Mrsa Manual For Nurses - Health and Community Services
Contents
1. 28 RISK FACTORS FOR MRSA CARRIAGE ccccssssssssssssssssssessssessssssssessssssssssseseseseseees 29 COLLECTING A SPECIMEN FOR 29 EE AE E E 30 TEST YOUR KNOWLEDGE Sea oi EEE T A a E EAT E ain 32 oea i a E A AE EA AAN A a e 33 WHAT IS STAPHYLOCOCCUS AUREUS To understand methicillin resistant Staphylococcus aureus MRSA first you need to understand something about Staphylococcus aureus S aureus It is a gram positive bacterium periodically found on the skin and mucous membranes of most adults and is no cause for alarm However S aureus can cause infections which can be treated by various antibiotics such as cephalosporins erythromycin and tetracycline WHAT IS MRSA When S aureus develops reduced susceptibility to the beta lactam class of antibiotics it becomes known as MRSA Beta lactam antibiotics include the penicillins such as methicillin dicloacillin nafcillin and oxacillin MRSA is also resistant to agents such as clindamycin erythromycin tetracycline cephalosporins and at times sulfamethoxazole trimethoprim Septra Infections with MRSA are treated with sulfamethoxazole trimethoprim Septra if susceptible or with intravenous vancomycin One big concern about the spread of both MRSA and vancomycin resistant enterococci VRE is the possi2. task To remove gloves 1 2 4 Grasp glove outside near the wrist Peel away from the hand turning the glove inside out Hold the removed glove in the opposite gloved hand Slide one or two fingers of the ungloved hand under the wrist of the remaining glove Peel off the glove from the inside creating a bag for both gloves and discard 18 Gowns must be worn to protect the arms and prevent soiling or contamination of clothing during procedures and direct care activities when caring for patients on Contact Precautions Things to consider e Before entering the room assess whether you will need to wear a gown the need for a gown depends on the tasks to be completed and the potential contact of the body with the patient and the patient s environment e The gown is put on before entering the room and is secured at the neck and waist The gloves must then be stretched to cover the cuffs of the gown e Do not reuse gowns remove the gown before leaving the room 19 To Remove the gown 1 2 Unfasten the ties Slip your hands underneath the neck and shoulder then peel away from the shoulders Put the fingers of one hand under the cuff of the other arm and grasp the gown from the inside Reach across and push the sleeve off the opposite arm 5 Turn the outside of the gown which is contaminated toward the inside and fold or roll into a bundle and discard Ensure hand hygiene is completed immediately a
3. Albrich W Harbarth S Health care workers source vector or victim of MRSA The Lancet Infectious Diseases 2008 8 289 301 Fadheel ZH Perry HE Henderson RA Comparison of methicillin resistant Staphylococcus aureus MRSA carriage rate in the general population with the health worker population New Zealand Journal of Medical Laboratory Science 2008 62 4 6 Dunaway ER 2008 MRSA Time to prevent as well as control Nursing Management 2008 49 53 Fitzpatrick F Murphy OM Brady A Prout S Fenelon LE A purpose built MRSA cohort unit Journal of Hospital Infection 2000 46 271 279 Afif W Huor P Brassard P Loo V 2002 Compliance with methicillin resistant Staphylococcus aureus precautions in a teaching hospital American Journal of Infection Control 2002 30 430 433 Bearman GML Marra AR Sessler CN Smith WR Rosato A Laplante JK Wenzel RP Edmond MB A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug resistant organisms American Journal of Infection Control 2007 35 650 655 33 10 11 12 13 14 15 16 17 18 19 20 21 Henderson DK Managing methicillin resistant staphylococci A paradigm for preventing nosocomial transmission of resistant organisms American Journal of Infection Control 2006 34 5 S46 54 Snyder GM Thom KA Furuno JP Perencevich EN Roghmann M Strauss SM Netzer G
4. ERRORS COMMITTED WHEN USING PPE e The biggest problem with PPE is that nurses don t wear the gloves and gowns when they should Researchers have found compliance rates for wearing PPE is approximately 65 e HCWs can contaminate themselves and transmit MRSA to other patients through improper removal of PPE or by not performing hand hygiene immediately after removal of PPE 17 Gloves must be worn when contact with blood or body fluids mucous membranes nonintact skin or potentially contaminated objects or the environment is anticipated Since hand contamination may occur due to holes leaks tears or improper removal gloves are not a substitute for proper hand hygiene Hand hygiene must be performed following removal of gloves Things to consider Apply the gloves before entering the room of a patient on Contact Precautions If you need to wear a gown you must put it on first Then you apply the gloves ensuring they are pulled over the cuffs of the gown Change your gloves if you move from a contaminated site to a clean site Work from clean to dirty Go from clean body sites or surfaces before heavily contaminated areas Be aware of touch contamination Do not scratch your nose or adjust your glasses once your hands have been in contact with a patient or surfaces in the room such as the light switch or bedside table Ensure the gloves fit properly Remove gloves and perform hand hygiene before moving to another patient or
