best practices: mrsa precautions
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BEST PRACTICES: MRSA PRECAUTIONS. Dr. Elizabeth Bryce. Topics to Be Covered. Devising Risk Strategies Risk Assessment for Level of Precautions Determining the Need for Additional Precautions. Devising Risk Strategies: Waxing Philosophical. To develop effective prevention strategies must - PowerPoint PPT PresentationTRANSCRIPT
Topics to Be Covered
Devising Risk StrategiesRisk Assessment for Level of
PrecautionsDetermining the Need for Additional
Precautions
Devising Risk Strategies: Waxing Philosophical
To develop effective prevention strategies mustunderstand the components responsible for the
current state in your facility: Rates of Community acquired MRSA Rates of Healthcare Acquired MRSA Rates in your Facility
The same situation?Very high rates of CMRSA+ high incidence of
HCMRSA + endemic in facility VSLittle CMRSA + little HCMRSA + low facility rates
Risk management strategies…
BUT also consider:Your Patient PopulationYour Environment Impact of implementation plan/proceduresFeasibility Probability of Effectiveness of measures
What is the goal of your strategy?
MRSA Eradication MRSA Control?
But Wait …..There’s More!
Who will you target?The Facility Population?Just Inpatients? Or Residents?Pre-Admit Population (prior to
admission)The Community?
Risk Assessment
Transmission and persistence determined by:Vulnerable patientsSelective antimicrobial pressureColonization pressure Impact of implementation strategiesContinued adherence to prevention (long-
term investment)
Risk Assessment
Two components to rememberOrganizational risk assessment which sets
policy and procedure Individual risk assessment with each
patient interaction
General Control Interventions
Administrative Support Antimicrobial Stewardship Surveillance Environmental Cleanliness Routine/Contact Precautions Education Additional Precautions Critical Review of implementation strategies
Administrative Support
Fiscal ResourcesHuman ResourcesImplementing System ChangesPhysical Plant ChangesPromoting Adherence/Role ModelingFostering a Safety Climate
Antimicrobial Stewardship
Shortest duration possibleNarrowest spectrum possibleTreat the patient, not the report!Formulary ReviewsBuilt-in Compliance features in PharmacyPractice Guidelines
Environmental Cleanliness
Correct Agent/DilutionCorrect methodAvoid ClutterFocus on frequently touched surfaces Isolation Cleaning ProtocolsDon’t forget shared equipment
Education
Many different strategiesFacility-wide versus focused Informational, interactive, training,
campaigns Ideally behaviour change oriented
And trying to effect a culture change
Routine Precautions
Have an essential role in preventing transmission – always
Particularly important vis a vis undetected cases
Hand Hygiene particularly important here as is Risk Assessment
Additional Precautions
Very important to consider the context and the situation
Contact Precautions: Evidence: Consensus versus evidence based
recommendation.Elements: single/isolation rooms or cohorting,use of gown and gloves for potential patient contact or
contact with contaminated areasUnresolved:
Duration of CPImpact of CP on patient well-being and careUse of CP preemptively
Other Barriers
For the most part; as per Routine Precautions
Mask – anticipated exposure to droplets/secretions
Respirator – generally not specifically for MRSA
Facial Protection – anticipated exposure to droplets/secretions
Other Measures
Notifying others of patient transfers or diagnostic procedures
Ensuring patients clean hands and cover open wounds when outside room
Visitors informed of appropriate precautions
Education of patient
Finally……
Control of MRSA should be Dynamic Systematic Tailored to reflect the epidemiology/environment Flexible – can be scaled up or down Measured
Strive to: Assess the problem, evaluate the effectiveness of the measures implemented.
References
Taconnelli E: MRSA: risk assessment and infection control policies. Clin Microbiol Infect 2008
Humphreys H National guidelines for the control and prevention of MRSA – what do they tell us? Clin Microbiol Infect 2007:13:846-853
PICNet revised ARO guidelines Dec 2007 Sigel J Management of multidrug-resistant organisms in healthcare
settings, 2006 Am J Infect control 2007;35:S165-193 Coia JE Guidelines for the ontrol and prevention of MRSA in
healthcare facilities. J Hosp Infect 2007;63S:S1-S44