Methicillin resistant Staphylococcus aureus (MRSA)

 

Why is it important?

 

Methicillin resistant Staphylococcus aureus (MRSA) has been recognized since the 1970's as a major hospital acquired pathogen that has caused problems in hospitals and other health care institutions worldwide. MRSA is a type of staph that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as, oxacillin, penicillin and amoxicillin. Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities such as nursing homes, who have weakened immune systems. Infected and colonized residents may serve as potential sources for the spread of MRSA in long-term care facilities. Residents are at increased risk of resistant infection due not only to colonization, but also to chronic illness and debilitation, multiple exposure to antimicrobial agents, presence of pressure ulcers, and indwelling devices. Elderly residents are at increased risk for colonization with MRSA, in addition to having the potential to carry MRSA for long periods of time.

MRSA has emerged as one of the predominant pathogens in healthcare-associated infections. According to the Centers for Disease Control (CDC) data, the proportion of infections that are antimicrobial resistant has been growing. In 1974, MRSA infections accounted for two percent of the total number of staph infections; in 1995 it was 22%; in 2004 it was 63%. Approximately 20% to 25% of patients admitted to long-term care facilities are colonized with MRSA, and another 10% will acquire the organism during their stay.

Treatment options are limited and less effective, resulting in higher patient morbidity and mortality. And the high prevalence is a major influence on unfavorable antibiotic prescribing which contributes to the further spread of resistance. MRSA also adds to the overall staphylococcus aureus infection burden.

Objectives

Through this learning module and clinical resource, you will learn to:

·         Develop an overall understanding of Methicillin Resistant Staphylococcus aureus. 

·         Explain the prevalence of MRSA and the importance for further research

·         Discuss behaviors that reduce the risk of transmission of MRSA

·         Implement evidence based-practice guideline/strategies in your facility in the care of older adults with MRSA

Science behind it

Symptoms:

Staph skin infections, including MRSA, generally start as small red bumps that resemble pimples, boils or spider bites. These can quickly turn into deep, painful abscesses that require surgical draining. Sometimes the bacteria remain confined to the skin. But they can also penetrate into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs. Fever, chills, low blood pressure, joint pains, severe headaches, shortness of breath, and "rash over most of the body" are symptoms that need immediate medical attention, especially when associated with skin infections.

Most MRSA infections are skin infections that produce the following signs and symptoms:

 

So: Any sign or symptom of skin infection or other infection needs to considered suspect as MRSA.

Causes:

MRSA is a strain of staph that is resistant to the broad-spectrum antibiotics commonly used to treat it. Staph bacteria are normally found on the skin or in the nose of about one-third of the population. If you have staph on your skin or in your nose but aren't sick, you are said to be "colonized" but not infected. Healthy people can be colonized and have no ill effects. However, they can pass the germ to others.

Staph bacteria are generally harmless unless they enter the body through a cut or other wound, and even then they often cause only minor skin problems in healthy people. However, staph infections can cause serious illness especially among older adults and people who have weakened immune systems, usually in hospitals and long term care facilities

So: Consider nursing home residents at-risk for MRSA and potential transfer of germs needs to be considered at all times

 

Leading causes of antibiotic resistance include unnecessary antibiotic (inappropriate use and mutation of germs) use as well as exposure to antibiotics in food and water.

So: Avoid unnecessary exposure to antibiotic use

Control of Transmission :

As with vancomycin-resistant enterococci (VRE), an individual with MRSA can either be infected (showing clinical signs/symptoms, e.g. fever, lesions, wound drainage) or colonized (MRSA is present in or on a body site without clinical signs/symptoms), and in either case is capable of transmitting it to others.

 

So:  Recognize that transmission can occur with or without clinical signs/symptoms

 

 

So what does this mean?

How MRSA Spreads in Healthcare Settings:

When we talk about the spread of an infection, we talk about sources of infection - where it starts, and the way or ways it spreads - the mode or modes of transmission. In the case of MRSA, patients who already have an MRSA infection or who carry the bacteria on their bodies but do not have symptoms (colonized) are the most common sources of transmission.

The main mode of transmission to other patients is through human hands, especially healthcare workers' hands. Hands may become contaminated with MRSA bacteria by contact with infected or colonized patients. If appropriate hand hygiene such as washing with soap and water or using an alcohol-based hand sanitizer is not performed, the bacteria can be spread when the healthcare worker touches other patients.

