BEST PRACTICES: MRSA PRECAUTIONS

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BEST PRACTICES MRSA PRECAUTIONS

• Dr. Elizabeth Bryce

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Topics to Be Covered

• Devising Risk Strategies
• Risk Assessment for Level of Precautions
• Determining the Need for Additional Precautions

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Devising Risk Strategies Waxing Philosophical

• To develop effective prevention strategies must
• understand the components responsible for the
  current state in your facility
• Rates of Community acquired MRSA
• Rates of Healthcare Acquired MRSA
• Rates in your Facility
• The same situation?
• Very high rates of CMRSA high incidence of
  HCMRSA endemic in facility VS
• Little CMRSA little HCMRSA low facility rates

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Risk management strategies

• BUT also consider
• Your Patient Population
• Your Environment
• Impact of implementation plan/procedures
• Feasibility
• Probability of Effectiveness of measures

What is the goal of your strategy?
MRSA Eradication
MRSA Control?
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But Wait ..Theres More!

• Who will you target?
• The Facility Population?
• Just Inpatients? Or Residents?
• Pre-Admit Population (prior to admission)
• The Community?

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Risk Assessment

• Transmission and persistence determined by
• Vulnerable patients
• Selective antimicrobial pressure
• Colonization pressure
• Impact of implementation strategies
• Continued adherence to prevention (long-term
  investment)

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Risk Assessment

• Two components to remember
• Organizational risk assessment which sets policy
  and procedure
• Individual risk assessment with each patient
  interaction

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General Control Interventions

• Administrative Support
• Antimicrobial Stewardship
• Surveillance
• Environmental Cleanliness
• Routine/Contact Precautions
• Education
• Additional Precautions
• Critical Review of implementation strategies

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Administrative Support

• Fiscal Resources
• Human Resources
• Implementing System Changes
• Physical Plant Changes
• Promoting Adherence/Role Modeling
• Fostering a Safety Climate

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Antimicrobial Stewardship

• Shortest duration possible
• Narrowest spectrum possible
• Treat the patient, not the report!
• Formulary Reviews
• Built-in Compliance features in Pharmacy
• Practice Guidelines

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Environmental Cleanliness

• Correct Agent/Dilution
• Correct method
• Avoid Clutter
• Focus on frequently touched surfaces
• Isolation Cleaning Protocols
• Dont forget shared equipment

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Education

• Many different strategies
• Facility-wide versus focused
• Informational, interactive, training, campaigns
• Ideally behaviour change oriented
• And trying to effect a culture change

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Routine Precautions

• Have an essential role in preventing transmission
  always
• Particularly important vis a vis undetected cases
• Hand Hygiene particularly important here as is
  Risk Assessment

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Additional Precautions

• Very important to consider the context and the
  situation
• Contact Precautions
• Evidence Consensus versus evidence based
  recommendation.
• Elements single/isolation rooms or cohorting,
• use of gown and gloves for potential patient
  contact or contact with contaminated areas
• Unresolved
• Duration of CP
• Impact of CP on patient well-being and care
• Use of CP preemptively

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Other Barriers

• For the most part as per Routine Precautions
• Mask anticipated exposure to droplets/secretions
  
• Respirator generally not specifically for MRSA
• Facial Protection anticipated exposure to
  droplets/secretions

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Other Measures

• Notifying others of patient transfers or
  diagnostic procedures
• Ensuring patients clean hands and cover open
  wounds when outside room
• Visitors informed of appropriate precautions
• Education of patient

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Finally

• Control of MRSA should be
• Dynamic
• Systematic
• Tailored to reflect the epidemiology/environment
• Flexible can be scaled up or down
• Measured
• Strive to Assess the problem, evaluate the
  effectiveness of the measures implemented.

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References

• Taconnelli E MRSA risk assessment and
  infection control policies. Clin Microbiol
  Infect 2008
• Humphreys H National guidelines for the control
  and prevention of MRSA what do they tell us?
  Clin Microbiol Infect 200713846-853
• PICNet revised ARO guidelines Dec 2007
• Sigel J Management of multidrug-resistant
  organisms in healthcare settings, 2006 Am J
  Infect control 200735S165-193
• Coia JE Guidelines for the ontrol and prevention
  of MRSA in healthcare facilities. J Hosp Infect
  200763SS1-S44