Administer vancomycin intravenously as prescribed.
Administer trimethoprim-sulfamethoxazole for minor MRSA infections as prescribed.
Advocate for avoiding unnecessary antibiotics to reduce the occurrence of resistant bacteria.
Avoid the use of topical or systemic agents for nasal or extra-nasal MRSA for decolonization. This is not supported
· Hand Hygiene after contact with blood, body fluids, secretions, excretions and any or all contaminated items whether or not wearing gloves. Immediately after patient contact, after gloves are removed, and/or between tasks on the same patient which may cause cross-contamination to other body parts completely clean hands.
Hand washing with soap or antiseptic –containing soap and water, and use of gels, foams or rinse agents that do not require water.
Hands should be dried with a dry, disposable paper towel, and facets should be turned off using a paper towel
- Standard universal precautions: Standard precautions should be practiced at all times, including handwashing, using gloves, and decontaminating linens and surfaces; regardless of MRSA status.
- Do not touch open wounds or skin sores with your bare hands.
- Wear gloves when changing bandages and properly dispose of the bandage right away after removal.
- Wash hands often throughout the day with soap and water; rub hands for 15-30 seconds each time. Use an alcohol based hand sanitizer if soap and water are not available.
- Shower daily with warm water and an antibacterial soap.
- Wash uniforms in warm to hot water, use bleach if possible and dry on highest setting possible.
- Keep open sores, cuts and scrapes on hands clean and covered with a bandage.
- Maintain nails at one quarter inch and avoid the use of artificial nails.
- Isolation or contact precautions should be implemented according to the type of MRSA infection or colonization
- The individual patient's clinical situation and prevalence or incidence of multi-drug resistant organisms (MDRO) in the facility should be considered when deciding to implement or modify contact precautions in addition to standard precautions for a patient colonized or infected with MRSA (Infectious Disease Epidemiology Section, LA Dept of Health, 2008).
- Transmission-based isolation precautions should be continued for as long as the resident continues to have secretions or excretions that cannot be contained.
- When the condition of a resident changes (e.g. wound drainage is contained), transmission-based isolation precautions can be modified or discontinued.
Implement a system of alerting healthcare workers and visitors that a resident is on contact precautions without compromising the resident's privacy.
Colonized patients: only when the patients are a documented source of transmission to other patients (Nicolle).
Gloves: Gloves (single use, disposable) must be used when touching blood and all body fluids, non-intact skin, and mucous membranes. Gloves should be worn when providing care that involves substantial personal contact such as changing clothes, bedding, etc. If gloves become soiled with potentially infectious material (e.g. urine, stool, blood), they should be changed before further contact with clean surfaces, the patient, or other staff. Remove the gloves after caring for the patient and wash hands with an antibacterial soap before leaving the room. Staff should be trained in these procedures and a competency measured on a yearly or more frequent basis as need arises.
Gowns: Gowns should be worn if the caregiver's clothing is likely to have substantial contact with a MRSA-positive resident in the course of care (e.g. bed baths, lifting). Gowns should be removed immediately after care and the caregiver's hands should be washed prior to leaving the resident's room with an antibacterial soap.
Masks and eye protection: masks are recommended when the patient has MRSA bronchitis or tracheitis, lower bronchial colonization or a tracheostomy, and during care of MRSA-infected burns. If extensive splattering is expected, protective eyewear may be warranted. Eyewear is recommended for intubation, suctioning of the respiratory tract, irrigation of a wound, caring for open tracheostomies, and any condition with the potential for projectile secretions. The National Institute for Occupational Safety and Health (NIOSH) recommends using eye protection that could include goggles, face shields, safety glasses, or full-face respirators depending on the activity being performed. Selection of protective eyewear appropriate for a given task should be made from an evaluation of each activity, including regulatory requirements when applicable (NIOSH, 2004).
