Methicillin resistant staphylococcus aureus secondary prevention
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Directions to Hospitals Treating Methicillin resistant staphylococcus aureus |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Secondary Prevention
Culturing of Personnel and Management of Personnel Carriers of MRSA:
Unless the objective of the hospital is to eradicate all MRSA carriage and treat all personnel who are MRSA carriers, whether or not they disseminate MRSA, it may be prudent to culture only personnel who are implicated in MRSA transmission based on epidemiologic data. MRSA-carrier personnel, who are epidemiologically linked to transmission, should be removed from direct patient care until treatment of the MRSA-carrier status is successful. If the hospital elects to culture all personnel to identify MRSA carriers, a) surveillance cultures need to be done frequently, and b) it is likely that personnel colonized by MRSA who are not linked to transmission and/or who may not be MRSA disseminators will be identified, subjected to treatment, and/or removed from patient contact unnecessarily. Because of the high cost to perform repeated surveillance cultures and the potential of repeated culturing to result in serious consequences to health care workers, hospitals should weigh the advantages and the adverse effects of routinely culturing personnel before doing so.
Control of MRSA Outbreaks:
When an outbreak of MRSA infection occurs, an epidemiologic assessment should be initiated to identify risk factors for MRSA acquisition in the institution. Clinical isolates of MRSA should be saved and submitted for strain typing. Colonized or infected patients should be identified as quickly as possible, appropriate barrier precautions should be instituted, and handwashing by medical personnel before and after all patient contacts should be strictly adhered to.
All personnel should be re-instructed on appropriate precautions for patients colonized or infected with multi-resistant microorganisms and on the importance of handwashing and barrier precautions in preventing contact transmission.
If additional help is needed by the hospital, a consultation with the local or state health department or CDC may be necessary.
Recommendations for preventing transmission of Methicillin-resistant Staphylococcus aureus (MRSA) in acute care hospitals
- Basic practices for prevention and monitoring of MRSA transmission include:
- Conduct MRSA risk assessment
- Implement MRSA monitoring program
- Promote compliance with Centers for Disease Control and Prevention or World Health Organization hand-hygiene recommendations
- Use contact precautions for MRSA-colonized or -infected patients
- Ensure cleaning and disinfection of equipment and environment
- Educate healthcare personnel and patients
- Implement an alert system notifying clinical personnel of new cases of MRSA
- Assign accountability
- Special approaches for prevention of MRSA transmission in hospitals with unacceptably high MRSA rates including:
- Implement an MRSA active surveillance testing program
- Routinely bathe adult patients with chlorhexidine
- MRSA decolonization therapy (e.g. 2% intranasal mupirocin with or without chlorhexidine