5. MRSA A RESOURCE MANUAL FOR NURSES AND OTHER HEALTHCARE WORKERS IN ACUTE CARE SETTINGS DEVELOPED BY AMANDA WHELAN MN BN RN amp DONNA MORALEJO PHD RN MEMORIAL UNIVERSITY SCHOOL OF NURSING ENDORSED BY PROVINCIAL INFECTION CONTROL NEWFOUNDLAND LABRADOR PIC NL NOVEMBER 201 1 WHO IS THIS RESOURCE MANUAL FOR AND WHY Are you a new nurse and not sure how to put a patient on Contact Precautions Or perhaps you re an experienced nurse dealing with MRSA for the first time in a long time Maybe you just want to know what the difference between colonization and infection with MRSA is This manual has been developed for nurses but may be useful for all healthcare workers Many of us figure we know enough about MRSA but do you really There are a lot of myths and misinformation surrounding MRSA Test yourself Are the following statements true or false Turn to page 4 for the answers and refer to the different sections in this resource manual listed on page 5 to learn more about MRSA and caring for patients with MRSA MYTHS AND MISINFORMATION Are the following statements true or false 1 All nurses are MRSA positive 2 I don t need to wear gloves when checking the blood pressure of a patient with MRSA 3 Nurses always clean their hands properly 4 It s only MRSA the doctor will order some antibiotics and it will be gone 5 It takes too much time and effort to put on gloves and a gown IF YOU THOUGHT THE
6. Harris AD Detection of Methicillin Resistant Staphylococcus aureus and Vancomycin Resistant Enterococci on the Gowns and Gloves of Healthcare Workers Infection Control And Hospital Epidemiology 2008 29 7 583 589 Madan AK Raafat A Hunt JP Rentz D Wahle MJ Flint LM Barrier precautions in trauma is knowledge enough Journal of Trauma 2002 52 3 540 543 Rod L Hoyt KS 2007 Methicillin Resistant Staphylococcus aureus MRSA Infection Advanced Emergency Nursing Journal 2007 29 2 118 128 Hoffmann KK Kittrell IP North Carolina Guidelines for Control of Antibiotic Resistant Organisms Specifically Methicillin Resistant Staphylococcus aureus MRSA and Vancomycin Resistant Enterococci VRE North Carolina Statewide Program for Infection Control and Epidemiology SPICE 1997 Public Health Agency of Canada 2008 The Canadian Nosocomial Infection Surveillance Program Available from http www phac aspc gc ca nois sinp survprog eng php Myatt R Langley S Changes in infection control practice to reduce MRSA infection British Journal of Nursing 2003 12 675 681 Goetghebeur M Landry PA Han D Vicente C Methicillin resistant Staphylococcus aureus A public health issue with economic consequences Canadian Journal of Infectious Diseases amp Medical Microbiology 2007 18 1 27 34 Barrett R Randle J Hand hygiene practices nursing students perceptions Journal of Clinical Nursing 2008 17 1851 1857 Cel
7. Test Your Knowledge page 32 1 F 2 F 3 F 4 F 5 F 6 F 7 F 8 F 9 F 10 F If you answered True to any of the questions go back and review the appropriate section of this resource manual 35
8. bed space e g syringes and needles or dressing supplies e Do not permit any sharing of personal effects e g powder or a deck of cards 25 5 Environment All horizontal and frequently touched surfaces should be cleaned and disinfected at least daily and when visibly soiled All curtains including shower and privacy curtains must be removed and laundered when soiled and after discharge of a patient on Contact Precautions Routine Practices apply when handling garbage Ensure cleaning supplies such as cloths and mops are changed following cleaning of a room where the patient is on Contact Precautions 6 Patient Transport The transporting of patients with MRSA infections should be limited to essential purposes only All personnel involved in the transfer of patients such as porters ambulance staff and or receiving department must be notified of the need for Contact Precautions Staff should apply PPE if direct contact with the patient or the patient s environment is anticipated All equipment used in the transfer must be cleaned and disinfected appropriately e g wheelchairs stretchers etc The MRSA status of a patient should not impede or affect the decision regarding acceptance of the patient in transfer 26 PATIENT MOVEMENT There are circumstances when it is necessary for patients to move about the hospital In such a situation you should ensure the following are met The patient must be instructed t
