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Back To Vidyya Methicillin-Resistant Staphylococcus Aureus

Facts for Healthcare Workers

Methicillin-resistant Staphylococcus aureus (MRSA) has become a prevalent nosocomial pathogen in the United States. In hospitals, the most important reservoirs of MRSA are infected or colonized patients. Although hospital personnel can serve as reservoirs for MRSA and may harbor the organism for many months, they have been more commonly identified as a link for transmission between colonized or infected patients. The main mode of transmission of MRSA is via hands (especially health care workers' hands) which may become contaminated by contact with a) colonized or infected patients, b) colonized or infected body sites of the personnel themselves, or c) devices, items, or environmental surfaces contaminated with body fluids containing MRSA. Standard Precautions, as described in the "Guideline for Isolation Precautions in Hospitals" (Infect Control Hosp Epidemiol 1996;17:53-80), should control the spread of MRSA in most instances.

Standard Precautions include:

1) Handwashing
Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. It may be necessary to wash hands between tasks and procedures on the same patient to prevent cross-contamination of different body sites.
2) Gloving
Wear gloves (clean nonsterile gloves are adequate) when touching blood, body fluids, secretions, excretions, and contaminated items; put on clean gloves just before touching mucous membranes and nonintact skin. Remove gloves promptly after use, before touching noncontaminated items and environmental surfaces, and before going to another patient, and wash hands immediately to avoid transfer of microorganisms to other patients or environments.
3) Masking
Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.
4) Gowning
Wear a gown (a clean nonsterile gown is adequate) to protect skin and prevent soiling of clothes during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions or cause soiling of clothing.
5) Appropriate device handling
Handle used patient-care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments. Ensure that reusable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed and that single-use items are properly discarded.
6) Appropriate handling of laundry
Handle, transport, and process used linen soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments.

If MRSA is judged by the hospital's infection control program to be of special clinical or epidemiologic significance, then Contact Precautions should be considered.

Contact Precautions consist of:

1) Placing a patient with MRSA in a private room. When a private room is not available, the patient may be placed in a room with a patient(s) who has active infection with MRSA, but with no other infection (cohorting).

2) Wearing gloves (clean nonsterile gloves are adequate) when entering the room. During the course of providing care for a patient, change gloves after having contact with infective material that may contain high concentrations of microorganisms (e.g., fecal material and wound drainage). Remove gloves before leaving the patient's room and wash hands immediately with an antimicrobial agent. After glove removal and handwashing, ensure that hands do not touch potentially contaminated environmental surfaces or items in the patient's room to avoid transfer of microorganisms to other patients and environments.

3) Wearing a gown when entering the room if you anticipate that your clothing will have substantial contact with the patient, environmental surfaces, or items in the patient's room, or if the patient is incontinent, or has diarrhea, an ileostomy, a colostomy, or wound drainage not contained by a dressing. Remove the gown before leaving the patient's room. After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces to avoid transfer of microorganisms to other patients and environments.

4) Limiting the movement and transport of the patient from the room to essential purposes only. If the patient is transported out of the room, ensure that precautions are maintained to minimize the risk of transmission of microorganisms to other patients and contamination of environmental surfaces or equipment.

5) Ensuring that patient-care items, bedside equipment, and frequently touched surfaces receive daily cleaning.

6) When possible, dedicating the use of noncritical patient-care equipment and items such as stethoscope, sphygmomanometer, bedside commode, or electronic rectal thermometer to a single patient (or cohort of patients infected or colonized with MRSA) to avoid sharing between patients. If use of common equipment or items is unavoidable, then adequately clean and disinfect them before use on another patient.

Culturing Of Personnel And Management Of Personnel Carriers Of MRSA

Unless the objective of the hospital is to eradicate all MRSA carriage and treat all personnel who are MRSA carriers, whether or not they disseminate MRSA, it may be prudent to culture only personnel who are implicated in MRSA transmission based on epidemiologic data. MRSA-carrier personnel who are epidemiologically linked to transmission should be removed from direct patient care until treatment of the MRSA-carrier status is successful. If the hospital elects to culture all personnel to identify MRSA carriers, a) surveillance cultures need to be done frequently, and b) it is likely that personnel colonized by MRSA who are not linked to transmission and/or who may not be MRSA disseminators will be identified, subjected to treatment, and/or removed from patient contact unnecessarily. Because of the high cost attendant to repeated surveillance cultures and the potential of repeated culturing to result in serious consequences to health care workers, hospitals should weigh the advantages and the adverse effects of routinely culturing personnel before doing so.

Control Of MRSA Outbreaks

When an outbreak of MRSA infection occurs, an epidemiologic assessment should be initiated to identify risk factors for MRSA acquisition in the institution; clinical isolates of MRSA should be saved and submitted for strain typing. Colonized or infected patients should be identified as quickly as possible, appropriate barrier precautions should be instituted, and handwashing by medical personnel before and after all patient contacts should be strictly adhered to.

All personnel should be reinstructed on appropriate precautions for patients colonized or infected with multiresistant microorganisms and on the importance of handwashing and barrier precautions in preventing contact transmission.

If additional help is needed by the hospital, a consultation with the local or state health department or even the CDC may be necessary.


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Editor: Susan K. Boyer, RN
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