Visit to Erasmus University Hospital Rotterdam

1
MRSA Control Measures

• Visit to Erasmus University Hospital -Rotterdam

Drs.Kerby Rajans visit 25th-26th May 2005
2
Standards of Hygiene

• National and local guidelines followed
• Training of all health care workers. Early
  introduction in curriculum in medical and nursing
  students and allied professions i.e. PT OT
  principles of good hygiene
• Cleaning contracted to private firm who are
  responsible to the hospital housekeeping
  department. Cleaning procedures are guided by a
  national protocol. It is the responsibility of
  the Manager of the housekeeping dept. to ensure
  all workers strictly adhere to the guidelines.

3
Infection Control Team

• Each hospital has an infection control team. In
  the Erasmus hospital headed by the Microbiology
  Dept.
• Team from Medical,Nursing,ITU,Microbiology,V
  irology, CSSD,Housekeeping Dept. Director of
  Hospital. All conversant with National Local
  guidelines which include detection of MRSA and
  Transportation of Patients from abroad

4
Investigation Identification of Infection

• In Hospital
• In Community
• Positive Cultures enhanced using enriched media
• Reception area identified in Microbiology
  Laboratory both from Hospital patients from
  those discharged home

5
Antibiotic Policy

• Primary care
• Hospital
• Only to be administered after sensitivity tests.
• Hospital policy to be enforced by Dept.of
  Microbiology only and not left to Ward Clinicians.

6
Patients

• Isolation for inpatients from residential homes,
  other hospitals and from abroad- includes
  children adopted from abroad.
• Isolation until proved negative (usually 5 days)
• Visitors must report to Ward Manager before
  visiting or leaving hospital immediately after
  the visit.

7
Risk Classification

• Class A-Proven carriers
• Class B-High Risk of being MRSA carriers.
• Class C-Increased risk of being MRSA carriers
• Class D-No Risk
• Class A B- ref previous slide
• Class C-e.g. patient receiving dialysis abroad
  ref previous slide

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Health Care workers

• All should have swabs routinely for MRSA,i.e
  nasal,throat,perineum and groin
• If proved positive banned from work until clear,
  usually 5-10 days. Swabs repeated in 1 year.
• Increased risk swabs then only work in the
  department until proved negative

9
Hospital Uniforms Data handling

• Responsibility of the Hospital and not
  individuals
• No handling of data paper records-the data is in
  bar codes accessible directly to wards ,clinics
  and general practitioners.
• MRSA CAN STAY ON PAPER OR FOIL FOR UP TO 25 WEEKS

10
Infection

• Staff dealing with suspected or proven MRSA
  should wear cap,gown,mask gloves
• All should be disposed in a bin inside the door
  of the room, then hands washed in soap water.
• Finally liquid solution (70 alcohol)-superior to
  gel (60 alcohol)

11
MRSA Outbreak

• Inform MRSA outbreak committee
• Ward closed to admissions
• No entrance without Gowns etc
• Personnel stay in closed wards
• Daily disinfection of rooms and passages
• Culture round repeated with each new finding
• Culture to Molecular Biology Dept. for
  identifying new strains of MRSA

12
Closed Wards

• All patients and personnel proven negative
• Disinfection of entire ward
• Disposal of non disinfected paraphernalia

13
Critical Success factors

• National Policy
• National Laboratory Guidelines for MRSA
• National Guidelines for transporting patients
  from abroad
• Infection Control committee
• All hospitals implement National guidelines
• Infection Control for Communities
• Trained health workers

14
Mainstay
"Search and Destroy strategy"
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