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We hope you enjoy this

inservice, prepared by

registered nurses

especially

for nursing assistants

like you!

After finishing this inservice, you will

be able to:

List the two major types of MRSA and explain the

difference between them.

List the main signs and symptoms of MRSA.

Describe the five major ways in which you can

prevent MRSA from spreading in a

healthcare setting.

Describe the risk factors of both types of MRSA and the

people they most affect.

Describe the five measures that must be taken when

caring for a client with MRSA.

If you are studying the inservice on your own, please do the following:

Read through all the material. You may find it useful to have a highlighting marker nearby as you read. Highlight any information that is new to you or that you feel is especially important.

If you have questions about anything you read, please ask _________________________.

Take the quiz. Think about each statement and pick the best answer.

Check with your supervisor for the right answers. You need 8 correct to pass!

Print your name, write in the date, and then sign your name.

Keep the inservice information for yourself and turn in the quiz page to _____________________________ no later than _______________. Show your Inservice Club Membership Card to ___________________ so that it can be initialed.

Email In the Know at [email protected] with your comments and/or suggestions for improving this inservice.

THANK YOU!

Instructions for the Learner

An Infection Control Module:

UNDERSTANDING MRSA

Developing Top-Notch CNAs, One Inservice at a Time

An Infection Control Module:

Understanding MRSA

MRSA: THE BASICS

Inside This Inservice:

MRSA Types and Transfer

Methods

2

Symptoms of MRSA 3

Care and Treatment of

MRSA

4

Associated Diseases 5

MRSA Prevention

Information

6-7

Risk Factors 8

What If You Suspect

MRSA?

9

Related Information 10

FAQs about MRSA 11

© 2012 In the Know, Inc. www.knowingmore.com

May be copied for use within each physical location that

purchases this inservice from In the Know. All other copying

or distribution is strictly prohibited.


There is a “new and improved” superbug out there called MRSA (often pronounced “mersa”). The MRSA bacteria is known officially as methicillin-resistant Staphylococcus aureus—and it’s on the prowl, looking for people to infect!

As the name implies, MRSA causes a staph infection that is resistant to a number of antibiotics, making it very difficult to treat. MRSA can also be spread easily, with or without skin-to-skin contact. For these reasons, experts have classified the bug as highly dangerous.

Imagine a sick, weakened client

whom you have treated recently. She may have a

serious medical condition or may be

recovering from a

serious surgery. Now imagine that she contracts a potentially deadly infection that never goes away…you can understand the concern about MRSA.

MRSA infections are categorized in two ways. The first and most common is healthcare-associated (HA for short), which means that the infection is contracted in a healthcare setting, such as in a nursing home or hospital. The second type is community-associated (CA for short), which is the transfer of MRSA through skin contact and other means outside of a healthcare setting.

Since this staph infection is resistant to many drugs, it has great potential to spread throughout an infected client’s body. The seriousness of MRSA comes from its eventual attack on vital organs. So aside from a rash, sores, boils and other superficial problems, MRSA can infect the bloodstream, urinary tract, lungs, surgical wounds and other parts of the body. It is certainly a deadly condition…between four and ten percent of cases are fatal!

Keep reading to learn more about MRSA.

MRSA TYPES AND TRANSFER METHODS

An Infection Control Module: Understanding MRSA © 2012 In the Know, Inc. Page 2

Community Associated (CA-MRSA)

Bacteria can pass from person to person almost anywhere…and the spread of this superbug outside of a healthcare setting is called community associated MRSA. Common modes of transfer are sharing contaminated hygiene items (towels, razors) or picking up bacteria from unclean shower floors, sinks, etc.

Transferring MRSA

Human hands (often those of healthcare workers) are the number one cause of spreading bacteria! For example, one hospital patient with MRSA can pass the bacteria on to another patient he’s never met, merely because they were both handled by the same healthcare worker!

Grab your favorite highlighter! As you read through this inservice, highlight five things you learn that you didn’t know before. Share this new information with your supervisor and co-workers!

CA-MRSA Facts

The CDC reports that 14% of MRSA infections are community associated. The rate of CA infection is on the rise, and is most commonly found in places where people are in close contact such as prisons, military barracks, dormitories,

schools and gyms.

Could You Be a Carrier?

More than 25% of us carry around staph, especially in our noses. Infections occur when the bacteria get past our skin—such as entering through a cut.

One percent of the population has MRSA, though not everyone is infected. Many people are simply carrying it around and spreading it unknowingly.