9. here see pages 21 28 for information on Contact Precautions For more information on Routine Practices see NL Guidelines for Routine Practices and Additional Precautions Manual Department of Health amp Community Services 2009 12 HAND HYGIENE Research has shown MRSA is most often transmitted in the hospital via the hands of HCWs 10 16 192 21 Effective hand hygiene kills or removes microorganisms on the skin However the failure to follow proper hand hygiene regimens is considered to be a leading cause of healthcare associated infections As the rates of hand hygiene increase the rates of MRSA decrease 2 WHEN SHOULD YOU PERFORM HAND HYGIENE 13 PERFORM HAND HYGIENE Before and after providing patient Before putting on and after taking off gloves Following contact with blood body fluids e g urine mucous membranes nonintact skin e g wounds or a rash this also includes e When providing direct care if the hands will be moving from a contaminated site on the body to another site Following personal body functions such as using the washroom or blowing one s nose Following contact with potentially contaminated objects e g bed pans or dressings or in the environment e g door handles or bed rails Before and after performing invasive procedures t Before preparing handling serving or eating food or feeding a patien whenever you in doubt about
10. patients and healthcare workers Again be sure to practice Routine Practices with every patient 21 1 Hand Hygiene Use alcohol based hand rub when hands are not visibly soiled Use soap and water when hands are visibly soiled Whenever you are in doubt Perform Hand Hygiene See Hand Hygiene section pages 13 17 2 Personal Protective Equipment Gloves are to be worn before entering the room of a patient on Contact Precautions Gowns are to be worn if performing tasks or activities that require direct patient contact or contact with the patient s environment Remove the gloves first then the gown and perform hand hygiene before leaving the patient s room See PPE section pages 17 20 3 Accommodation A private room with a private toilet is the preferred accommodation for a patient with an MRSA infection door may remain open A sign must be clearly posted indicating the patient is on Contact Precautions If the patient is not in a private room the sign must be posted near the bed 22 space to unmistakably indicate which patient is on Contact Precautions The sign will give instructions on items such as seeing a nurse before entering PPE and visitation rules A cart table must be placed outside the room or bed space containing gloves in varying sizes gowns and disinfectant wipes If there are no private rooms available the Infection Control Practitioner ICP must be consulted before placement can be determined Th
11. the Agent Treat with antibiotics Break Transmission 100 Compliance with Hand Hygiene and Contact Precautions Susceptible Host Promote optimal nutrition and hydration and prevent skin breakdown 11 How CAN YOU PREVENT THE TRANSMISSION OF MRSA THROUGH CONSISTENT USE OF e ROUTING PRACTICES e HAND HYGIENE e PERSONAL PROTECTIVE EQUIPMENT PPE e CONTACT PRECAUTIONS ROUTINE PRACTICES The adherence to Routine Practices formerly called Standard Precautions for all patients will prevent the spread of MRSA and other infectious organisms from unidentified patients No control program e g screening will identify all patients with MRSA 1 Point of Care Risk 5 Environmental Controls 6 Source Controls Assessment e Cleaning of equipment e Patient Flow PCRA e Environmental cleaning e Respiratory hygiene 2 Hand Hygiene e Patient placement cough etiquette 3 Personal e Management of linen dishes Visitor management Protective Equipment PPE and waste e Aseptic technique 4 Education e Sharps safety Routine Practices assumes that everyone has some kind of infectious process therefore you can help to decrease the transmission of infectious microorganisms through strict adherence to these practices When an infection such as MRSA is identified it is important to then implement Contact Precautions along with Routine Practices Routine Practices will not be discussed further
12. Patients developing MRSA infections can be treated with vancomycin However new strains of MRSA are emerging that are resistant to this antibiotic further reducing treatment options 5 It takes too much time and effort to put on gloves and a gown The time it takes to put on a gown and gloves is approximately one minute In one study it was found that the same HCWs citing lack of time as a reason for not wearing gloves and a gown were noted to not follow proper procedures regardless of time availability WHAT INFORMATION ARE YOU LOOKING FOR WHAT IS STAPHYLOCOCCUS AUREUS cccccccccsssssseesesseeecesssseeccesssseccesssseeceesssseeseeenaes 6 WHAT IS MRSA ancire hs eel Seed nn eens 6 WHATS os 6 WHAT IS THE DIFFERENCE BETWEEN COLONIZATION AND 1 7 COLONIZATION E E 7 ASD aicu KoI EPEE E E EA E AE E E E ET 7 IS MRSA REALLY A PROBLEM orisiirisii oaea e T E EEE EEE 7 WHAT CAN YOU Do TO DECREASE THE TRANSMISSION OF 9 HOW IS MRSA TRANSMITTED ccccssssssssssssssssssssssssssssssssssesssssssesssessesesesssesesesesenaes 10 DIRECT CONTACT TRANSMISSION cccccsssssssssssssssssssessssssssssssecssssssseessscsssssessseees 10 INDIRECT CONTACT TRANSMISSION cccccssssssssssssssssssssssssssssssssssssssssssesesessseseees 10 CAN
