CAMRSA

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CA-MRSA

• Wanda White RN BSN MHS
• DHSS
• Communicable Disease Consultant
• March 26, 2009

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Objectives

• Describe epidemiology
• Enhance Surveillance to assist classification
• Community Prevention Programs
• Gaps

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CA-MRSA

• Definition MRSA in a person who has none of the
  following risk factors for HA-MRSA
• isolation of MRSA more than 48 hours after
  hospital admission, surgery, dialysis or
  residence in a long-term care facility within one
  year of the culture date the presence of an
  indwelling catheter or a percutaneous device or
  previous isolation for MRSA.
• Limitations It is not always possible to
  identify the source of MRSA with certainty,
  making the classification of CA or HA strains
  based on epidemiological criteria is somewhat
  imprecise.

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CA-MRSA

• Because hospital strains have moved into the
  community vice versa, it can be difficult to
  categorize.
• Genetically different then HA MRSA.
• Grows faster in vitro may develop because of a
  gene transfer (not antibiotic pressure like HA).
• NWT has decided to do DNA fingerprinting all
  isolates.

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CA-MRSA vs HA-MRSA

• HA MRSA
• Since 1961
• Older population
• Nursing homes
• PVL unusual
• Predominant Strain (CMRSA-1)
• Multidrug-resistance is common

• Ca MRSA
• Recent development
• Younger
• Minority Population
• PVL common
• Predominant Strain (CMRSA 10)
• Multidrug resistance - rare

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NWT Methicillin Resistant Staphylococcus Aureus
(MRSA) n161
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NWT Methicillin Resistant Staphylococcus Aureus
(MRSA)2000-2008 n 161
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Demographics of MRSA cases from the NWT(May to
Nov 2008)
Sample only represents isolates which were sent
to the National Microbiology Laboratory for
genotyping
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MRSA Strains(among isolates sent to NML)
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Distribution of Aboriginal Status by MRSA type
Includes CMRSA-2, CMRSA-3/6, and CMRSA-8
Includes CMRSA-10, CMRSA-7
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Distribution of gender by MRSA types
Includes CMRSA-2, CMRSA-3/6, and CMRSA-8
Includes CMRSA-10, CMRSA-7
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Distribution of age groups by MRSA type
Includes CMRSA-2, CMRSA-3/6, and CMRSA-8
Includes CMRSA-10, CMRSA-7
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Distribution of community type by MRSA type
Includes CMRSA-2, CMRSA-3/6, and CMRSA-8
Includes CMRSA-10, CMRSA-7
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MRSA types Investigation vs. NML
a All these cases were CMRSA-10 This table does
not include cases of MRSA with strain European
or USA700. It also does not include MRSA cases in
which the type was classified as unknown based on
the information from the investigation.
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Among the 8 CMRSA-10 cases initially categorized
as hospital-associated types
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Demographics of CA-strains
CMRSA-10, Pattern 1028
CMRSA-10, Pattern 0473
Significantly higher in the aboriginal
population, seems to be more predominant in the
20-29 year age group, and evenly distributed
between Yellowknife and Regional centres
Somewhat evenly distributed among aboriginal
groups, spread throughout the different age
groups, and significantly higher in Yellowknife .
Also three cases from individuals residing out of
province.
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CA-MRSA Prevention

• Role of Patient
• The goal is to prevent transmission from the
  infected or colonized individual to other people
  in the family or community.
• Regular hand hygiene
• Regular bathing with soap water
• Cover skin lesions
• Do not share personal items that come in contact
  with skin lesions (razors, toothbrushes, towels,
  etc)
• Wash hands after changing dressings, or touching
  potentially infected materials.

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CA-MRSA Prevention

• Role of Practitioner
• Use antibiotics judiciously.
• Treatment of viral infections with antimicrobials
  should be avoided.
• Patients should be encouraged to complete all
  courses of antibiotics.

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CA-MRSA Prevention

• Role of Public Health
• Notification required PH Surveillance will
  occur if spread occurs in community or closed
  groups, such as correction, school teams, etc.
• Educate about appropriate hygiene practices.
• Public education targeting specific settings
  households with CA-MRSA infection, corrections,
  schools, sports settings, pets owners Vets,
  newborn care facilities.
• Public education on the appropriate use of
  antibiotics.
• Educate HCWs.

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CA-MRSA

• NWT has had SSTI in corrections.
• SSTI in sports school settings.
• Connected to physicians office.
• In school children.
• In several communities.
• Two cases of necrotizing fasciitis.

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Infection Control

• Major gaps
• Lack of designated IC personnel.
• General sanitation (facilities, public Venues.
• Personnel training
• Supervision
• Ongoing education
• Education of physicians in particular.
• Education required for public, especially around
  CA MRSA.

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Infection Control Public Health

• There are many areas of concern for infectious
  disease infection control.
• Carefully F/U all clients with infectious
  diseases to prevent transmission
• Ensure all staff receives training infection
  control PPE
• Infection control infrastructure expertise
• Monitor good infection control techniques
• Ensure sanitation standards are met.

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Resources
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