Healthcare Associated (HA-MRSA)

More than 80% of the total number of MRSA cases are healthcare associated MRSA. As you might guess, clients contract MRSA in various healthcare settings—including home health. By far the most common and the most serious, HA-MRSA is what you can expect to encounter with your clients. Keep in mind that the people who contract MRSA in a healthcare setting are already weakened due to other conditions or diseases, which enhances the danger of the infection.

MRSA bacteria can be passed by skin-to-skin contact, but also by touching an object or surface that an infected person has touched. This includes bedding, clothing, door knobs, sinks, floors, etc. Especially dangerous in the healthcare setting are catheters, breathing tubes and bandages, since bacteria on these items can easily enter a client’s body. If bacteria gets to the lungs and other vital organs in an already sick person, it can mean serious trouble. The majority of MRSA fatalities occur when the infection reaches internal organs.

Boils

Abscesses (pus under the skin)

Impetigo (bacteria-related blisters)

Lesions

Hordeloa (eye sty)

Carbuncles (larger boil)

MRSA is often mistaken for a spider bite! The initial infection looks very similar. If your client complains of a bad bug bite, make sure you take it seriously. Perhaps MRSA is the real culprit!

© 2012 In the Know, Inc. Page 3 An Infection Control Module: Understanding MRSA

Generally, MRSA infection will be diagnosed if there is no improvement in a staph infection despite several days of antibiotic treatment and the infection seems to be worsening or spreading rapidly. If your client is on penicillin (or a related antibiotic) for an infection, and there are no signs of improvement (even worsening), there is a good chance that the bacteria are resistant to the drug.

If you see these symptoms in a client who is already at risk from having a weak immune system, the client is likely infected with MRSA. A proper diagnosis needs to be made very quickly. Tell your supervisor immediately and follow the “If MRSA is Suspected” guidelines on page 9 of this inservice.

TIP:

A client with multiple symptoms should be considered infected until proven otherwise, to avoid passing the bacteria to others.

SIGNS AND SYMPTOMS

Did You Know?

If the infection worsens, but is still contained, you may also see:

When you add the following symptoms to the above, it may mean that the

MRSA has spread:

Chest pain

Fatigue

General ill feeling

Headache

Muscle aches

Fever, chills, shortness of breath

Low blood pressure

Rashes

Generally, MRSA will cause the following symptoms on the skin:

Redness

Swelling

Painful patches

©2012 In the Know, Inc. Page 4 An Infection Control Module: Understanding MRSA

Since 1961 when MRSA was first discovered, it has slowly become more resistant to antibiotics. This is because the bacteria develop immunity if they are not killed off by the drugs. Why aren’t they killed off? It’s because people tend to stop taking their antibiotics when their symptoms go away—rather than finishing the prescription. This means only the weakest bacteria are killed. The strong ones live—and learn how to resist that antibiotic. When the bacteria spread to other people, they remain resistant to that particular drug.

Fatal infection by MRSA is quite rare in a healthy person, but for someone with a weak immune system, it can be deadly. Generally, if caught in time (before the infection gets to vital organs), full recovery is expected. The doctor might drain the infection if it is only localized... often the pus needs to be removed to allow healing to occur.

Since many antibiotics are no longer effective, HA-MRSA in particular is becoming more difficult to treat. There are still some antibiotics that are useful against MRSA, but even they don’t work in every case. And, it is likely that in the future, MRSA bacteria will form a resistance to those drugs as well.

The good news is there are still a few medications that might work. The following are some antibiotics that could be effective:

Clindamycin

Linezolid (Zyvox)

Tetracycline (doxycycline)

Trimethoprim-sulfamethoxazole (Bactrim, Septra)

Vancomycin (Vancocin, Vancoled)

CARE AND TREATMENT

Clients who have been prescribed antibiotics for MRSA must make sure to complete their medication, even if the symptoms disappear. If they don’t, there’s a chance that the bacteria might survive and develop further resistances! The infection might also eventually return, as it may not have been completely destroyed. If the infection is more serious, the client will need to be admitted to the hospital to receive specialized treatment. This could include additional antibiotics and the following:

Fluids (and medications) given intravenously Kidney dialysis (if kidney failure occurs) Oxygen

Have you cared for clients with MRSA or other bacterial infections during your career? What did you learn from those experiences?

Getting a potentially lethal infection such as MRSA will frighten clients, especially those that are elderly and already sick. What have you learned in the past that might be used to calm or assure a client with a MRSA infection?

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Pneumonia

MRSA can move into the lungs, often from the nose, which can cause pneumonia. This is especially true for children or people with less developed or weakened immune systems. Normally a MRSA infection of the lungs comes right after a bout of influenza. The flu virus will break down a person’s lung defense, which allows the bacteria to grow rapidly.

