Approach to CAMRSA Investigations

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Approach to CA-MRSA Investigations

• Danae Bixler, MD, MPH

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Objectives

• Highlight
• Step 2 (establish the presence of an outbreak)
• Step 4 (define and identify cases)
• Step 9 (implement control and prevention
  measures)
• Step 10 (communicate findings)
• Present an approach to CA-MRSA in West Virginia

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Step 2 Establish the Existence of an Outbreak

• Two or more epidemiologically linked confirmed
  cases in two or more households, OR
• Occurrence of disease above the expected level,
  e.g.,
• High school sports team
• Expected level 0
• Regional jail / corrections
• Check historical data line listing

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Line Listing for Correctional Facilitieshttp//ww
w.nicic.org/Downloads/PDF/2003/019356.pdf
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Step 4 Define and Identify Cases

• Expanded working case definition for outbreaks of
  CA-MRSA infection (draft working case definition)
• Clinical Description
• Staphylococcus aureus infection can produce a
  variety of syndromes with clinical manifestations
  including skin and soft tissue lesions, empyema,
  and pyarthrosis, bloodstream infections,
  pneumonia, osteomyelitis, septic arthritis,
  endocarditis, sepsis and meningitis.
• Staphylococcus aureus colonization is not
  associated with clinical signs of illness or
  inflammation.

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Step 4 Define and Identify Cases

• Expanded working case definition for outbreaks of
  CA-MRSA infection (draft working case definition)
• Laboratory Criteria
• Isolation of Staphylococcus aureus from any body
  site and resistance to oxacillin
  (methicillin-resistant strains are resistant to
  oxacillin and all other ß-lactam drugs, including
  the cephalosporins).
• Epidemiological Criteria
• During the one year prior to onset, absent
  history of
• hospital or nursing home stay or
• indwelling line

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Step 4 Define and Identify Cases

• Expanded working case definition for outbreaks of
  CA-MRSA infection (draft working case definition)
• Case Classification
• Probable A clinically compatible case that meets
  the epidemiological criteria and is
  epidemiologically-linked to a confirmed case.
• Confirmed (infection) A clinically compatible
  case of methicillin resistant Staphylococcus
  aureus that meets the epidemiological criteria
  and is laboratory confirmed.
• Confirmed (colonization) A case without clinical
  signs or symptoms that meets the epidemiological
  criteria and is laboratory confirmed.

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Community Acquired MRSA Spider biteJABFP
May-June 2004 Vol 17 pg 3
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Cellulitis
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Folliculitis
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Provider Investigation (1)http//www.wvdhhr.org/i
dep/wvedss_forms.htm
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Provider Investigation (2) http//www.wvdhhr.org/i
dep/wvedss_forms.htm
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Provider Investigation (2) http//www.wvdhhr.org/i
dep/wvedss_forms.htm
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Public Health Investigation (1)
http//www.wvdhhr.org/idep/wvedss_forms.htm
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Public Health Investigation (2)
http//www.wvdhhr.org/idep/wvedss_forms.htm
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Step 9 Prevention and Control Measures

• (In development)
• For schools
• Education
• Surveillance
• Personal hygiene
• Handwashing
• Showering with soap and water
• No sharing of personal items / equipment /
  clothing
• Environmental cleaning

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Step 9 Prevention and Control Measures

• For corrections FBOP guidelines
• http//www.nicic.org/Downloads/PDF/2003/0193
  56.pdf
• Primary prevention (pg 13)
• Education
• Correctional standard precautions
• Hand hygiene program
• Sanitation (environmental cleaning)
• Antibiotic prescribing practices
• Screening and surveillance

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Step 10 Communicate Findings

• Who
• Physicians
• Community
• Schools
• Corrections
• What
• Appropriate antibiotic use
• Other prevention and control measures
• Surveillance

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Resources for Education About Appropriate
Antibiotic Use

• Website
• Get Smart
• Drop in articles for newsletters
• Editorials
• Letters to the editor
• School campaign
• Appropriate antibiotic use
• Hand hygiene and infection prevention measures
• Parent and physician education materials
• Mary A Myers (800)-423-1271 for
• Printed material
• Enrolling a school in the campaign
• Physician visits

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Suggestions for CA-MRSA Investigations

• Investigate
• Outbreaks not sporadic cases
• Use the WVEDSS form
• (or yellow card, supplemental form, lab slip)
• Educate
• Appropriate antibiotic use
• Prevention and control guidelines