Danae Bixler, MD, MPHInfectious Disease Epidemiology Program
West Virginia Bureau for Public HealthWest Virginia Department of Health and Human
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ObjectivesObjectivesParticipants should understand
Staphylococcus aureusMRSASurveillance (documentation via line list)Diagnosis and treatmentPreventionOutbreak management guidanceEducational materials
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Staphylococcus aureusStaphylococcus aureusCommon skin organism
~ 1 in 3 persons are … carriersMild skin infections commonSevere, life threatening infections
Very youngVery oldChronic conditions
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Methicillin resistant Methicillin resistant Staphylococcus aureusStaphylococcus aureusS. aureus resistant to most commonly used effective
antibioticsThe most common cause of skin infections:
ChildrenYoung adults
Severe, life-threatening infections:Very youngVery oldChronic conditions
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Contaminated Surfacesand Shared Items
Frequent Contact
Cleanliness
Crowding
Compromised Skin
Antimicrobial Use
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Screening and SurveillanceScreening and SurveillanceFederal Bureau of Prisons Clinical Practice Guidelines, 2005
IntakeRecently hospitalized inmatesInmates at risk during routine medical evaluation
DiabetesDialysisSkin compromise
Monitor bacterial culture resultsObservations by correctional workersDocument ongoing surveillance (line list)
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Diagnosis and TreatmentDiagnosis and Treatment Federal Bureau of Prisons Clinical Practice Guidelines, 2005
DiagnosisSkin examinationCulture
TreatmentWarm soaksIncision and drainageRemove foreign devicesAntibiotic therapy
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Primary PreventionPrimary Prevention
(prevention activities BEFORE you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005
EducationCorrectional standard precautions
Regular hand hygieneAssume all body fluids are infectious / use gloves:
Blood Feces Urine Saliva / mucous / sputum Wound drainage
Safe disposal of sharpsSafe placement of inmates
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Primary Prevention (2)Primary Prevention (2) (prevention activities BEFORE you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005
Hand hygiene programOversightTraining
SanitationRoutine cleaningTerminal cleaningSanitation inspections
Antibiotic prescribing practices
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Secondary PreventionSecondary Prevention(prevention activities AFTER you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005
Correctional contact precautionsHand hygiene before and after EVERY contactSingle cell if drainage cannot be containedPPE (gloves / gown ) for contact with contaminated items
or blood/body fluidsSanitation
Daily and terminal cleaning Safe disposal of sharps and bandages
Transfers Contain drainage Inform escort officers and receiving institution clinical director
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Secondary PreventionSecondary Prevention(prevention activities AFTER you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005
SurveillanceInterview index case
Risk factors Contacts
Evaluate contactsHistory of food handling?Increased surveillance at routine visitsBacterial cultures
Document (line list)
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Outbreak ManagementOutbreak Management Federal Bureau of Prisons Clinical Practice Guidelines, 2005Laboratory confirmation – save isolatesTracking – line listContainmentTransfers
Evaluate each inmate before transferInfection control
Hand hygieneIntensified correctional contact precautionsIntensified inspections
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Outbreak Management (2)Outbreak Management (2) Federal Bureau of Prisons Clinical Practice Guidelines, 2005
SurveillanceCommon source
Evaluate all potentially exposed inmatesSustained or involving multiple inmates
Consider targeting high risk inmatesDecolonization (caution)Education
InmatesCorrections staffHealth care personnel
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ConclusionsConclusionsCornerstones of prevention
Hand hygieneCorrectional standard precautionsSurveillance (document on your line list)
Cornerstones of controlHand hygieneCorrectional standard and contact precautionsSurveillance (document on your line list)
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