13. STATEMENTS WERE TRUE THEN THIS MANUAL IS FOR YOU IS ANOTHER RESOURCE MANUAL ON INFECTION PREVENTION AND CONTROL NECESSARY Methicillin resistant Staphylococcus aureus MRSA is an ongoing problem for institutions world wide There are many places where you may find the information you are looking for e g institutional Infection Prevention amp Control policies and procedures or the internet however at times these are neither easily accessible nor user friendly This resource manual will provide a quick and easy reference for the information you need HOW CAN YOU USE THIS RESOURCE MANUAL This resource manual is divided into sections which will provide answers to questions or concerns that may arise when dealing with MRSA e Use it as an educational tool e Use it as a reference to refresh your memory or skills e Use it to gain the knowledge and skills necessary to prevent and control the transmission of MRSA in your setting THIS MRSA RESOURCE MANUAL IS FOR USE IN ANY HEALTHCARE SETTING IT CAN BE USED IN ACUTE CARE SETTINGS LONG TERM CARE SETTINGS AND IN COMMUNITY SETTINGS THE CONTENT OF THIS MANUAL IS INTENDED TO PROVIDE INFORMATION AND GUIDELINES YOU MUST FOLLOW THE POLICIES AND PROCEDURES OF THE INSTITUTION WHERE YOU WORK This resource manual is based on infection prevention and control guidelines as set out in the Newfoundland and Labrador Guideline for Routine Practices and Additional Precautions Department
14. YOU RECALL THE CHAIN OF INFECTION ccccsssssscscccccessssssecesccceesssssssseeeeecees 10 How CAN YOU PREVENT THE TRANSMISSION OF 12 ROUTINE PRACTICE Ss polkas VaR I OR ae EE 12 HYGIENE cies Sos 13 WHEN SHOULD YOU PERFORM HAND 13 HOW DO YOU PERFORM HAND 15 PERSONAL PROTECTIVE EQUIPMENT 17 ERRORS COMMITTED WHEN USING PPE Q ccccsssscsessssseeceessseeceeeseeeceessseeceesaaes 17 CTO VES TAR 18 19 CONTACT PRECAUTIONS 21 Ly Ay Stee vans Wes E E E 22 2 Personal Protective 22 35 ACCOMMOM AL ON va ss E EA E NSS 22 45 Healthcare 25 S VEMVITOUMMENE 26 Patient Transport 26 Hos 27 ENE Re Re ee eee eee eee 28 18 8 Wissen eds me a Ieee 28 SCREENING FOR
15. bility that the gene that codes for vancomycin resistance could be transferred from VRE to MRSA which would enable MRSA to become resistant to vancomycin as well WHAT IS CA MRSA MRSA has also become prevalent in the community known as community acquired MRSA CA MRSA These infections are not attributable to hospital stays or medical procedures within the previous year and can occur in otherwise healthy individuals CA MRSA infections appear as skin and soft tissue infections and are transmitted through close contact such as occurs with athletes prisoners and in daycare centers Although hospital acquired HA MRSA and CA MRSA have genetic and phenotypical differences both are transmitted in the same fashion through direct skin to skin contact or contact with shared items or surfaces that have come into contact with someone else s colonized or infected skin WHAT IS THE DIFFERENCE BETWEEN COLONIZATION AND INFECTION You may have wondered what the difference is between a patient who is colonized with MRSA and one who has an MRSA infection COLONIZATION An individual with MRSA present growing and multiplying without clinical symptoms tissue invasion or cellular injury is said to be colonized The sites where colonization most often occurs are the anterior nares axillae and the perineum An individual may become colonized with MRSA but may never develop an MRSA infection INFECTION An individual becomes infected when t
16. e ICP will help to select an appropriate roommate The ICP will consider factors such as whether the patient has respiratory issues or 15 immunocompromised 23 COHORTING There may be periods when the availability of private rooms is in short supply or even worse there may be an increase in the number of patients with MRSA infections In situations such as these patients colonized or infected with MRSA may be cared for in the same room or on an entire unit The decision to create an MRSA ward or unit will be made by the Infection Control Practitioner in consultation with the healthcare team Consideration will be given to the following Patients with other potentially transmissible microorganisms e g Varicella Zoster primarily Chickenpox recurrent Shingles Neisseria meningitides Haemophilus influenzae Type B Tuberculosis Measles HIV Cystic Fibrosis or who are severely compromised would not be suitable for sharing a room with others The MRSA strain should be the same for each patient in the cohort However most labs don t do strain typing but you can consider strains to be the same if they show the same resistance and susceptibility patterns If a decision is made to cohort patients Instruct each patient on the importance of good hygiene e g hand hygiene and respiratory etiquette e g coughing into sleeve all wounds must be covered and drainage contained adequately Reinforce the no sharing of persona
