best practices: mrsa precautions dr. elizabeth bryce
TRANSCRIPT
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BEST PRACTICES: MRSA PRECAUTIONS
Dr. Elizabeth Bryce
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Topics to Be Covered
Devising Risk StrategiesRisk Assessment for Level of
PrecautionsDetermining the Need for Additional
Precautions
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Devising Risk Strategies: Waxing Philosophical
To develop effective prevention strategies mustunderstand 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 VSLittle CMRSA + little HCMRSA + low facility rates
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Risk management strategies…
BUT also consider:Your Patient PopulationYour Environment Impact of implementation plan/proceduresFeasibility Probability of Effectiveness of measures
What is the goal of your strategy?
MRSA Eradication MRSA Control?
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But Wait …..There’s More!
Who will you target?The Facility Population?Just Inpatients? Or Residents?Pre-Admit Population (prior to
admission)The Community?
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Risk Assessment
Transmission and persistence determined by:Vulnerable patientsSelective antimicrobial pressureColonization pressure Impact of implementation strategiesContinued adherence to prevention (long-
term investment)
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Risk Assessment
Two components to rememberOrganizational risk assessment which sets
policy and procedure Individual risk assessment with each
patient interaction
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General Control Interventions
Administrative Support Antimicrobial Stewardship Surveillance Environmental Cleanliness Routine/Contact Precautions Education Additional Precautions Critical Review of implementation strategies
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Administrative Support
Fiscal ResourcesHuman ResourcesImplementing System ChangesPhysical Plant ChangesPromoting Adherence/Role ModelingFostering a Safety Climate
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Antimicrobial Stewardship
Shortest duration possibleNarrowest spectrum possibleTreat the patient, not the report!Formulary ReviewsBuilt-in Compliance features in PharmacyPractice Guidelines
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Environmental Cleanliness
Correct Agent/DilutionCorrect methodAvoid ClutterFocus on frequently touched surfaces Isolation Cleaning ProtocolsDon’t forget shared equipment
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Education
Many different strategiesFacility-wide versus focused Informational, interactive, training,
campaigns Ideally behaviour change oriented
And trying to effect a culture change
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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
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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 areasUnresolved:
Duration of CPImpact of CP on patient well-being and careUse of CP preemptively
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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
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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
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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.
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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 2007:13:846-853
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