People with higher risk of MRSA infection are those with obvious skin breaks (surgical patients, hospital patients with intravenous lines, burns, or skin ulcers) and patients with depressed immune systems (infants, elderly, or HIV-infected individuals) or chronic diseases (diabetes or cancer). Patients with pneumonia (lung infection) due to MRSA can transmit MRSA by airborne droplets. Health-care workers as a group are repeatedly exposed to MRSA-positive patients and can have a high rate of infection if precautions are not taken. Health-care workers should use disposable masks, gowns, and gloves when they enter the MRSA-infected patient's room.

Residents and their families and visitors should be educated about MRSA infections and the precautions to be taken in the long-term care facility. Family and visitors should clean their hands before entering and leaving the room of a resident who has MRSA. Family/visitors should wear gloves when handling the secretions/excretions of the resident or when providing direct care. Families and visitors and other residents must have sufficient education to alleviate their concerns, ensure that precautions are maintained, and understand that residents with MRSA need to be avoided.

Common risk factors for acquiring MRSA:

How is MRSA diagnosed?

A skin sample, pus on the skin, or blood, urine, or biopsy material (tissue sample) is sent to a microbiology lab and cultured for Staphylococcus aureus. If Staphylococcus aureus is isolated (grown on a Petri plate), the bacteria are then exposed to different antibiotics including methicillin. Staphylococcus aureus that grows well when methicillin is in the culture are termed MRSA, and the patient is diagnosed as MRSA-infected. The same procedure is done to determine if someone is an MRSA carrier (screening for a carrier), but sample skin or mucous membrane sites are only swabbed, not biopsied.

In 2008, the U.S. Food and Drug Administration (FDA) approved a rapid blood test that can detect the presence of MRSA genetic material in a blood sample in as little as two hours. The test is also able to determine whether the genetic material is from MRSA or from less dangerous Staph bacteria. The test is not recommended for use in monitoring treatment of MRSA infections and should not be used as the only basis for the diagnosis of a MRSA infection.

Interventions/Major Recommendations

 

A

Administer vancomycin intravenously as prescribed.

A

Administer trimethoprim-sulfamethoxazole for minor MRSA infections as prescribed.

 A

Advocate for avoiding unnecessary antibiotics to reduce the occurrence of resistant bacteria.

 

A

Avoid the use of topical or systemic agents for nasal or extra-nasal MRSA for decolonization.  This is not supported

 

A

·         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


A

 

B

 

B

Implement a system of alerting healthcare workers and visitors that a resident is on contact precautions without compromising the resident's privacy.

 

 

B

Colonized patients: only when the patients are a documented source of transmission to other patients (Nicolle).

B

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.

 B

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.

 B

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

B

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.

 B

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.

 B

 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.

 C

Room Placement/Cohorting:

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.

C

Outbreak Control:

Surveillance:

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. 

 

Definitions:

 

Evaluation

Expected Outcome

Patient

Health Care Provider

Institution

 

 

Module Development

This module was developed by Damita Carryer, Brenda Kirby, Melissa Miller, and Melinda Seifers as a part of the course requirements for N626 as graduate nursing students at Winona State University, Spring semester 2009 under the direction of course faculty member Phyllis Gaspar, Ph.D., RN.  Review was completed by Constance Schein, M.Sc., RN July 2009.

 

The development of this module was supported through a Stratis Health Building Healthier Communities Award.

 

 

References

Arnow, P. M., Allyn, P. A., Nichols, E. M., Hill, D. L., Pezzlo, M., & Bartlett, R. H. (1982). Control of methicillin-resistant Staphylococcus aureus in a burn unit: Role of nurse  staffing. The Journal of Trauma, 22(11), 954-959.

 

Boyce, J. (2004). New Insights for improving hand hygiene practices. Infection Control and Hospital Epidemiology, 25(3), 187-188.

 

Bradley, S. F. (1999). Methicillin-resistant Staphylococcus aureus: Long term care concerns. The American Journal of Medicine, 106(5), 2-10.

 

Bradley, S. F., Terpenning, M. S., Ramsey, M. A., Zarins, L. T., Jorgensen, K. A, Sottile, W. S., et al. (1991). Methicillin-resistant Staphylococcus aureus: Colonization and infection in a long-term care facility. Annals of Internal Medicine, 115(6), 417-422.

 

Byers, K. E., Anglim, A. M., Anneski, C. J., Germanson, T. P., Gold, H. S., Durbin, L. J., et al. (2001). A hospital epidemic of vancomycin-resistant Enterococcus: Risk factors and control. Infection Control and Hospital Epidemiology, 22(3), 140-147.

 

Capitano, B., Leshem, O. A., Nightingale, C. H., & Nicolau D. P. (2003). Cost effect of managing methicillin-resistant Staphylococcus aureus in a long-term care facility. Journal of the American Geriatrics Society, 51, 10-16.

