Best Practices: MRSA Precautions
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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
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