2. 2
1. Discuss the transmission of methicillin-
resistant Staphylococcus aureus (MRSA)
infections.
2. Identify ways to prevent MRSA infections.
3. Identify ways to treat MRSA infections.
3. 3
Six interventions:
1. Deploy rapid response teams.
2. Prevent ventilator-associated pneumonia (VAP).
3. Prevent adverse drug events.
4. Prevent central line infections.
5. Prevent surgical site infections (SSIs).
6. Deliver evidence-based care to treat acute
myocardial infarction (MI).
4. 4
Goal is to prevent 5 million incidents of medical harm
in a 2-year period (12/06 to 12/08)
Six additional interventions:
Reduce surgical complications.
Prevent harm from high-alert medications
Prevent pressure ulcers
Reduce methicillin-resistant Staphylococcus aureus (MRSA)
infection
Deliver reliable, evidence-based care for heart failure
Get boards on board by defining and spreading the best-known
leveraged processes for boards of directors
5. 5
Easily transmitted and drug resistant, MRSA
can survive on hands, clothing, environmental
surfaces, and equipment.
About 126,000 hospitalized patients develop
MRSA infections each year.
Over 5,000 of those patients die.
6. 6
Improve hand hygiene.
Make fastidious environmental cleaning and
disinfection a priority.
Consider performing active surveillance cultures.
Identify colonized patients and implement
contact precautions.
Implement and perform all interventions from
the central line bundle and the ventilator bundle.
7. 7
Staphylococcus aureus is commonly carried on
healthy people’s skin, nares, and perineum.
It may cause superficial skin infections
treatable with beta-lactam inhibitors (such as
methicillin).
Over time, some strains have become resistant.
First cases of MRSA in the United States
occurred in the 1960s.
Today, 46 out of 1,000 patients have MRSA.
8. 8
Using antibiotics appropriately is key.
Encourage cultures before antibiotics are started,
and, if necessary, narrow the spectrum of antibiotics
based on culture results.
Review all culture reports to ensure that bacteria are
sensitive to the prescribed antibiotics.
Teach the patient how to use antibiotics:
Take as prescribed
Finish the course of treatment
Don’t take someone else’s prescribed medication
9. 9
Community-associated MRSA (CA-MRSA)
Causes skin and soft-tissue infections, such as boils, blisters,
abscesses, folliculitis, and carbuncles
Also, fever and local warmth, swelling, pain, and purulent
drainage
Health care-associated MRSA
More highly drug resistant
Causes more invasive infections, such as surgical site infection,
endocarditis, osteomyelitis, bacteremia, pneumonia
“According to the Centers for Disease Control and Prevention definition, a
diagnosis of CA-MRSA requires that the patient have no medical history of
MRSA or colonization and no risk factors associated with
health care–associated MRSA.”
10. 10
CA-MRSA
Person-to-person by sharing personal items (clothing
and towels)
Close contact
Health care-associated MRSA
Contaminated environmental surfaces
Staff members
11. 11
Patients weakened by
disease or injury
Recent hospitalization
or surgery
An invasive device
Surgical wound or
pressure ulcer
Prolonged
hospitalization
Severe underlying
illness
Immunocompromised
status
Undergoing dialysis
I.V. drug abuse
Diabetes
Burns
Dermatitis
Previous exposure to
broad-spectrum
antibiotics
Proximity to patient
colonized or infected
with MRSA
12. 12
Incision and drainage, followed by routine
wound care
Broad-spectrum antibiotic, changed as
indicated based on susceptibility testing
Local antibiograms should be used to guide
antibiotic therapy
13. 13
1. Perform hand hygiene.
2. Make sure patient rooms are cleaned well and
often.
3. Actively look for MRSA.
4. Implement contact precautions to prevent
transmission.
5. Bundle up best practices.
14. 14
After each glove change and when entering
and exiting any patient’s room
Alcohol-based sanitizers are a suitable
substitute as long as hands aren’t visibly soiled
or grossly contaminated.
Use appropriate technique
Focus on fingernails, nail beds, between fingers, and
around thumbs
Keep jewelry to a minimum; clean under your rings
and watch
15. 15
MRSA survives for hours or days in the
environment.
Surfaces and equipment must be cleaned,
especially between patients.
Make sure that every item that comes out of a
MRSA patient’s room is cleaned.
If patient is on contact precautions,
housekeeping should clean the room daily.
16. 16
Active surveillance refers to taking cultures of a
group of people to see if they’re colonized with
MRSA.
Each infection-control program should evaluate
the benefit of active surveillance cultures.
Some facilities culture all patients on admission;
others culture certain groups, such as ICU patients
or those being admitted from long-term care
facilities.
A person colonized with MRSA carries the
bacteria; although he has no signs or symptoms, he
can transmit it to others.
17. 17
Reservoirs for MRSA
Anterior nares (most common)
Skin of the axillae, perineum, hands, arms
Gastrointestinal tract
Ostomy sites
Pressure ulcers and other wounds
Sputum
Drug susceptibility testing can differentiate
MRSA from S. aureus
Active surveillance cultures of the anterior nares will identify 80% of
colonized adults. Cultures of clinical specimens identify patients
infected but won’t detect up to 85% of colonized patients.
18. 18
Active surveillance is controversial and
challenging.
If used, it must be combined with other control
efforts, such as contact precautions.
Be aware of facility transmission rates–it helps
reinforce what works well to stop transmission.
19. 19
Anatomic location – make sure the area from
which the specimen was taken is correct.
Gram stain report – look for the presence of
white blood cells (indicates infection).
Antibiogram – identifies susceptible and
resistant antibiotics.
Organisms – know the epidemiology of the
isolated organism.
Source
Potential for multiple-drug resistance
Mode of transmission
20. 20
Always wear a gown and gloves when caring
for infected or colonized patients.
Always perform hand hygiene between
patients and as you leave each room and after
removing gloves.
Follow contact precautions for those infected or
colonized.
Remember that a patient on contact precautions requires the
same level of care and attention as any other patient.
21. 21
Private room for those infected or colonized (if
not possible, use visual cues, such as signs or a
line on the floor to remind everyone).
Cohort patients with MRSA, if necessary.
Gloves and gowns for caregivers and visitors
(keep a supply handy).
Use dedicated patient-care equipment or
disposable equipment.
Clean equipment upon removal from room.
Discontinue precautions when appropriate (at
least three negative cultures on separate days).
22. 22
A colonized patient is more likely to develop a
MRSA infection because he already has the
bacteria as part of his normal flora.
Central line bundle and ventilator bundle
implemented to reduce or eliminate device-
related infections.
Review these bundles in detail at
http://www.ihi.org.