Linens: All linen, regardless of the diagnosis of the resident, should be collected and bagged at the bedside. If linen is wet, or saturated with urine or feces, is should be collected in a plastic or fluid impervious bag. All linen should be treated as potentially infectious
Environmental Cleaning: surfaces and equipment that may be contaminated with pathogens be cleaned and disinfected on a regular basis and according to institutional and national guidelines. The areas that are in close proximity to the patient (e.g., bed-rails, over-bed tables), and frequently-touched surfaces in the patient care environment (e.g., door knobs, toilet areas, sinks) should be cleaned on a more frequent basis with an approved disinfectant.
Cleaning of computer equipment used in multi-patient care: recommend that computer cleaning should be done using the same protocols to clean other environmental surfaces in the area and it should be done between each individual patient or patient room. It is also recommended that plastic covers be used if the equipment cannot be cleaned in the same manner, and that equipment being ordered contain as many smooth surfaces as possible. Good hand hygiene should be practiced before using the equipment between patients.
Group Activities: A long-term care facility is normally considered a resident's home. A MRSA-positive resident should be allowed to ambulate, socialize as usual, and participate in therapeutic and group activities as long as contaminated body fluids are contained. When residents leave their room, they should have their hands cleaned. In addition, they should have clean, dry dressings and wear clean clothes. Where appropriate, enhanced barrier protection to contain a contaminated body substance is preferred over restriction of the resident.
A private room is not necessary unless the patient has a condition that would increase the likelihood of transmission (e.g., eczema, a large MRSA-infected or colonized burn, or lower respiratory tract infection).
When placing residents with MRSA in multiple-bed rooms, their roommates should not be severely immunocompromised or have indwelling lines or open wounds.
When single-patient rooms are available, assign priority for these rooms to patients with known or suspected multi drug resistant organism (MDRO) colonization or infection. Give highest priority to those patients who have conditions that may facilitate transmission (e.g., uncontained secretions or excretions).
When single-patient rooms are not available, cohort patients with the same MDRO in the same room or patient-care area. Contaminated rooms may be a risk factor for the acquisition of nosocomial pathogens by unaffected patients.
- Improved hand hygiene has been associated with a sustained decrease in the incidence of MRSA. Hand hygiene can be reduced by restricting the use of artificial nails as they have been shown to harbor more pathogenic organisms.
- Protect open sores by keeping them covered and avoid contact with MRSA infected persons. Decolonization of residents or staff is not routinely recommended as this has not been shown to be effective for large populations because re-colonization occurs.
- If possible try to restrict staff to one cohort of the patient population to avoid cross contamination.
- Reinforce and monitor compliance to infection control procedures throughout the facility.
- Try to keep MRSA patients in private rooms.
- It is not necessary to restrict admissions or discharges to the facility unless it is shown that the facility is not following the proper protocols for those residents that are currently in the facility.
Surveillance in an essential tool for case-finding of single patients or clusters of patients who are infected or colonized with epidemiologically important organisms such as MRSA, for which transmission-based precautions are required. Surveillance is defined as the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health. Surveillance is an important component of all infection control programs, including those in long-term care facilities.
- The long term care facility should maintain a confidential listing of the names and other appropriate information of residents and admissions that are found to be colonized or infected with MRSA. Do not include on the listing residents who are colonized with MRSA in the nares ONLY. These colonized patients should be tracked separately.
- Facilities should regularly monitor and record endemic MRSA case rates using incidence or incidence density ratio (e.g., percent cases or cases per 1,000 resident-days).
- Facilities can use surveillance data in educational programs to reinforce infection control practices and to prioritize infection control activities.
- Staphylococcus aureus: a common species of gram-positive bacteria found on the skin and in the anterior nares of many people
- Methicillin Resistant Staphylococcus aureus (MRSA): strains of S. aureus that are resistant to the antibiotics methicillin, oxacillin, nafcillin and other antimicrobials
- Colonization: the presence of microoroganisms in or on a host with growth and multiplication but without tissue invasion or damage
- Infection: the entry and multiplication of microorganisms in the tissues of the host accompanied by clinical signs and symptoms
- Disinfection: a process that kills or destroys nearly all microorganisms, with the exception of bacterial spores, on inanimate objects