 

Cepeda, J. A., Whitehouse, T., Cooper, B., Hails, J., Jones, K., Kwaku, F, et. al. (2005). Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive care units: Prospective two center study. The Lancet, (365), 295-304.

 

Chou, A. F., Yano, E. M., McCoy, K. D., Willis, D. R., Doebbeling, B. N. (2008). Structural and process factors affecting the implementation of antimicrobial resistance prevention and control strategies in U.S. Hospitals. Health Care Management Review, 33(4), 308-322.

 

Dancer, S. (2008). Considering the introduction of universal MRSA screening. Journal of the Hospital Infection, 69, 315-320.

 

Darnowski, S. B, Gordon, M., & Simor, A. E. (1991). Two years of infection surveillance in a geriatric long-term care facility. American Journal of Infection Control, 19(4), 185-190.

 

Dieekma, D., & Climi, M. (2008). Preventing MRSA infections: Finding it is not enough. Journal of the American Medical Association, 299(10), 1190.

 

Drinka, P. J., Gauerke, C., & Le, D. (2004). Antimicrobial use and methicillin-resistant Staphylococcus aureus in a large nursing home. Journal of the American Medical Directors Association, 5, 256-258.

 

Eveillard, M., Eb, F., Tramier, B., Schmit, J. L.,  Lescure, F. X.,  Biendo, M., et al. (2001). Evaluation of the contribution of isolation precautions in prevention and control of multi-resistant bacteria in a teaching hospital. Journal of Hospital Infection, 47, 116-124.

               

Flores, A. (2007). Appropriate glove use in the prevention of cross-infection. Nursing Standard, 21(35), 45-48.

 

Furuno, J. P., Hebden, J. A., Standiford, H. C., Perencevich, E. N., Miller, R. R., Moor, A. C, et. al.(2008).  Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacterbaumannii a long-term care facility. American Journal of Infection Control, 36(7), 468-471.

 

Harbath, S. (2006) Control of endemic methicillin-resistant Staphylococcus aureus-recent advances and future challenges. Clinical Microbiology and Infection, 12(12), 1154-1162.

 

Healthcare Infection Control Practices Advisory Committee. (2006). Management of multidrug- resistant organisms in healthcare settings. Retrieve October 2, 2008 from http//www.cdc.gov/ncidod/dhqp/pdf/ar_mrsaspotlight_2006.

 

Henderson, D. (2006). Managing methicillin-resistant staphylococci: A paradigm from preventing transmission of resistant organisms. American Journal of Infection Control, 34(5), 546-54.

 

Holcomb, S. (2008). MRSA infections. Nursing 2008, 38(6), 33-34.Hota, B. (2004). Contamination, disinfection, and cross-colonization: Are hospital surfaces reservoirs for nosocomial infection? Healthcare Epidemiology, 2004:39, 1182-1189.

 

Huang, T., & Wu, S. (2007). Evaluation of a training programme on knowledge and compliance of  nurse assistants' hand hygiene in nursing homes. Journal of Hospital Infection, 68, 164-170.

 

Hughes, C. M., Smith, M. B., & Tunney, M. M. (2008). Infection control strategies for preventing the transmission of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people. Cochrane Database of Systematic Reviews. (1):CD006354, 2008.

 

Institute for Healthcare Improvement (IHI). (2006). Fact Sheet: Protecting 5 Million Lives. Retrieved October 2, 2008, from http//www.ihi.org/IHI/Programs/Campaign.

 

Jackson, M. M., Fierer, J., Barrett-Connor, E., Fraser, D., Kaluber, M. R., Hatch, R., et al. (1992). Intensive surveillance for infections in a tree-year study of nursing home residents.  American Journal of Epidemiology, 135(6), 685-696.

 

Jarvis, W. R., Schlosser, J., Chinn, R. Y,. Tweeten, S., & Jackson, M. (2007).National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006. American Journal of Infection Control, 35(10), 631-637.

 

Klevens, R. M., Morrison, M. A., Nadle, J., Petit, S., Gershman, K., Ray, S., et al. (2007). Invasive  methicillin-resistant Staphylococcus aureus infections in the United States. Journal of the American Medical Association, 298(15), 1763-1771.

 

Lee, Y. L, Trupp, L. D., Friis, R. H., Fine, M., Maleki, P., Cesario, T. C. (1992). Nosocomial infection and antibiotic utilization in geriatric patients: A pilot prospective surveillance program in skilled nursing facilities. Gerontology, 38, 223-232.