During the winter flu season of 2006-2007, 24 healthy, young people died from MRSA-related pneumonia. In some cases, the infection caused death within four hours!

If someone has pneumonia caused by MRSA, they can pass it on by coughing. Small droplets of fluid can be flung out into the air during a violent cough, which could be contaminated. For this reason, caring for someone with this condition can be risky. Proper infection control precautions must be taken.

Burns/Skin Conditions

Any opening in the skin is a prime place for bacteria to enter the body. Burn victims and those with psoriasis and eczema are particularly at risk for MRSA. Make sure that wounds and/or openings to the body are covered to avoid infection. Notify your supervisor if a client’s wound shows signs of infection: redness, swelling, warmth and/or pain.

ASSOCIATED CONDITIONS/DISEASES

THE PROBLEM: Mr. Rivera, an elderly man in an assisted living facility, has HIV. He tends to be in contact with many people for treatment, and MRSA has been found on one of the staff members who regularly cares for him.

WHAT YOU KNOW: The staff member has a small MRSA infection on her arm. She says that she noticed it two days ago and she has treated Mr. Rivera since.

GET CREATIVE: Think of 3 creative solutions to continue caring for Mr. Rivera without passing MRSA on to him (or perhaps getting it from him). How can you help him?

TALK ABOUT IT: Share your ideas with your co-workers and supervisor and find out how they would solve the problem.

HIV/AIDS

Anyone with HIV or AIDS must be extremely careful concerning possible bacterial infection. Many people with HIV/AIDS have weakened immune systems. MRSA can quickly attack vital organs and cause severe damage when unchecked. A client who has HIV/AIDS must be considered at great risk for possible infection. Preventative measures need to be taken, such as increased attention to hygiene and cleanliness of the room or dwelling. If an infection is suspected, the client will probably need attention from a doctor. Tell your supervisor right away.


Wash your hands before touching your clients or any medical equipment that you intend to use. It is a good idea to wash your hands as frequently as possible—at least before and after handling a client.

TIP:

While you wash your hands, recite the alphabet... when you get to ‘Z’ you have washed long enough.

Gloves need to be worn when you anticipate handling a client, especially if you

expect to come into contact with bodily fluids, contaminated skin or used medical equipment. Always

remove and dispose of the gloves after use! Never

use the same pair of gloves on two different clients! This is the easiest way to pass on MRSA. Wash your hands after handling used gloves.

MRSA PREVENTION INFORMATION

Wear a mask if you expect the care of your client to involve spraying or splashing fluid, coughing or the presence of waste. If you have goggles available, they are an extra line of defense against bacteria in these circumstances. Masks are especially necessary when a client has pneumonia caused by MRSA. In that case, the bacteria can be transferred through the air.

If there is the possibility of your clothing or skin being contaminated during care of a client, wearing a gown can be a preventative measure. If you are sure that a client has MRSA or another bacterial infection, a gown is a must to avoid spreading it to another person…perhaps even yourself or your family! Often the bacteria can cling to clothing. A gown will prevent this from happening and potentially keep you from passing MRSA to another client!

Alcohol based hand sanitizers are a great way to quickly kill bacteria before touching clients.

©2012 In the Know, Inc. Page 7 An Infection Control Module: Understanding MRSA

Any single-use equipment that has been in contact with a client should be disposed of properly. If the equipment is re-usable, ensure that it is properly cleaned or sterilized before coming into contact with another person or surface.

Commonly touched surfaces around the client such as doorknobs, toilets, tables, chairs, counter tops, cabinets and sinks need extra cleaning to avoid the spread of MRSA. Spray disinfectants work great at killing bacteria on various objects, such as remotes, phones and many other commonly used items.

The two types of MRSA have some different preventative measures...

HA-MRSA

Observe and make sure that wounds are covered with clean bandaging—including any wounds infected with MRSA. Be very careful with any waste material. Always wear gloves and properly dispose of any bandage materials used by your client. Never touch a bandage with your bare hands, it must remain as clean as possible. This will help keep the

wound from becoming contaminated. Report any loose, worn or seeping

bandages to your supervisor. One of the fastest ways to

infect a client with MRSA is by letting a bandage become

contaminated.

MRSA PREVENTION INFORMATION, CONTINUED

Apply What You Know! SOME EXTRA INFO

CA-MRSA

Do not share personal hygiene items such as towels and razors (with or between clients). Clothing and bedding needs to be machine washed often and thoroughly. Drying instead of hanging (to air-dry) works much better at killing bacteria. Clean common areas such as bathrooms and kitchens regularly.

