mrsa infectionsbasics, implications, and prevention

01/05/2023 Dr.T.V.Rao MD @ MRSA

MRSA INFECTIONSbasics, implications, and

preventionDr.T.V.Rao MD


Purpose of the lecture •Participants will understand the differences between infection control and infection prevention

•Understand the epidemiology of MRSA•Understand risk factors for MRSA•Review current MRSA management trends•Discuss MRSA prevention and control strategies


Staphylococcus aureus• Staphylococcus aureus:

– common cause of infection in the community– Lives on skin, in nose, in soil, water, dead plant material– Causes colonization or infection

• Methicillin-resistant Staphylococcus aureus (MRSA):– Increasingly important cause of healthcare-associated infections

since 1970s– In 1990s, emerged as cause of infection in the community


History of MRSA• Methicillin-resistance in S. aureus was first identified

in the 1960s primarily among hospitalized patients • Since that time, methicillin-resistant S. aureus(MRSA) has become a predominant cause of S. aureus infections in both healthcare and community settings Primarily due to transmission of relatively few ancestral clones rather than the de novo development of methicillin resistance among susceptible strains


Definition of MRSA• Staphylococcus aureus (S.

aureus) commonly colonises the skin and nose. Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a strain of bacteria that has become resistant to the antibiotics commonly used to treat ordinary staphylococcal infections.


Definitions of different MRSA

• CA-MRSA: Community-acquired MRSA• HA-MRSA: Healthcare-associated MRSA• Nosocomial: infection acquired while in the

hospital• SSTI: Skin and Soft Tissue Infection


MRSA in Healthcare• Historical Risk Factors

–Prolonged hospitalization–Prolonged antimicrobial use– Stay in an intensive care or burn unit– Exposure to a colonized/infected person–Residence in a nursing home–Age >65

• Common infections include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia


MRSA is ContagiousMRSA is usually spread by unwashed hands.

Even a person who does not have an infection and is only colonized can spread MRSA.

It is also spread when someone comes in contact with MRSA infected skin or touches something that has been in contact with MRSA skin.

Personal items such as towels, bandages, razors, etc.If you touch your infected skin and touch other things

around you before washing your hands, the item you touched can carry the MRSA bacteria – it is considered contaminated.


Who are at Risk with MRSA • People with higher risk of MRSA

infection are those with skin breaks (scrapes, cuts, or surgical wounds) or hospital patients with intravenous lines, burns, or skin ulcers. In addition, MRSA may infect people with weak immune systems (infants, the elderly, people with diabetes or cancer, or HIV-infected individuals) or people with chronic skin diseases (eczema and psoriasis) or chronic illnesses.


Treatment Options Limited• Treatment options for

MRSA are limited and less effective than options available for susceptible S. aureus infections and result in higher morbidity and mortality


Increasing Risk with MRSA• A patient acquiring MRSA

colonization during a hospital stay has increased risk for MRSA infections following discharge, or during subsequent acute and long-term care admissions

01/05/2023

Colonization Sites

Dr.T.V.Rao MD @ MRSA

Infections


Common Infections with MRSA


MRSA can cause Severe Infections

• In the right setting MRSA can cause severe and at times fatal infections such as bloodstream infection (BSI), infective endocarditis, pneumonia and skin and soft tissue infections (SSTI


Factors that Facilitate Transmission

Cleanliness

Contaminated Surfacesand Shared Items

Frequent ContactCrowding

Compromised Skin

Antimicrobial Use


MRSA Skin andSoft Tissue Infections


Antibiotic resistance in S. aureus

• Penicillin, 1950• Methicillin (= all β-lactam antibiotics), 1961• Tetracycline, Co-trimoxazol, rifampin,

clindamycin, macrolides, quinolones• Vancomycin, intermediate-R, 2000• Vancomycin, high-level-R, 2002• Linezolid, Daptomycin?


Cardo et al. Infection Control and Hospital Epidemiology , Vol. 31, No. 11 (November 2010), pp. 1101-1105

How we can work on this Matter


Patient

Rehabilitation

Home Care

Surgery Center

HospitalLong Term Care

Dialysis

Physician Office

Staff/ Medical Staff

Visitors and Family


Standard Precautions• Apply to all patients• Integrate and expand Universal Precautions

to include organisms spread by blood and also • Body fluids, secretions, and excretions except

sweat, whether or not they contain blood• Non-intact (broken) skin• Mucous membranes


Elements of Standard Precautions

• Handwashing• Use of gloves, masks, eye protection, and

gowns• Patient care equipment• Environmental surfaces• Injury prevention

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Preventing Transmissionin the Community

• Persons with skin infections should keep wounds covered, wash hands frequently (always after touching infected skin or changing dressings), dispose of used bandages in trash, avoid sharing personal items.

• Uninfected persons can minimize risk of infection by keeping cuts and scrapes clean and covered, avoiding contact with other persons’ infected skin, washing hands frequently, avoiding sharing personal items.

Dr.T.V.Rao MD @ MRSA

01/05/2023

Preventing Transmissionin the Community

• Exclusion of patients from school, work, sports activities, etc should be reserved for those that are unable to keep the infected skin covered with a clean, dry bandage and maintain good personal hygiene.

• In general, it is not necessary to close schools to “disinfect” them when MRSA infections occur.

