Transcript Preventing Transmission of MRSA in the Hospital Setting

Preventing Transmission of
MRSA in the Hospital Setting
Patricia A. Pearson RN, CIC
Infection Prevention & Control
Synergy / St. Joseph’s Hospital
Patient Safety
Hand Hygiene
• Before patient contact
• After patient contact
• Before invasive procedures, e.g. starting
and IV
• After removing gloves
• Whenever hands are visibly soiled
The importance of this in preventing the transmission of infections
cannot be stressed enough.
How it Works
• Care providers are expected to cleanse
their hands upon entering the patient room
in view of the patient.
• Standardization of patient room design
allows the patient to view the hand
hygiene station.
• Patients and families are educated on the
importance of good hand hygiene and that
“it’s OK to ask” their care provider to
cleanse their hands if they do not observe
it being done.
Screening For MRSA
• Done by Risk Factors
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History of MRSA
Resident of LTC
Current implanted devices
Recent prolonged hospitalization for serious illness
Current skin or soft tissue infections
Prolonged treatment with ABX in past 30 days
Place in contact precautions & obtain nares swab.
Why we do Active Surveillance
Cultures (ASC)
• > 50 % of Staph aureus cultures are now
resistant (MRSA)
• MRSA is difficult to treat
• We want to know who is colonized when they
enter our facility so we can isolate and prevent
transmission of this “super bug” to other patients
• Hand hygiene, isolation, barrier precautions and
proper cleaning & disinfection of the
environment and equipment have been proven
to prevent transmission.
Overall % positive= 5%
821/40
MRSA Screening
May 2007- February 2008
120
110
100
95
93
92
91
89
89
85
77
80
60
Screens
#+
40
20
9
1
4
6
4
5
3
6
2
0
May
June
July
August
September
October
November
December
January
Isolation Precautions
• We follow Standard Precautions for the
care of all patients.
• We add Contact Precautions for patients
suspected of, or known to be infected with
MRSA.
• Requires the use of gloves and gowns in
addition to proper hand hygiene. It may
include wearing a mask if the infection is in
the respiratory tract.
Use of Barrier Precautions
• Gowns, gloves and
sometimes masks are
used to protect the
healthcare worker
and to prevent
transmission of
microorganisms
• Patient care
employees are
trained on this
Identification of Known
Infectious Patients
• Microbiology keeps a list of patients with a
history of MRSA
• This information was put into EPIC (our
electronic Medical Record)
• Infection control is notified of any newly
identified patients and puts this information into
EPIC
• Healthcare workers access this information by
checking the EPIC record of their patients
Communication regarding this history is very important
prior to transferring them to another department or
facility or when scheduling procedures.
# New + MRSA Cultures
May 2007- February 2008
(Non-Nares ASC)
120
100
80
60
114
40
20
21
13
13
5
Ja
m
be
r
ce
De
No
ve
m
be
r
be
r
ct
o
O
te
m
Se
p
Au
gu
st
ly
Ju
ne
Ju
ay
M
be
r
Months in 2007
nu
ar
y
3
0
ew
14
ta
lN
16
To
17
12
# New + MRSA Cultures (non-nares)
MRSA Positive Cultures May 2007- February 2008
Urine, blood,
sputum and
wound
28%
Abscesses of various body
sites, cellulitis of the face,
carbuncles, insect bites,
wound infection etc
# + Cultures Non- hosp
# + Cultures Hosp & LTC
72%
Questions and Concerns