List the 5 main ways to prevent the spread of MRSA:

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Choose two of the ways from above that you consider the most important and explain why you feel that way:

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HA-MRSA

The greatest risk factor for getting infected is currently being, or having recently been hospitalized. (More than 1 million hospital patients are infected with MRSA every year.) The largest risk groups are the elderly and those with conditions or diseases that weaken the immune system.

The longer a client is hospitalized, the greater the chance of contracting MRSA. About 50 out of every 1,000 people who are in the hospital are MRSA infected or are carriers! Similarly, nursing homes and other facilities where at-risk people are living together are areas where MRSA is passed on frequently. If your client uses dialysis, needs a breathing or a feeding tube or is catheterized, he or she is at much greater risk of infection.

In addition, anyone hospitalized with certain conditions will be at a higher risk. These are things like burns, psoriasis or any other condition involving a break in the skin.

CA-MRSA

Children often carry bacteria, which can cause infections by entering through cuts or scrapes and/or by putting their hands in their mouths.

Small kids are at risk since their immune systems are not yet mature enough to fight off infection. Children also get respiratory infections much easier and more often than adults—and these can be due to MRSA.

Anyone who plays contact sports is at greater risk. Any skin-to-skin contact and use of the same sporting equipment might pass on MRSA. If hygiene items are shared, such as towels and razors, the bacteria can be passed along. Work-out gear and equipment, as well as locker room and shower floors and sinks, can spread MRSA.

There is greater risk of spreading MRSA in environments where many people are living close together, such as prisons, military barracks or where hygiene and sanitation conditions are poor. Anyone who is cared for by a healthcare professional is at risk, as the worker could be passing on MRSA from one client to another. That is why it is so important to follow the prevention guidelines!

RISK FACTORS

Those Most at Risk…

HA-MRSA Elderly

Using invasive equipment

Have weak immune systems

CA-MRSA

Athletes

Healthcare workers and their families

People in close living quarters

Children


IF MRSA IS SUSPECTED!

If you suspect your client has MRSA, contact your supervisor immediately. The client needs to be tested to avoid worsening of the condition and possible passing of MRSA to other clients and healthcare workers. The diagnosis will require a sample and lab test. In the meantime, follow these precautions—along with any applicable policies at your workplace:

Containment/Isolation

Keep the client separated from others, especially those who are at risk! The best bet is a room with minimal surfaces for bacteria to gather so that it can be kept clean easily. It’s also best if the room has access to a separate bathroom. If the client cannot be isolated for whatever reason, ensure that people in contact with that client are at low risk for MRSA infection. In addition, the room must be kept clean at all times, especially if the client cannot be isolated. All equipment and surrounding surfaces need cleaning on a regular and frequent basis.

Gloving

Whenever you touch clients, their equipment, or anything in their room you should be wearing gloves. In fact, gloves should be the number one rule concerning MRSA infected clients. Never enter the client’s room without them! Always throw away the gloves immediately after caring for the client—and then wash your hands!

Gowning

Rule number two should be to wear an appropriate gown to cover your skin and clothing. When you are finished with the client, remove the gown but make sure that it is handled appropriately…it needs to be cleaned or disposed of immediately to avoid passing on MRSA to other people. Put it in a biohazard hamper if one is available. Make sure that you wash your hands after removing the gown. Like with gloves, never wear the same gown to care for another client.

Transport

If the client needs to be moved or taken somewhere, you must wear all of your PPE (personal protective equipment). The client should have all contaminated areas of his/her body bandaged and covered. When you reach your destination, clean your protective wear before handling anything or anyone else! Be wary of contaminating anything on the way there or back.

Equipment

Always try to use disposable equipment. If it’s necessary to use non-disposable items, ensure proper cleaning before and after contact with the client. It is a good idea to have equipment that is dedicated to a MRSA-infected client to avoid contaminating others. Place used items in a Ziploc bag for transport if you must keep them. Make sure to disinfect everything after use. Rule three is to keep everything clean!

An Infection Control Module: Understanding MRSA © 2012 In the Know, Inc. Page 10

Usually, MRSA tends to worsen considerably within one to two days after being spotted. Much of the progress of the infection depends on the immune systems of individual clients. Most at-risk clients will have noticeable changes very quickly.

Testing for MRSA involves obtaining a tissue or mucous sample. The sample is put into a culture (a dish where it is surrounded by nutrients) so that the bacteria can grow. If it does grow, the client is infected. This can take up to two days, which is why early detection is necessary.

Some hospitals are testing new patients who have a history of MRSA. Since MRSA has spread so much in healthcare settings, it is a good idea to test as soon as MRSA is suspected, if not before. In addition, following preventative measures (pages 6-7) should be your goal at all times.

