It's a reality that no part of a healthcare system exists as an island; inpatient and outpatient settings overlap. This became apparent at VA Pittsburgh Healthcare System (VAPHS), an integrated three-division system with a medical center consisting of 583 operational beds, servicing a veteran population of over 360,000 patients. VAPHS had made an organizational commitment to reduce methicillin-resistant Staphylococcus aureus (MRSA) infections, even though in national comparisons its MRSA rates were less than the national average. Of particular concern at VAPHS was the relationship between MRSA and surgical site infections (SSIs).1 Although MRSA prevention efforts were concentrated on inpatient areas and there were no immediate plans to expand into other areas, the outpatient staff recognized the efficacy of a proactive approach and also began working toward MRSA prevention.
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