Nationwide safety program associated with 65% reduction in hospital-onset MRSA bloodstream infections

by Johns Hopkins University School of Medicine

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A large-scale, quality improvement program developed in collaboration with infection prevention experts at the Johns Hopkins Armstrong Institute for Patient Safety and Quality was associated with a 65% reduction in hospital-onset bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA) among participating hospital units.

The findings, published Aug. 27 in JAMA Network Open, suggest that a comprehensive approach to putting existing infection prevention evidence into everyday practice can substantially reduce infections among hospitalized patients. The Agency for Healthcare Research and Quality (AHRQ) Safety Program for MRSA Prevention was implemented in 106 intensive care units (ICUs) and 87 non-ICUs at 94 hospitals across the United States. The results highlight both the preventability of MRSA infections and the importance of a deliberate strategy for turning evidence into everyday practice.

"Some people think risks from multidrug-resistant organisms like MRSA are inevitable, that they're not preventable, but we in infection prevention know that they are," says Lisa Maragakis, M.D., M.P.H., senior author of the study, professor of medicine and epidemiology at the Johns Hopkins University School of Medicine and a faculty member at the Armstrong Institute for Patient Safety and Quality. "Infection prevention works, but it is complex. It takes a very deliberate implementation strategy to translate the existing evidence into practice so we can protect patients."

MRSA is a type of staph bacteria that is resistant to antibiotics, making infections more difficult to treat. Staph bacteria commonly live on human skin without causing illness, but hospitalized patients can be particularly vulnerable to infection because of underlying illnesses and invasive medical procedures. Devices such as central venous catheters provide lifesaving medications and fluids but also cross the body's natural skin barrier, creating a potential route for bacteria to enter the bloodstream.

Putting prevention into practice

To help prevent these infections, Johns Hopkins Armstrong Institute researchers and collaborators from NORC at the University of Chicago and AHRQ conducted an 18-month program centered on helping health care teams consistently implement a comprehensive set of infection prevention strategies targeting MRSA transmission and infection.

Participating hospital units received education and implementation resources on hand hygiene, environmental cleaning, device-associated infection prevention, chlorhexidine bathing and nasal decolonization. The program also engaged front-line workers across disciplines, including environmental services personnel.

"Taking the available evidence and implementing it is quite complex because you have to make sure that every front-line member of the health care team is aware of the evidence and has the knowledge, skills and tools they need to implement it," Maragakis says. "The system and workflow also have to support making sure those things happen every single time for every patient."

Broad declines across hospital units

Researchers compared infection rates during the 18-month implementation period with rates during the 12 months before the program began. Across participating ICUs and non-ICUs, the rate of hospital-onset MRSA bloodstream infections was 65% lower during the implementation period. Researchers also observed a 39% reduction in MRSA-positive clinical cultures collected later during hospitalization, a 37% reduction in bloodstream infections from all causes and a 31% reduction in central line-associated bloodstream infections.

The researchers also found changes in how participating units approached infection prevention. The proportion of ICUs reporting nasal MRSA decolonization for all patients increased from 35% to 61%, while the proportion of non-ICUs reporting the practice increased from 13% to 35%. Monitoring of environmental cleaning also increased from 50% to 75% among ICUs and from 52% to 76% among non-ICUs.

A toolkit for wider use

Collaboration among institutions helped make it possible to implement the program across hospitals nationwide, with researchers at NORC and AHRQ contributing to the coordination and infrastructure needed to support participating sites.

"It really was a large collaborative project," Maragakis says. "Each researcher brought something different to the table, and that was important to making a project of this scale possible."

The resulting AHRQ MRSA Prevention Toolkit is publicly available and includes educational and implementation materials that health care teams can use to build or strengthen infection prevention programs. Hospitals can select components based on the needs of an individual unit.

Researchers say many of the toolkit's strategies address fundamental infection prevention practices that can help reduce the spread of other organisms and health care-associated infections as well.

"This toolkit is about MRSA prevention, but once you get into it, you'll see it's really about preventing health care-associated infections and organism transmission," Maragakis says. "There will be collateral benefits to doing these basics of infection prevention well beyond MRSA prevention."

Other Johns Hopkins researchers who contributed to the study are Clare Rock, Valeria Fabre, Sara Cosgrove, Kathleen Speck, Samuel Kim, Kerri Huber, Cheryl Conners and Sandra Swoboda.

Publication details

Lisa L. Maragakis et al, Hospital-Onset Methicillin-Resistant Staphylococcus aureus Prevention in Acute Care Hospitals, JAMA Network Open (2026). DOI: 10.1001/jamanetworkopen.2026.31225

Journal information: JAMA Network Open

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Infectious diseasesHospital medicine Provided by Johns Hopkins University School of Medicine Who's behind this story?

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