17. ember different settings have different policies and procedures regarding screening be sure to follow the policies of your workplace COLLECTING A SPECIMEN FOR MRSA Before you obtain a specimen for MRSA check to ensure the patient is not on antibiotics sensitive to MRSA as it will yield a false negative result The appropriate place to obtain the screening specimen is from the anterior nares e Use a sterile swab moistened from the culture tube transport medium or sterile saline e Gently place the swab in the nares and rotate to touch as much mucous membrane as possible The same swab can be used for both nostrils e Place the swab back in the tube and label appropriately 29 Alternate Sites for Screening Specimens e If the patient has an open wound swab the wound if more than one wound swab each with a separate swab e If the patient has a tracheostomy send a sputum sample for the screen e If the patient has a urinary catheter send a urine sample for the screen e If the patient has indwelling devices present swab the exit sites Be sure the tube is labeled appropriately and immediately sent to the lab or placed in a specimen only fridge WRAP UP You should now be able to confidently answer the two questions below Think about the answers now and then check your answers on the next page YOUR PATIENT HAS BEEN IDENTIFIED AS HAVING AN MRSA INFECTION WHAT WILL YOU DO WHO SHOULD YOU TELL 30 e Explai
18. fter removing the gown For further information on PPE see the PowerPoint presentation on the CDC website or CHICA Canada 20 CONTACT PRECAUTIONS Contact Precautions are intended to prevent the transmission of infectious agents such as MRSA This term is used by the Public Health Agency of Canada to describe the Additional Precautions needed to reduce the risk of transmitting infectious agents Contact Precautions are used in addition to Routine Practices as discussed on page 12 1 COMMON ERRORS RELATED TO CONTACT PRECAUTIONS Failure to follow proper hand hygiene practices is the most common error Most studies have found that approximately 50 of nurses and other healthcare workers do not wash their hands as often as they should Failure to put on gloves and a gown when providing direct patient care is another error cited in research studies Failure to properly remove the gloves and gown How often do you take off the gown before the gloves When you remove gloves are you careful to take them off properly so your hands don t become contaminated Failure to clean equipment being used for multiple patients is an error made daily Do you always clean the blood pressure cuff and stethoscope before moving to another noninfected patient Failure to place an infected or colonized patient on Contact Precautions Often it is not known if a patient has MRSA before being in contact with other
19. he bacteria invade the tissues and causes an immune response and cellular changes This is accompanied by clinical signs of illness such as fever elevated white blood count purulence and inflammation Is MRSA REALLY A PROBLEM Do you need to worry about MRSA in the facility where you work The answer is YES MRSA infection and colonization is increasing in Canada as shown in Figure 1 In 1995 there were 0 25 cases per 1 000 admissions of MRSA infection found In 2007 there were 2 57 cases of MRSA infection per 1 000 patient admissions a ten fold increase Figure 1 Overall MRSA incidence rates per 1 000 patient admissions from 1995 to 2007 Overall Infection Colonization MRSA per 1 000 admissions gt amp DN 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Reprinted from the Canadian Nosocomial Infection Surveillance Program 2009 These statistics were taken from 47 hospitals throughout Canada by the Canadian Nosocomial Infection Surveillance Program CNSIP and are newly identified cases As you can see MRSA really is a problem for everyone The effects of MRSA infections can be devastating to the patient and the healthcare system See the Implications of MRSA Infections box below There are implications to being colonized with MRSA as well Being colonized means the individual can potentially transmit MRSA therefore it is necessary to take a
