WIP 120 - Got Your Nose!: A Quality Improvement Initiative to Increase MRSA Nasal Surveillance Screening in Pediatric Patients Admitted for Skin and Soft Tissue Infections

Poster Number: WIP 120
Publication Number: WIP 120.2584

Background: Staphylococcus aureus is a common cause of skin and soft tissue infections (SSTI) frequently treated with empiric methicillin-resistant Staphylococcus aureus (MRSA) coverage in pediatric populations. However, there is increasing data on the utility of determining MRSA or methicillin-sensitive Staphylococcus aureus (MSSA) colonization status to guide providers in adhering to antimicrobial stewardship efforts. Prior literature in adults and pediatrics has shown that positive MRSA nasal surveillance (MNS) swabs in patients with pneumonia and SSTI have a high negative predictive value (NPPV) for MRSA infections. As a result, this has led to limited use of anti-MRSA antimicrobials.

Objective: To reduce the inappropriate use of antimicrobials for MRSA coverage in pediatric patients admitted for SSTI. We aimed to increase the use of MNS collection prior to the initiation of antimicrobials by 40% over a 3-month period.

Design/Methods: Review by the Office of Research Integrity determined that this initiative met the definition of quality improvement (QI) and therefore did not qualify as human subjects research. Pre-intervention baseline data included pediatric patients (birth through 21 years) admitted to Inpatient Pediatrics and/or Pediatric Intensive Care Unit (PICU) for SSTIs between 2021/11/01-2022/11/01. Data points included patient medical record number (MRN), admitting diagnosis, MNS collection status, and ordered/administered antimicrobials. The starting point for this Plan-Do-Study-Act (PDSA) cycle included the provision of formal educational sessions and departmental newsletter reminders for all pediatric post-graduate trainees. Post-intervention data was then collected following these interventions over a 3-month period. The second PDSA cycle aims to utilize a 'hard stop' feature within the electronic medical record system (EMRS) with a goal for post-intervention data collection to be completed by 2024/03/01.