Fairview Hospital 29 Lewis Avenue Great Barrington, MA 01230 Geraldine A. McQuoid RN, MA, MSN Director of Education and Infection Control Protocols for MRSA management in a 25-bed Federally designated Critical Access Hospital

Collaboration with our local Long Term Care Facilities Higher susceptibility & communicability of infections Impact on Hospital census Industry trends in the diagnosis & treatment of MRSA Rapid MRSA PCR test bilateral swab of the anterior nares 24-hour turn around time VIP Screen {EMR} Point of admission, institute precautions Bed availability Private room Over 67% of our patients come from three local long term care facilities. Patients in these facilities/institutional environments have higher susceptibility and communicability. This impacts Fairview as we make decisions on our specific hospital population in regards to MRSA vs the current industry trends. EXPLAIN SWABS

LTC Testing of Residents / FVH Admission Communication to residents & families 153 patients tested by ICP for reliability 33 patients tested positive for a total rate of 22% Treatment options in LTC Do not treat Decolonization with Mupirocin Institute precautions Cohorting of patients FVH Emergency Room protocol MRSA PCR Swab on all residents not in our database Onsite Education to LTC facility staff Environmental recommendations Extensive hand hygiene Increased personal protective equipment Ongoing communication The project required the support of the Administrators at the facilities. Two of the three agreed to move forward. Letters were sent to all residents and families. In nursing home A, 82 patients were tested. In nursing home B, 71 patients were tested for a total of 153 patients.

On the Rise Who will be tested? Community Acquired and Hospital Acquired MRSA continue to rise LTC positive patients were asymptomatic for infection Colonization often precedes clinical infection with MRSA Often times deadly to geriatric patients Decisive Action CMS recent regulations on reimbursement Outside influences: CDC – SHEA – NIH Cost of Universal Testing of admissions vs loss of revenue for Hospital Acquired MRSA infection Who will be tested? It is a fact that community acquired (CA) MRSA as well as hospital acquired (HA) MRSA is on the rise. The long term care residents who tested positive were asymptomatic for infection. These residents were colonized with MRSA. Colonization with MRSA often precedes full blown clinical MRSA infection which can be deadly for geriatric patient. Colonized patients with MRSA provide a substantial reservoir for person-to-person spread in the hospital.