BEST PRACTICES: MRSA PRECAUTIONS

Dr. Elizabeth Bryce

Topics to Be Covered

Devising Risk StrategiesRisk Assessment for Level of

PrecautionsDetermining the Need for Additional

Precautions

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

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?

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 patientsSelective antimicrobial pressureColonization pressure Impact of implementation strategiesContinued adherence to prevention (long-

term investment)

Risk Assessment

Two components to rememberOrganizational 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 ResourcesHuman ResourcesImplementing System ChangesPhysical Plant ChangesPromoting Adherence/Role ModelingFostering a Safety Climate

Antimicrobial Stewardship

Shortest duration possibleNarrowest spectrum possibleTreat the patient, not the report!Formulary ReviewsBuilt-in Compliance features in PharmacyPractice Guidelines

Environmental Cleanliness

Correct Agent/DilutionCorrect methodAvoid ClutterFocus on frequently touched surfaces Isolation Cleaning ProtocolsDon’t forget shared equipment

Education

Many different strategiesFacility-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 areasUnresolved:

Duration of CPImpact of CP on patient well-being and careUse 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 2007:13:846-853

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