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  MRSA Backgrounder

MRSA Implementation Guide

Are CA-MRSA and S. pneumo. 19A Emergence Linked? • S. aureus and S. pneumo both colonize. the nasopharynx. – S. pneumo may inhibit S. aureus colonization

 

Signs and Symptoms including Images

 More Images (LA County DPH)

 

 

 

 

     

 

MRSA ♦  in Healthcare Settings 

 

Overview of MRSA in Health Care Settings.

How MRSA Spreads in Healthcare Settings 

MRSA and the Expensive Results of Antimicrobial Resistance

MRSA: a Growing Problem in the Healthcare Setting, But One with a Cure 

What are the criteria for distinquishing community-associated MRSA (CA-MRSA) from healthcare-associated MRSA (HA-MRSA)?

What is the main way that staph or MRSA is transmitted in the community?

How is a MRSA infection diagnosed?

How are CA-MRSA infections treated?

How do CA-MRSA and HA-MRSA strains differ?

Information on  surveillance, prevention, epidemiologic and laboratory research and outbreak and laboratory support

Standard Precautions

Contact Precautions 

 

Overview of MRSA in Healthcare Settings.

MRSA has been featured in the news and on television programs a great deal recently. MRSA stands for Methicillin-resistant Staphylococcus aureus. This type of bacteria causes “staph” infections that are resistant to treatment with usual antibiotics.

MRSA occurs most frequently among patients who undergo invasive medical procedures or who have weakened immune systems and are being treated in hospitals and healthcare facilities such as nursing homes and dialysis centers. MRSA in healthcare settings commonly causes serious and potentially life threatening infections, such as bloodstream infections, surgical site infections, or pneumonia.

In addition to healthcare associated infections, MRSA can also infect people in the community at large, generally as skin infections that may look like pimples or boils and can be swollen, painful and have draining pus. These skin infections often occur in otherwise healthy people.

How MRSA Spreads in Healthcare Settings

When we talk about the spread of an infection, we talk about sources of infection - where it starts, and the way or ways it spreads - the mode or modes of transmission.

In the case of MRSA, patients who already have an MRSA infection or who carry the bacteria on their bodies but do not have symptoms (colonized) are the most common sources of transmission.

The main mode of transmission to other patients is through human hands, especially healthcare workers' hands. Hands may become contaminated with MRSA bacteria by contact with infected or colonized patients. If appropriate hand hygiene such as washing with soap and water or using an alcohol-based hand sanitizer is not performed, the bacteria can be spread when the healthcare worker touches other patients.

 

  MRSA and the Expensive Results of Antimicrobial Resistance

Along with MRSA, many significant infection-causing bacteria in the world are becoming resistant to the most commonly prescribed antimicrobial treatments. What causes this and what does it mean?

Antimicrobial resistance occurs when bacteria change or adapt in a way that allows them to survive in the presence of antibiotics designed to kill them. In some cases bacteria become so resistant that no available antibiotics are effective against them. At this time, treatment options still exist for healthcare-associated MRSA.

People infected with antibiotic-resistant organisms like MRSA are more likely to have longer and more expensive hospital stays, and may be more likely to die as a result of the infection. When the drug of choice for treating their infection doesn’t work, they require treatment with second- or third-choice medicines that may be less effective, more toxic and more expensive.

So this means that if you or I get an MRSA infection, we may suffer more, and we may pay more for our treatment. Yet American society as a whole suffers more and pays more too because of the increased burden and expense in the healthcare system.

 

  MRSA: a Growing Problem in the Healthcare Setting, But One with a Cure

MRSA is becoming more prevalent in healthcare settings. According to CDC data, the proportion of infections that are antimicrobial resistant has been growing. In 1974, MRSA infections accounted for two percent of the total number of staph infections; in 1995 it was 22%; in 2004 it was 63%.

The good news is that MRSA is preventable. The first step to prevent MRSA, is to prevent healthcare infections in general. Infection control guidelines produced by CDC and the Healthcare Infection Control and Prevention Advisory Committee (HICPAC) are central to the prevention and control of healthcare infections and ultimately, MRSA in healthcare settings.

 

What are the criteria for distinguishing community-associated MRSA (CA-MRSA) from healthcare-associated MRSA (HA-MRSA)?

Persons with MRSA infections that meet all of the following criteria likely have CA-MRSA infections:

  • Diagnosis of MRSA was made in the outpatient setting or by a culture positive for MRSA within 48 hours after admission to the hospital.
  • No medical history of MRSA infection or colonization.
  • No medical history in the past year of:
    • Hospitalization
    • Admission to a nursing home, skilled nursing facility, or hospice
    • Dialysis
    • Surgery
  • No permanent indwelling catheters or medical devices that pass through the skin into the body.

 

What is the main way that staph or MRSA is transmitted in the community?

The main mode of transmission of staph and/or MRSA is via hands which may become contaminated by contact with a) colonized or infected individuals, b) colonized or infected body sites of other persons, or c) devices, items, or environmental surfaces contaminated with body fluids containing staph or MRSA. Other factors contributing to transmission include skin-to-skin contact, crowded conditions, and poor hygiene.

 

How is a MRSA infection diagnosed?

In general, a culture should be obtained from the infection site and sent to the microbiology laboratory. If S. aureus is isolated, the organism should be tested as follows to determine which antibiotics will be effective for treating the infection.

Skin Infection: Obtain either a small biopsy of skin or drainage from the infected site. A culture of a skin lesion is especially useful in recurrent or persistent cases of skin infection, in cases of antibiotic failure, and in cases that present with advanced or aggressive infections.

