Term of Award

Fall 2013

Degree Name

Doctor of Public Health in Community Health Behavior and Education (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)


Jiann-Ping Hsu College of Public Health

Committee Chair

John S. Luque, Ph.D., M.P.H.

Committee Member 1

Robert L. Vogel, Ph.D

Committee Member 2

Claire Robb, Ph.D.

Committee Member 3

Stephanie Baer, MD

Committee Member 3 Email



The purpose of this retrospective case-control study was to assess risk factors contributing to hospital acquired methicillin Staphylococcus aureus (HA-MRSA) and gain a better understanding of the burden of HA-MRSA infection in patients with spinal cord injuries. The study was also conducted to see if new information would be found on HA-MRSA infections and validate or refute current research for patients in a dedicated spinal cord injury unit at a Veterans Affairs Medical Center. During the study period, the infection control department identified 95 cases of HA-MRSA. Additional data retrospectively collected were basic demographics, admitting diagnosis, presence of varying comorbidities, ASIA score, presence of indwelling medical device, BMI, LOS, MRSA colonization, and quarterly hand hygiene compliance. The patient population was described using appropriate univariate descriptive statistics and crude odd ratios (ORs) with 95% confidence intervals (CIs) calculated. The most common sources of infection for cases were ulcer related (31.6%), from skin and soft tissue infections besides pressure ulcers (23.2%), 14.7% were Foley catheter related, 8.4% were blood stream infections and 22.1% were from other sites/sources. Assessment of risk factors for HA-MRSA for spinal cord injury patients in this study found that colonization (OR: 3), device use (Foley OR: 3.3, PICC OR: 39.4, use of both OR: 21.1) , paralysis (1.9), ASIA score A (OR: 4.5), amputee (OR: 3.5), decubitus ulcer (OR: 7.1), length of hospital stay > 30 days (OR: 17.1) and a hand hygiene compliance