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Results of a multicentre randomised controlled trial of statistical process control charts and structured diagnostic tools to reduce ward-acquired meticillin-resistant Staphylococcus aureus: the CHART Project
Abstract
Statistical process control (SPC) charts have previously been advocated for infection control quality improvement. To determine their effectiveness, a multicentre randomised controlled trial was undertaken to explore whether monthly SPC feedback from infection control nurses (ICNs) to healthcare workers of ward-acquired meticillin-resistant Staphylococcus aureus (WA-MRSA) colonisation or infection rates would produce any reductions in incidence. Seventy-five wards in 24 hospitals in the UK were randomised into three arms: (1) wards receiving SPC chart feedback; (2) wards receiving SPC chart feedback in conjunction with structured diagnostic tools; and (3) control wards receiving neither type of feedback. Twenty-five months of pre-intervention WA-MRSA data were compared with 24 months of post-intervention data. Statistically significant and sustained decreases in WA-MRSA rates were identified in all three arms (P<0.001; P=0.015; P<0.001). The mean percentage reduction was 32.3% for wards receiving SPC feedback, 19.6% for wards receiving SPC and diagnostic feedback, and 23.1% for control wards, but with no significant difference between the control and intervention arms (P=0.23). There were significantly more post-intervention 'out-of-control' episodes (P=0.021) in the control arm (averages of 0.60, 0.28, and 0.28 for Control, SPC and SPC+Tools wards, respectively). Participants identified SPC charts as an effective communication tool and valuable for disseminating WA-MRSA data.
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“They did not find a statistically significant difference in rates of methicillin‐resistant Staphylococcus aureus infections in hospital wards (adjusted change = 5%, high risk of bias, patient outcome; P = 0.46).”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Curran 2008
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Metadata
- Authors
- Curran, E., Harper, P., Loveday, H., Gilmour, H., Jones, S., Benneyan, J., Hood, J., & Pratt, R.
- Affiliations
- Health Protection Scotland (GB)
- University of West London (GB)
- University of Glasgow (GB)
- Northeastern University (US)
- NHS Greater Glasgow and Clyde (GB)
- Corresponding author
- Harper, P.
- Venue
- Journal of Hospital Infection
- Publisher
- Elsevier BV
- Published
- 2008-10
- Volume
- 70
- Issue
- 2
- Pages
- 127-135
- ISSN
- 0195-6701 (ISSN-L)
- OpenAlex
- W2142617186
- Cited by
- 37
- References
- 25
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 2 · 2013: 2 · 2012: 5
- FWCI
- 0.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- Journal of Hospital Infection (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- UWL Repository (University of West London) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Advanced Statistical Process Monitoring
- Keywords
- control charts, MRSA colonization, MRSA infection, infection control, infection control nurses, quality improvement, hospital wards
- MeSH terms
- Cross Infection, Data Interpretation, Statistical, United Kingdom, Health Personnel, Hospital Units, Hospitals, Humans, Staphylococcal Infections, Staphylococcus aureus, Models, Statistical, Incidence, Methicillin Resistance, Infection Control
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