MRSA Update

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MRSA Update

• A program jointly sponsored by
• Howard County General Hospital
• and the
• Howard County Health Department

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MRSA Putting it in perspective

• What is the extent of the problem?
• Who is at risk?
• How is this spread to others?
• Why is this bacteria different from regular staph?

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The basic facts

• We are covered in bacteria
• Staphylococcus aureus is part of the normal
  population of skin bacteria
• In the past 5 years, several new nationwide
  strains of resistant Staph aureus have become
  prominent. These strains can cause more
  aggressive infections.

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MRSA

• M Methicillin
• R Resistant
• S Staphylococcus
• A -- Aureus

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MRSA

• First described 1959 in laboratory isolates
• First US case in 1968
• Established risk factors
• Recent hospitalization
• Recent surgery
• Residence in long-term care facility
• Dialysis
• Indwelling catheters
• New strains with no healthcare exposure risks
  have become prominent (CA-MRSA)

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CA-MRSA Facts

• Most infections involve the skin
• Cellulitis
• Boils
• Pimples
• abscesses
• More serious infections can occur, including
  pneumonia, blood stream infections, or bone
  infections

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MRSA Facts

• Skin lesions can look like spider bites
• The infections often require drainage and are
  usually treated with antibiotics
• The usual antibiotics for skin infections do
  not work against this strain of Staph aureus
  (MRSA)

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A story about spider bites
MMWR. 200352(5)88.
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Community-acquired MRSA Wound Infections

• Los Angeles County Jail (N165,000)
• 928 inmates with MRSA wound infections in 2002
• 66 hospitalized
• 39 with initial skin infections
• 10 with invasive disease (bacteremia,
  endocarditis, osteomyelitis)
• Common predominant strain consistent with
  community outbreaks in other parts of United
  States

MMWR. 200352(5)88.
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Football and MRSA
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Kazakova SV et al. N Engl J Med 2005352.
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Kazakova SV et al. N Engl J Med 2005352.
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MRSA Characteristics and Risks

• Misdiagnosis of spider bite
• Close contact with others
• Uncovered wounds
• Shared personal equipment

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Defining the problem

• In a prevalence study from 2001-2002, 30 of
  individuals had Staph aureus in the nose, only 1
  had MRSA in the nose
• For Staph infections in hospitals, 50-60 of all
  strains are MRSA

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Why is MRSA important in the hospital?

• Increased mortality
• Increased length of stay
• Increased costs, eg. bloodstream infections
• Hospital-acquired bloodstream infections cost
  33,268/year
• HA MRSA bloodstream infections cost an additional
  27,083/year

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How is MRSA spread in the hospital?

• 1.HANDS, HANDS, HANDSof
  Healthcare Workers
• 2.Clothes
• 3.Equipment
• 4.Environment

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How is MRSA detected and managed in healthcare
settings?

• The MRSA Bundle
• Active Surveillance
• Use of Barrier Precautions (gowns, gloves, masks)
• Clean or use dedicated equipment
• Scrupulous hand hygiene

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Why actively look for MRSA?

• MRSA colonization is often silent
• MRSA colonization correlates with infection
• Actual infections (bloodstream, pneumonia, skin
  and soft tissue, wounds) comprise only the "tip
  of the iceberg
• Cultures done for infection alone would miss
  75-80 of silent carriers

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Active Surveillance for MRSAin the Intensive
Care Unitat Howard County General Hospital

• Patient Safety/Quality Improvement Initiative

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• All patients have nasal swabs for MRSA on
  admission to the ICU
• If positive
• they are placed on contact isolation for the rest
  of their hospital stay
• a computerized flag is entered into their medical
  record. This ensures that they will be placed on
  isolation in all subsequent visits to the hospital

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• All patients are screened weekly until transfer
  out of the ICU
• All patients colonized or infected with MRSA are
  tracked by the infection control practitioner
  (ICP) to analyze and identify opportunities for
  improvement
• A MRSA Information Sheet is available for
  patients and family members explaining the
  purpose of screening and isolation

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MRSA Rates - ICU

• February-September 2007
• 446 admissions
• 78 with any positive culture for MRSA
• 38 were picked up by nasal screen
• 49!

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Hospital-Wide MRSA Rates

• March 2007 - 65
• August 2007 - 49 (406 MRSA/822 S. aureus)

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How Can MRSA Be Prevented?

• To understand prevention, modes of transmission
  must be understood

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HOW IS MRSA TRANSMITTED?

• HANDS, HANDS, HANDS!!!
• 5 CS
• Crowding
• Cutaneous (skin-to-skin) Contact
• Compromised skin
• Contaminated equipment
• Lack of Cleanliness

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HOW ARE MRSA SKIN INFECTIONS TREATED?

• Recognize/Seek medical attention
• Drainage of pus
• Antibiotics
• Decolonization

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HOW DO I PREVENT SPREAD TO OTHERS?

• Cover your wound
• Clean your hands frequently soap, water,
  alcohol gels
• Launder soiled sheets, towels, clothing with
  laundry detergent and dry in a hot dryer
• Do NOT share personal items towels, razors,
  equipment
• Use a barrier (ie. towel or clothing) between
  your skin and equipment that is shared
• Wipe surfaces before and after use with approved
  disinfectant

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What percentage of the audience is carrying Staph
aureus in the nose?

• A. 5
• B. 25
• C. 50
• D. 80

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What percentage of the audience is carrying Staph
aureus in the nose?

• A. 5
• B. 25
• C. 50
• D. 80

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Staph aureus can stay alive on surfaces for

• A. 10 MINUTES
• B. 10 HOURS
• C. 10 DAYS
• D. 10 MONTHS

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Staph aureus can stay alive on surfaces for

• A. 10 MINUTES
• B. 10 HOURS
• C. 10 DAYS
• D. 10 MONTHS

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A recent survey culturing tray tables on
airplanes found MRSA on what percent of the 19
trays sampled?

• A. 16
• B. 42
• C. 72
• D. 100

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A recent survey culturing tray tables on
airplanes found MRSA on what percent of the 19
trays sampled?

• A. 16
• B. 42
• C. 72
• D. 100

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The current level of MRSA in the community has
been present

• A. ONLY IN THE LAST 3 MONTHS
• B. FOR THE PAST YEAR
• C. FOR THE PAST 4 YEARS
• D. ONLY SINCE THE LAST CASE OF BIRD FLU
  REPORTED IN THE NEWS

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The current level of MRSA in the community has
been present

• A. ONLY IN THE LAST 3 MONTHS
• B. FOR THE PAST YEAR
• C. FOR THE PAST 4 YEARS
• D. ONLY SINCE THE LAST CASE OF BIRD FLU
  REPORTED IN THE NEWS