every two weeks. The rate of MRSA-positive infants' pre-intervention and post-intervention was obtained, and a chi-squared test was utilized to compare the rates and determine statistical significance (p-value Results In the 11 months prior to the intervention, there were 13 infants with positive HAI MRSA screens across 11,010 patient days (1 per 847). In the subsequent 11 months, there were 6 infants with positive HAI MRSA screens across 12,191 patient days (1 per 2,032) When comparing these two rates, the p-value is 0.067. Conclusions We observed a decrease in the rate of infants with positive HAI MRSA screens following our introduction of hand hygiene simulations although that difference did not reach statistical significance. The fact that the scenarios were created by frontline care providers was one of the keys to success.