 

Loeb, M., Main, C., Walker-Dilks, C., Eady, A. (2003). Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database of Systematic Reviews. Retrieved November 26, 2008, from http://www.cochrane.org/reviews/en/ab003340.html

 

Makris, A. T., Morgan, L., Gaber, D. J., Richter, A., & Rubino, J. R. (2000). Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities. American Journal of Infection Control, 28(1), 3-7.

 

Marra, A., D'Arco, C., Bravim, B., Martino, M., Correa, L., Silva, C., et al. (2008) Controlled trial measuring the effect of a feedback intervention on hand hygiene compliance in a step-down unit. Infection Control and Hospital Epidemiology, 29(8), 730-735.

 

Maryland Department of Health and Mental Hygiene. (2002). Guideline for control of methicillin-resistant Staphylococcus aureus (MRSA) in long term care facilities. Community Health Administration. Retrieved September 25, 2008, from http:www.cha.state.md.us/edcp/guidelinesmrsa.html.

 

Mayer, R. A, Geha, R., Helfand, M. S., Hoyen, C.K., Salata, R. A., & Donskey, C. J.(2003).  Role of fecal incontinence in contamination of the environment with vancomycin resistant Enterococci. American Journal of Infection Control, 31(4), 221-225.

 

Mayo Clinic. (2008). Diseases and Conditions. Retrieved November 28, 2008 from http://www.mayoclinic.com/health/mrsa/DS00735

 

McGuckin, M., Taylor, A., Martin, V., Porten, L., & Salcidon, R. (2004). Evaluation of a patient education model for increasing hand hygiene compliance in an inpatient rehabilitation unit. American Journal of Infection Control, 32(4), 235-238.

 

McKibben, L., Horan, T. C., Tokars, J.  I., Fowler, G., Cardo, D. M., Person, M. L. et. al. (2005). Guidance on public reporting of healthcare-associated infections: Recommendation of the Healthcare Infection Control Practices Advisory Committee. Infection Control and Hospital Epidemiology, 26(6), 580-587.

 

Mody, L., Kauffman, C. A., Donabedian, S., Zervos, M., & Bradley, S. F. (2008). Epidemiology of  Staphylococcus aureus colonization in nursing home residents. Clinical Infectious Diseases, 46, 1368-1373.

 

Morbidity and Mortality Weekly Report. (2002, October 25). Guideline for hand hygiene in health-care settings. Retrieved October 2, 2008 from, http:www.cdc.gov/mmwr.

 

Muder, R. R., Cunningham, C., McCray, E., Squier, C., Perreiah, P., Jain, R., et al.(2008). Implementation of an industrial systems-engineering approach to reduce the incidence of methicillin-resistant Staphylococcus aureus infection. Infection Control and Hospital Epidemiology, 29(8), 702-708.

 

Mylotte, J. M. (1999). Antimicrobial prescribing in long-term care facilities: Prospective evaluation of  potential antimicrobial use and cost indicators. American Journal of Infection Control, 27(1), 10-19.

 

National Institute for Occupational Safety and Health. (2004). Eye protection for infection control. Retrieved November 4, 2008, from http://www.cdc.gov/niosh/topics/eye/eye-infections.html

 

Neely, A. N., Weber, J. A., Daviau, P., MacGregor, A., Mirancda, C., Nell, M., et al. (2005). Computer equipment used in patient care within a multihospital system: recommendations for cleaning and disinfection. American Journal of Infection Control, 33(4), 233-237.

 

Nicolle, L. E. (2001) Preventing infections in non-hospital settings: Long-term care. Center for Disease Control, 7(2), Retrieved October 10, 2008, from http:www.cdc.gov/ncidod/eid/vol7no2/nicoll.html

 

Nicolle, L. E., Bentley, D. W., Garibaldi, R., Neuhaus, E. G., & Smith, P. W.(2000).  Antimicrobial use in long-term care facilities. Infection Control and Hospital Epidemiology, 21(8), 537-545.

 

Office of Public Health Louisiana Department of Health and Hospitals. (2008). MRSA guidelines for long term care facilities (LTCF). Retrieved October 5, 2008, from http://www.infectiondisease.louisiana.dhh.gov

 

Pittett, D. (2008). Hand hygiene: It's all about when and how. Infection Control and Hospital Epidemiology, 29(10), 957-957.

 

Pop-Vicas A., Mitchell, S. L., Kandel, R., Schreiber, R., & D'Agata, E. M. (2008).Multidrug- resistant gram-negative bacteria in a long-term care facility: prevalence and risk factors. Journal of the American Geriatrics Society, 56, 1276-1280.

 

Rice, L. (2006). Antimicrobial resistance in gram-positive bacteria. American Journal of Infection Control, 34(5), S11-19.