20. ik S Kocash S Hygienic hand washing among nursing students in Turkey Applied Nursing Research 2006 21 207 211 Sharir R Teitler N Lavi I Raz R High level handwashing compliance in a community teaching hospital a challenge that can be met Journal of Hospital Infection 2001 49 55 58 Pittet Hugonnet S Harbarth 5 Mourouga Sauvan Touveneau S Pemeger TV Effectiveness of a hospital wide programme to improve compliance with hand hygiene Infection Control Programme The Lancet 2000 356 1307 1312 34 22 23 24 25 26 Community and Hospital Infection Control Association Canada Grand Prix of PPE Video August 20 2010 Available from http www chica org inside_products html Centers for Disease Control and Prevention 2004 Personal Protective Equipment PPE in Healthcare Settings Available from www cdc gov HAI prevent ppe_train html Morgan DJ Diekema DJ Sepkowitz K Perencevich EN Adverse outcomes associated with contact precautions A review of the literature American Journal of Infection Control 2009 37 2 85 93 Boyce JM MRSA patients proven methods to treat colonization and infection Journal of Hospital Infection 48 Supp A S9 S14 Williams V Callery C Vearncombe M Simor A 2011 Universal versus targeted active surveillance for Methicillin resistant Staphylococcus aureus in medical patients The Canadian Journal of Infection Control 26 105 111 Answers to
21. ination of your hands ERRORS COMMITTED WHEN PERFORMING HAND HYGIENE INCLUDE Missing areas of the hands especially the outside of the thumbs between the fingers and the fingertips Turning off taps with the hands not with a paper towel Not using enough ABHR to cover all surfaces Not rubbing the hands until the ABHR is dry 16 Other Issues Involved in Proper Hand Hygiene e Intact skin is the first line of defense Apply lotion frequently to avoid dry cracked skin which would allow for microorganisms to enter your body e Cover any breaks in skin integrity with a bandage and change it often Further Information on Hand Hygiene An interactive website for hand hygiene can be found at http www health gov on ca en ms handhygiene More information can be found via PIDAC published 2008 revised 2009 Best Practices for Hand Hygiene In All Health Care Settings Available from http www oahpp ca resources pidac knowledge best practice manuals hand hygiene html PERSONAL PROTECTIVE EQUIPMENT PPE PPE such as gloves and a gown act as a barrier between the individual and infectious agents such as MRSA Gloves are to be worn when caring for a patient with an MRSA infection A gown may also be required depending on the activities to be completed Facial protection is required when caring for patients with MRSA related pneumonia or other respiratory infections or if suctioning of a tracheostomy is anticipated
22. l effects recommendation Use dedicated equipment where possible or ensure equipment is cleaned and disinfected between patients Clean all horizontal and frequently touched surfaces at least twice daily and when soiled Remember each patient is on Contact Precautions remove PPE and perform hand hygiene before moving to the next patient or task 24 Research has shown that patients may suffer from high levels of depression and anxiety while maintained on Contact Precautions due to decreased visits from friends and family Also nurses and other HCWs tend to organize care to minimize the number of times entering the room which further decreases opportunities for conversation and socialization Be sure to provide your patient with time to ask and answer questions when in the room and recognize the patient s need for socialization 1 4 Healthcare Equipment Remember as previously stated MRSA can survive on inanimate objects An error committed by many is that equipment is not cleaned after use on one patient and prior to the use on another patient e Try to dedicate equipment to a single patient on Contact Precautions whenever possible e g a wheelchair which must be clearly labeled with the name of the patient e When using equipment for multiple patients be sure to clean and disinfect it between patients e g a blood pressure cuff or stethoscope e Limit the amount of supplies brought into the room or
23. ll necessary precautions e Contain respiratory secretions e Cover all wounds e Perform hand hygiene when appropriate See page 13 WHAT CAN YOU DO TO DECREASE THE TRANSMISSION OF MRSA Now that you know a little more about MRSA and what it means to the patient individual healthcare system and you what can you do about it The next sections will explain how MRSA gets spread and how you can help to stop or decrease the spread The following are guidelines to follow but remember to always check the institutional policies in place where you work How Is MRSA TRANSMITTED The successful transmission of MRSA and other infectious agents requires a source a susceptible host with a portal of entry and a mode of transmission Assuming that nurses have the most direct contact with patients and that MRSA can be found in the environment as well as on individuals nurses must become knowledgeable of the modes of transmission and the methods to reduce the rate of transmission MRSA is transmitted via Contact Transmission and occurs through either direct or indirect contact with infected persons or objects DIRECT CONTACT TRANSMISSION takes place when MRSA is transferred from one colonized or infected person to another person This can occur through skin to skin transfer e g touching or whe