• In ambulatory care settings, use standard precautions for all patients (hand hygiene before and after contact, barriers such as gloves, gowns as appropriate for contact with wound drainage and other body fluids). Dr.T.V.Rao MD @ MRSA


Role of Screeningand Decolonization

• Pre-operative screening• High risk screening• Universal screening• Decolonization of skin• Decolonization of nose

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Prevention and control


Responsibilities of Health care Workers

• Screening - Infection prevention and control measures in the acute hospital setting - MRSA in the non-acute healthcare setting - MRSA in obstetrics and neonates - Community-associated MRSA - MRSA decolonisation - Antimicrobial stewardship and the prevention and control of MRSA - Occupational health aspects of MRSA


Preventing Healthcare Transmission:

• Standard Precautions–Hand Hygiene–Contain body fluids

• Transmission Based Precautions–Contact Precautions

• Gown and gloves• Appropriate use of antibiotics


Environmental Decontamination• Adequate surface disinfection

• Validation of cleaning efficacy• New technology


Core Prevention Strategies: Hand Hygiene

• Hand hygiene should be a cornerstone of prevention efforts – Prevents transmission of pathogens via hands of healthcare personnel • As part of a hand hygiene intervention, consider: – Ensuring easy access to soap and water/alcohol-based hand gels


Why Is Hand Hygiene Important?

• Hands are the most common mode of pathogen transmission

• Reduce spread of antimicrobial

resistance

• Prevent health care-associated

infections

Hands Need to be Cleaned When

• Visibly dirty• After touching contaminated objects with bare hands

• Before and after patient treatment (before glove placement and after glove removal)


Hand WashingProcedure for Washing Hands: Wet hands with warm, running water and apply liquid, bar or powder

soap. Rub hands together vigorously to make a lather and scrub all surfaces.

Scrub well for 15-20 seconds! It takes that long to dislodge and remove stubborn germs. To time yourself, sing the ABCs once or the “Happy Birthday” song twice.

Rinse the soap off under running water. Dry hands with a paper towel or air dryer. If possible, turn the faucet off with the paper towel.


Special Hand Hygiene Considerations

• Use hand lotions to prevent skin dryness • Consider compatibility of hand care products with

gloves (e.g., mineral oils and petroleum bases may cause early glove failure)

• Keep fingernails short• Avoid artificial nails • Avoid hand jewelry that may tear gloves


Education of Health care workers

• Education for healthcare personnel and patients – Observation of practices -particularly around high-risk procedures (before and after contact with colonized or infected patients) – Feedback – “Just in time” feedback if failure to perform hand hygiene observed


Contact Precautions • Involves use of gown and

gloves for patient care – Don equipment prior to room entry – Remove prior to room exit • Single room (preferred) or cohorting for MRSA colonized/infected patients


PreventingHealthcare

Transmission:Hand Hygiene


Hospital staff • Hospital staff who come into contact with patients

should maintain high standards of hygiene and take extra care when treating patients with MRSA.

• Staff should thoroughly wash their hands before and after caring for a patient, before and after touching any potentially contaminated equipment or dressings, after bed making and before handling food.


Soap water and common sense are best antiseptics

WILLIAM OSLER •Hands can be washed with soap and water or, if they are not visibly dirty, a fast-acting antiseptic solution like a hand wipe or hand gel.


Use of Disposable Gloves • Disposable gloves should

be worn when staff have physical contact with open wounds – for example, when changing dressings, handling needles or inserting an intravenous drip. Hands should be washed after gloves are removed.


General Hygiene too Matters • The hospital

environment, including floors, toilets and beds, should be kept as clean and dry as possible.

• Patients with a known or suspected MRSA infection should be isolated.

• Patients should only be transferred between wards when it is strictly necessary.


Cleaning your Environment

Frequently clean surfaces that touch people’s bare skin and surfaces that people touch often such as: Doorknobs, handles and light switches. Phones, remotes and keyboards. Counters, tables, sinks and toilets. Weight and locker room benches. Athletic gear and other shared equipment.

Launder clothes, towels, bedding and gear regularly. Change clothes daily. Do not put clothes that have been worn with clean clothes. Wash and dry clothing in the warmest temperature listed on the clothing label.


WHAT REALLY WE NEED TODAY • Always washing your hands after using the toilet or

commode (many hospitals now routinely offer hand wipes) • Always washing your hands or cleaning them with a hand

wipe immediately before and after eating a meal • Following any advice you're given about wound care and

devices that could lead to infection (such as urinary catheters)

• Reporting any unclean toilet or bathroom facilities to staff – don't be afraid to talk to staff if you're concerned about hygiene


Protecting Yourself in the CommunityAvoid excessive antibiotic use.Shower daily and after work outs.Wash hands or use a hand sanitizer often; especially

after shopping, using the bathroom and before eating.Do not share towels, soap, razors, water bottles and

other personal items with other people.Use a towel as a barrier between you and exercise

equipment.Wash athletic clothing daily.Clean, disinfect and dry your gym bag.


Education• Patients and families

• Standardized hand outs• Multi-media

• Staff and Medical Staff• In-services• Just in time• Safety Fairs• Make it fun, make it memorable

• Yourself• Webinars• Internet• Peers


Prevention• Evaluate and implement

best practice regularly

• Engage staff…they are smart people!

• Prevention doesn’t happen in an office!


•Program Created by Dr.T.V.Rao MD for Medical and Health

professionals for Improving the Hygiene and Control of Hospital

associated InfectionsEmail

[email protected]