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

J Hosp Infect. 2008 Oct;70(2):127-35. doi: 10.1016/j.jhin.2008.06.013. Epub 2008 Aug 23.


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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross Infection* / diagnosis
  • Cross Infection* / epidemiology
  • Cross Infection* / prevention & control
  • Data Interpretation, Statistical
  • Health Personnel
  • Hospital Units / statistics & numerical data
  • Hospitals / statistics & numerical data
  • Humans
  • Incidence
  • Infection Control / organization & administration
  • Infection Control / standards
  • Infection Control / statistics & numerical data*
  • Methicillin Resistance*
  • Models, Statistical*
  • Staphylococcal Infections* / diagnosis
  • Staphylococcal Infections* / epidemiology
  • Staphylococcal Infections* / prevention & control
  • Staphylococcus aureus* / drug effects
  • United Kingdom / epidemiology