Pneumonia: Obtain a sputum culture (expectorated purulent sputum, respiratory lavage, or bronchoscopy).

Bloodstream Infection: Obtain blood cultures using aseptic techniques.

Urinary Infection: Obtain urine cultures using aseptic techniques.

 

How are CA-MRSA infections treated?

Staph skin infections, such as boils or abscesses, may be treated by incision and drainage, depending on severity. Antibiotic treatment, if indicated, should be guided by the susceptibility profile of the organism.

 

How do CA-MRSA and HA-MRSA strains differ?

Recently recognized outbreaks of MRSA in community settings have been associated with strains that have some unique microbiologic and genetic properties compared with the traditional hospital-based MRSA strains, suggesting some biologic properties (e.g., virulence factors) may allow the community strains to spread more easily or cause more skin disease. Additional studies are underway to characterize and compare the biologic properties of HA-MRSA and CA-MRSA strains.

There are at least three different S. aureus strains in the United States that can cause CA-MRSA infections. CDC continues to work with state and local health departments to gather organisms and epidemiologic data from known cases to determine why certain groups of people get these infections.

 

Are MRSA infections a reportable disease?

MRSA is reportable in several states. The decision to make a particular disease reportable to public health authorities is made by each state, based on the needs of that individual state. To find out if MRSA is reportable in your state, call your state health department.

 

 

Standard Precautions

1) Hand Hygiene
Perform hand hygiene after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Perform hand hygiene immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. When hands are visibly soiled with blood or other body fluids, wash hands with soap and water. It may be necessary to perform hand hygiene 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 it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intact skin (e.g., of a patient incontinent of stool or urine) could occur. Remove gloves after contact with a patient and/or the surrounding environment (including medical equipment) using proper technique to prevent hand contamination. Do not wear the same pair of gloves for the care of more than one patient. Do not wash gloves for the purpose of reuse since this practice has been associated with transmission of pathogens.
 
3) Mouth, nose, eye protection
Use PPE to protect the 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. Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed.
 
4) Gowning
Wear a gown, that is appropriate to the task, to protect skin and prevent soiling or contamination of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions, or excretions is anticipated.
 
5) Appropriate device handling of patient care equipment and instruments/devices
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. Clean and disinfect surfaces that are likely to be contaminated with pathogens, including those that are in close proximity to the patient (e.g., bed rails, over bed tables) and frequently-touched surfaces in the patient care environment (e.g., door knobs, surfaces in and surrounding toilets in patients’ rooms) on a more frequent schedule compared to that for other surfaces (e.g., horizontal surfaces in waiting rooms).
 
6) Appropriate handling of laundry
Handle, transport, and process used linen to avoid contamination of air, surfaces and persons.

Contact Precautions

In addition to Standard Precautions, Contact Precautions consist of:

1) Patient placement
In Patient placement in hospitals and LTCFs, When single-patient rooms are available, assign priority for these rooms to patients with known or suspected MRSA colonization or infection. Give highest priority to those patients who have conditions that may facilitate transmission, e.g., uncontained secretions or excretions. When single-patient rooms are not available, cohort patients with the same MRSA in the same room or patient-care area. When cohorting patients with the same MRSA is not possible, place MRSA patients in rooms with patients who are at low risk for acquisition of MRSA and associated adverse outcomes from infection and are likely to have short lengths of stay.

In general, in all types of healthcare facilities it is best to place patients requiring Contact Precautions in a single patient room.

2) Gloving
Wear gloves whenever touching the patient’s intact skin or surfaces and articles in close proximity to the patient (e.g., medical equipment, bed rails). Don gloves upon entry into the room or cubicle.
 
3) Gowning
Don gown upon entry into the room or cubicle. Remove gown and observe hand hygiene before leaving the patient-care environment. After gown removal, ensure that clothing and skin do not contact potentially contaminated environmental surfaces that could result in possible transfer of microorganism to other patients or environmental surfaces.
 
4) Patient transport
In acute care hospitals and long-term care and other residential settings, limit transport and movement of patients outside of the room to medically-necessary purposes. When transport or movement in any healthcare setting is necessary, ensure that infected or colonized areas of the patient’s body are contained and covered. Remove and dispose of contaminated PPE and perform hand hygiene prior to transporting patients on Contact Precautions. Don clean PPE to handle the patient at the transport destination.
 
5) Patient-care equipment and instuments/devices
In acute care hospitals and long-term care and other residential settings, use disposable noncritical patient-care equipment (e.g., blood pressure cuffs) or implement patient-dedicated use of such equipment. If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient.

In home care settings limit the amount of non-disposable patient-care equipment brought into the home of patients on Contact Precautions. Whenever possible, leave patient-care equipment in the home until discharge from home care services. If noncritical patient-care equipment (e.g., stethoscope) cannot remain in the home, clean and disinfect items before taking them from the home using a low- to intermediate-level disinfectant. Alternatively, place contaminated reusable items in a plastic bag for transport.

6) Environmental measures
Ensure that rooms of patients on Contact Precautions are prioritized for frequent cleaning and disinfection (e.g., at least daily) with a focus on frequently-touched surfaces (e.g., bed rails, overbed table, bedside commode, lavatory surfaces in patient bathrooms, doorknobs) and equipment in the immediate vicinity of the patient.
 
7) Discontinuation of Contact Precautions
No recommendation can be made regarding when to discontinue Contact Precautions.

Source: CDC www cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html

Source: CDC  www cdc.gov/ncidod/dhqp/ar_mrsa.html 

Source: CDC  www cdc.gov/ncidod/dhqp/ar_mrsa_healthcareFS.html

 

 

 

   
   
 

 

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