24. n blood or other body fluids from one individual directly enters another individual s body through the mucous membranes or a break in the skin INDIRECT CONTACT TRANSMISSION takes place when MRSA is transferred on a nurse s hands or through a vehicle such as a contaminated object that are transiently contaminated e g a blood pressure cuff Given the exposure and proximity to both carriers and infected patients nurses may act as source a vehicle or victim The nurse who is colonized is the source for direct transmission The nurse with temporary carriage acts as a vehicle For example you may transmit MRSA if you have contact with an infected wound of one person and then provide care to another individual without performing hand hygiene The nurse who gets an infection is a victim CAN YOU RECALL THE CHAIN OF INFECTION THE SUCCESSFUL TRANSMISSION OF MRSA AND OTHER INFECTIOUS AGENTS REQUIRES A SOURCE A SUSCEPTIBLE HOST WITH A PORTAL OF ENTRY AND A MODE OF TRANSMISSION 10 REMEMBER THE CHAIN OF INFECTION IF YOU Do BREAK THE CHAIN YOU CAN TRANSMIT MRSA TO YOUR PATIENTS The Chain of Infection transmission Break the Chain agent reservoir The Chain of Infection An agent MRSA Transmission Contact with contaminated individuals environment or objects Susceptible Host A patient with reduced Defences Breaking the Chain of Infection Break Any Link Eliminate
25. n to the patient and family the need for Contact Precautions and answer questions or concerns they may have e Immediately place the patient on Contact Precautions e Assess the need to move the patient to another room e Inform the physician e Consult the Infection Contact Practitioner e Obtain a cart with PPE and place it outside the room or bed space e Post the Contact Precautions sign e Update the patient s chart and Kardex so the whole healthcare team is aware of the patient s status If you weren t sure of the answers perhaps there is a section you may want to review If you were able to answer correctly good for you you are on the way to helping to decrease the transmission of MRSA in your facility TEST YOUR KNOWLEDGE DO THE TEST ON THE NEXT PAGE TO ASSESS YOUR UNDERSTANDING OF MRSA 31 TEST YOUR KNOWLEDGE Answer the following true or false 1 MRSA is a gram negative bacterium True 2 All nurses have MRSA True False 3 MRSA is most often transmitted via droplets False True False 4 There is no need to wear gloves or a gown when checking the blood pressure for a patient with MRSA True LU False 5 When a patient has been identified as MRSA positive Airborne Precautions must be followed 0 True False 6 You must wear gloves gown and goggles before entering a patient s room with MRSA True False 7 MRSA positive patient
26. o perform hand hygiene before leaving the room The patient must be instructed on proper cough etiquette e g using tissues or coughing into the sleeve 3 The patient must be instructed not to visit with other patients All wounds must be covered appropriately to contain the drainage If the patient cannot understand or is not able to follow these guidelines a HCW should accompany the patient 7 Education In an acute care setting patients with MRSA infections and their family members must be provided with the following written information e What is MRSA e How is it transmitted How is MRSA treated e What are Contact Precautions All visitors must be directed to see the nurse before entering the room of a patient on Contact Precautions to receive specific information and instructions This would include e A demonstration of applying and removing PPE e A review of hand hygiene procedures and when it is to be performed A demonstration of the proper disposal of linen and PPE e An explanation of the need for a minimum number of visitors 21 Instructions to not visit other patients at the facility common areas of the Unit e g such as the kitchen while wearing PPE or without performing hand hygiene 8 Linen e All soiled linen must be handled as little as possible Place it in a receptacle immediately e A receptacle for linen must be kept in the room to ensure linen is contained at point of
