Transcript Best Practices: MRSA Precautions

BEST PRACTICES:
MRSA PRECAUTIONS
Dr. Elizabeth Bryce
Topics to Be Covered
Devising Risk Strategies
Risk Assessment for Level of
Precautions
Determining the Need for Additional
Precautions
Devising Risk Strategies:
Waxing Philosophical
To develop effective prevention strategies must
understand the components responsible for the
current state in your facility:
 Rates of Community acquired MRSA
 Rates of Healthcare Acquired MRSA
 Rates in your Facility
The same situation?
Very high rates of CMRSA+ high incidence of HCMRSA
+ endemic in facility VS
Little CMRSA + little HCMRSA + low facility rates
Risk management strategies…
BUT also consider:
 Your Patient Population
 Your Environment
 Impact of implementation plan/procedures
 Feasibility
 Probability of Effectiveness of measures
MRSA Eradication
What is the goal of
your strategy?
MRSA Control?
But Wait …..There’s More!
Who will you target?
The Facility Population?
Just Inpatients? Or Residents?
Pre-Admit Population (prior to
admission)
The Community?
Risk Assessment
Transmission and persistence determined by:
 Vulnerable patients
 Selective antimicrobial pressure
 Colonization pressure
 Impact of implementation strategies
 Continued adherence to prevention (longterm investment)
Risk Assessment
Two components to remember
 Organizational risk assessment which sets
policy and procedure
 Individual risk assessment with each
patient interaction
General Control Interventions
 Administrative Support
 Antimicrobial Stewardship
 Surveillance
 Environmental Cleanliness
 Routine/Contact Precautions
 Education
 Additional Precautions
 Critical Review of implementation strategies
Administrative Support
Fiscal Resources
Human Resources
Implementing System Changes
Physical Plant Changes
Promoting Adherence/Role Modeling
Fostering a Safety Climate
Antimicrobial Stewardship
 Shortest duration possible
 Narrowest spectrum possible
 Treat the patient, not the report!
 Formulary Reviews
 Built-in Compliance features in Pharmacy
 Practice Guidelines
Environmental Cleanliness
 Correct Agent/Dilution
 Correct method
 Avoid Clutter
 Focus on frequently touched surfaces
 Isolation Cleaning Protocols
 Don’t forget shared equipment
Education
Many different strategies
 Facility-wide versus focused
 Informational, interactive, training,
campaigns
 Ideally behaviour change oriented
And trying to effect a culture change
Routine Precautions
 Have an essential role in preventing
transmission – always
 Particularly important vis a vis undetected
cases
 Hand Hygiene particularly important here
as is Risk Assessment
Additional Precautions
Very important to consider the context and the situation
Contact Precautions:
Evidence: Consensus versus evidence based
recommendation.
Elements: single/isolation rooms or cohorting,
use of gown and gloves for potential patient contact or
contact with contaminated areas
Unresolved:
Duration of CP
Impact of CP on patient well-being and care
Use of CP preemptively
Other Barriers
 For the most part; as per Routine
Precautions
 Mask – anticipated exposure to
droplets/secretions
 Respirator – generally not specifically for
MRSA
 Facial Protection – anticipated exposure to
droplets/secretions
Other Measures
 Notifying others of patient transfers or
diagnostic procedures
 Ensuring patients clean hands and cover
open wounds when outside room
 Visitors informed of appropriate
precautions
 Education of patient
Finally……
Control of MRSA should be
 Dynamic
 Systematic
 Tailored to reflect the epidemiology/environment
 Flexible – can be scaled up or down
 Measured
Strive to: Assess the problem, evaluate the
effectiveness of the measures implemented.
References
 Taconnelli E: MRSA: risk assessment and infection control
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policies. Clin Microbiol Infect 2008
Humphreys H National guidelines for the control and prevention of
MRSA – what do they tell us? Clin Microbiol Infect 2007:13:846853
PICNet revised ARO guidelines Dec 2007
Sigel J Management of multidrug-resistant organisms in healthcare
settings, 2006 Am J Infect control 2007;35:S165-193
Coia JE Guidelines for the ontrol and prevention of MRSA in
healthcare facilities. J Hosp Infect 2007;63S:S1-S44