 

Richmond, I., Berstein, A., Creen, C., Cunningham, C., & Rudy, M. (2007). Best practice protocols: Reducing harm from MRSA. Nursing Management, 22-27.

 

Rollins, G. (2008). Curbing hospital-acquired infections: Hand hygiene compliance remains a goal unrealized. Materials Management in Health Care, 17(7), 22-29.

 

Romero, D. T. (2006). Hand-to-hand combat: Preventing MRSA infection.  Advances in Skin and Wound Care, 19(6), 328-333.

 

Rutala, W. A., & Weber, D. (2004). Disinfection and sterilization in health care facilities: What clinicians need to know. Healthcare Epidemiology, 39, 702-709.

 

Sadar, N. M. (2006). Effectiveness of preemptive barrier precautions on controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit. American Journal of Infection Control, 34(8), 476-483.

 

Sample, M. L., Gravel, D., Oxley, C., Toye, B., Garber, G., & Ramotar, K. (2002). An outbreak of vancomycin-resistant Enterococci in a hematology-oncology unit: control by patient cohorting and terminal cleaning of the environment. Infection Control and Hospital Epidemiology, 23(8), 468-470.

 

Sawaya, G., Gulrguls-Blake, J., LeFevre, M., Harris, R., Petitti,D. (2007). Updates on the methods of the U.S. preventative services task force: Estimating certainty and magnitude of net benefit. Annals of Internal Medicine, 147, 871-875.

 

Scanvic, A., Denic, L., Gaillon, S., Giry, P., Andremont, A., & Lucet, J. C. (2001). Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clinical Infectious Diseases, 32, 1393-1398.

 

Siegel, J., Rhinehart, E., Jackson, M., Chiarello, L., and the Healthcare Infection Control Practices Advisory Committee. (2007, June). Guideline for Isolation Precautions: Preventing transmission of infections agents in healthcare settings, retrieved October, 2008 from http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf.

 

Smith, A. C. (2008). Hand hygiene practices of health care workers in long-term care facilities. American Journal of Infection Control, 36(7), 492-494.

 

Stone, N. D., Lewis, D. R, Lowery, H. K., Darrow, L. A., Kroll, C. M., Gaynes, R. P., et, al.(2008). Importance of bacterial burden among methicillin-resistant Staphylococcus aureus carriers in a long-term care facility. Infection Control and Hospital Epidemiology, 29, 143-148.

 

Strausbaugh, L., Crossley, K., Nurse, B., Trupp, L. (1996). Antimicrobial resistance in long- term-care facilities. Infection Control and Hospital Epidemiology, 17, 129-140.

 

Suetens, C., Niclaes, L., Jans, B., Verhaegen, J., Schuermans, A., Van Eldere, J., et. al. (2006). Methicillin-resistant Staphylococcus aureus colonization is associated with higher mortality in nursing home residents with impaired cognitive status. Journal of the American Geriatrics Society, 54, 1854-1860.

 

Talon, D., Vichard, P., Muller, A., Bertin, M., Jeunet, L., & Bertrand, X. (2003). Modeling the usefulness of a dedicated cohort facility to prevent the dissemination of MRSA. Journal of Hospital Infection, 54, 57-62.

 

Tarzi, S., Kennedy, P., Stone, S., Evans, M. (2001). Methicillin-resistant Staphylococcus aureus: Psychological impact of hospitalization and isolation in an older adult population. Journal of Hospital Infection, 49, 250-254.

 

Tokars, J. I., Richards, C., Andrus, M., Klevens, M, Curtis, A., Horan, T., et al. (2004). The changing face of surveillance for health care-associated infections. Healthcare Epidemiology, 2004:39,1347-1352.

 

Trick, W. E., Weinstein, R. A., DeMarais, P. L. , Kuehnert, M. J., Tomaska, W., Nathan, C.,et al.(2001). Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. Journal of the American Geriatric Society, 49(3), 270-276.

 

U.S. Food and Drug Administration. (2008, January 2). FDA clears first quick test for drug-resistant Staph infections. Retrieved September 26, 2008, from FDA News: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01768.html

 

Widmer, A., Conzelmann, M., Tomic, M., Frei, R., & Stranden, A. (2007). Introducing alcohol-based hand rub for hand hygiene: The critical need for training. Infection Control and Hospital Epidemiology, 28(1), 50-54.

 

Wolf, R., Lewis, D., Cochran, R., & Richards, C. (2008). Nursing staff perceptions of methicillin-resistant Staphylococcus aureus and infection control in a long-term care facility. Journal of the American Medical Directors Association, 9, 342-346.

 

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