A school might announce a staph infection if one has been found on one or more students. Most of the time the school will remain open and function normally while the administration takes steps to keep the facilities clean—especially bathrooms and the cafeteria. If your children’s school announces a staph infection, make sure they wash their hands often, especially before and after lunch or trips to the bathroom.

Remember the five C’s of increased risk for transmitting MRSA: Contact (skin-to-skin), Compromised skin (cuts and scrapes), Crowding, Contaminated items and surfaces, and Lack of Cleanliness.

RELATED INFORMATION

Schools are not required to announce an outbreak of MRSA! In some cases, a county health official may mandate an announcement—or the school may announce it voluntarily. However, the vast majority of the time, the school community will have no knowledge of a MRSA infection among one or more students.

Considering this, what impact could an outbreak have on the school and the larger community? Who is most likely to be infected if a student brings the bacteria home?

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Should schools be required to provide information to the local community about every bacterial infection? Why or why not?

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FREQUENTLY ASKED QUESTIONS ABOUT MRSA

Q: How can clients protect themselves from becoming infected with HA (healthcare associated) MRSA?

A: The best way for clients to protect themselves is by practicing proper infection control measures. This means that they should:

Ask all healthcare workers to wash their hands or use an alcohol-based hand sanitizer before touching them.

Wash their own hands frequently.

Make sure that any IV and/or catheter tubing is inserted under sterile conditions.

If the client is too sick to be able to follow these precautions, the next best thing is for a friend or family member to help enforce them.

Q: Nearly 50 of every 1000 hospital patients are affected by MRSA. And, nursing home residents are at risk because they live in close contact with each other. But, how common is MRSA among home health clients?

A: According to research, infection with MRSA appears relatively common among home health clients. One French study found that 13% of home care clients who had recently been in the hospital were infected with MRSA. In addition to bringing the bacteria home with them from the hospital, home care clients run the risk of acquiring MRSA from home health workers. What’s the answer? Home health clients and their caregivers should follow the same precautions listed above for hospitalized patients.

Q: Can people really “catch” MRSA from swimming in the ocean?

A: It’s possible. Physicians at the University of Miami studied sea water and found that swimmers have a 37% chance of coming into contact with “regular” staph bacteria and a 3% chance of encountering MRSA. The best prevention is to shower before and after swimming in the ocean. In addition, keep in mind that MRSA has been found on flip flops. A study done in New York City found that after just four days of walking around the city, people had accumulated thousands of bacteria, including E. coli and MRSA. If you love your flip flops, just be sure to lather your feet with soap every day and check your feet for any broken skin where MRSA could enter your body.

Q: What are scientists doing about MRSA and other drug resistant “superbugs”?

A: They aren’t giving up! In fact, they are hard at work developing new antibiotics. They have two strategies: one, modify existing antibiotics and two, discover entirely new ones.

In general, scientists tend to like the second option—discovering new antibiotics—since it takes bacteria longer to become resistant to new drugs. Currently, they are focused on identifying enzymes that bacteria require for survival and making drugs that kill those enzymes.

In the meantime, practice careful infection control measures, follow your workplace policies and remember the five “C’s” of MRSA risk factors listed on page 10.

Are you “In the Know” about MRSA? Circle the best choice. Then check your answers with your supervisor!

1. True or False You need to wash your hands only before handling a client. 2. True or False You can wear the same gloves when treating two clients in the same room. 3. True or False The elderly are a high risk group for MRSA because they need more care and they might have weak immune systems. 4. True or False Pneumonia can often be a result of MRSA, especially in children. 5. How does CA-MRSA differ from HA-MRSA? A. CA-MRSA is spread by healthy people. B. CA-MRSA is generally less lethal. C. HA-MRSA is only spread in a healthcare setting. D. All of the above. 6. True or False MRSA is passed from one person to another mostly by touching a contaminated floor, sink, counter or toilet. 7. Which of the following symptoms may mean that MRSA is life-threatening? A. Fever, chills and shortness of breath. B. Abscesses and carbuncles. C. Redness and swelling. D. None of the above. 8. True or False There is nothing your clients can do to protect themselves from MRSA.

9. True or False Re-usable medical equipment should never be used with a client who has MRSA.

10. True or False Completing antibiotic prescriptions is necessary when you have MRSA.

Inservice Credit:

Self Study 1 hour

Group Study 1 hour

File completed test in employee’s personnel file.

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DATE: __________________

I understand the information presented in this inservice.

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An Infection Control Module: Understanding MRSA


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