27. of Health amp Community Services 2009 Newfoundland and Labrador Guidelines for Management of Multidrug resistant organisms across the Continuum of Care Department of Health amp Community Services 2007 and Best Practices for Infection Prevention and Control of Resistant Staphylococcus aureus and Enterococci Ministry of Health and Long Term Care Public Health Division Provincial Infectious Diseases Advisory Committee 2007 Every effort has been made to reflect the most up to date evidence available at the time of writing MYTHS AND MISINFORMATION THE REAL FACTS 1 All nurses are MRSA positive In fact this could not be further from the truth Several studies have estimated that approximately 5 of healthcare workers HCWs are colonized by MRSA 2 I don t need to wear gloves when checking the blood pressure of a patient with MRSA Since MRSA has been found on the patient s skin and can survive in the environment on surfaces such as over bed tables counter tops and door knobs gloves must be worn 67 Gloves prevent the contamination of the hands 3 Nurses always wash their hands properly Many research studies have been completed observing rates of hand hygiene compliance for HCWs The results vary from 11 to 58 Therefore there is room for improvement for all professions in all healthcare settings 4 It s only MRSA the doctor will order some antibiotics and it will be gone
28. s cannot be admitted to a room which already has three non infected patients O True False 8 separate swab must be used for each nostril for screening O True 1 False 9 Cohorting is not permitted with patients known to be carriers of MRSA True False 10 There is no treatment for MRSA infections Answers on page 35 C True False 32 REFERENCES 1 Department of Health amp Community Services Disease Control Division Newfoundland Labrador Guideline for Routine Practices and Additional Precautions February 26 2009 Available from http www health gov nl ca health publichealth cdc routine_practices_additional_pre cautions pdf Department of Health amp Community Services Disease Control Division Newfoundland Labrador Guidelines for Management of Multidrug resistant Organisms July 27 2007 Available from http www health gov nl ca health publichealth cdc multidrug_resistance_manageme nt pdf Ontario Ministry of Health and Long Term Care Public Health Division Provincial Infectious Diseases Advisory Committee Annex A Screening Testing and Surveillance for Antibiotic Resistant Organisms AROs In All Health Care Settings July 2011 Update of Best Practices for Infection Prevention and Control of Resistant Staphylococcus aureus and Enterococci March 2007 http www oahpp ca resources documents pidac Annex 20A 20 20PHO 20template 20 20FINAL 20 20201 1 08 08 pdf
29. use e If linen is wet or contains blood or body fluids use a leak resistant receptacle 9 Dietary Dishes e Use Routine Practices when handling dishes and cutlery SCREENING FOR MRSA Screening which involves doing a culture and sensitivity test on a nasal swab is conducted to identify those individuals who may be colonized with MRSA but show no clinical signs and systems of infection Why Not Screen Everybody Screening is not a control method Instead screening allows for control measures such as placement and Contact Precautions to be put in place Routine Practices must still be carried out at all times with all patients whether screening is conducted or not so that there is no transmission of MRSA or other infectious microorganisms If every patient was screened for MRSA and treated if found to be colonized there would be an overuse of antibiotics which could lead to further resistant strains of MRSA Individuals treated for colonization have an increased risk of becoming recolonized following treatment As well more patients would be placed in an isolated room which can cause anxiety and depression Also screening and treatment are expensive Therefore it is recommended that screening be completed on high risk individuals only 28 A research team at Sunnybrook Health Sciences Center in Ontario identified the risk factors for MRSA carriage for their facility See the Risk Factors for MRSA Carriage below Rem
30. whether hand hygiene should be performed 14 HOW DO YOU PERFORM HAND HYGIENE There are 2 methods used for hand hygiene i using an alcohol based hand rub ABHR which is the preferred method to kill microorganisms when hands are not visibly soiled and ii washing with soap and running water when hands are visibly soiled Hand washing physically removes organisms but using ABHR kills microorganisms Also use of ABHR is faster and easier to do and is more readily available than washing with soap and water Using Alcohol Based Hand Rub ABHR e Ensure hands are visibly clean and dry e Apply between 1 to 2 full pumps of ABHR depending on manufacturer or enough to cover all surfaces and dry within the recommended time e Spread the ABHR over all surfaces of the hands Pay attention to finger tips between the fingers the backs of the hands and base of the thumbs Rub hands for a minimum of 15 seconds until ABHR is dry 15 washing with Soap and Wate Wet hands with warm not hot water 1 Vigorously lather all surface of the hands for a minimum of 15 seconds Apply liquid or foam soap attention to finger tips between the fingers the backs of the hands and base of the thumbs Thoroughly rinse the soap off Leaving soap on the hands will lead to dryness and cracking Dry hands fully and gently blotting with a paper towel Use a paper towel to turn off taps to avoid recontam
Download Pdf Manuals
Related Search