MRSA in Corrections Danae Bixler, MD, MPH Infectious Disease Epidemiology Program West Virginia Bureau for Public Health West Virginia Department of Health and Human Resources

West Virginia Department of Health and Human Resources Objectives Participants should understand Staphylococcus aureus MRSA Surveillance (documentation via line list) Diagnosis and treatment Prevention Outbreak management guidance Educational materials February 2009 West Virginia Department of Health and Human Resources

February 2009 West Virginia Department of Health and Human Resources

Staphylococcus aureus Common skin organism ~ 1 in 3 persons are … carriers Mild skin infections common Severe, life threatening infections Very young Very old Chronic conditions February 2009 West Virginia Department of Health and Human Resources

Methicillin resistant Staphylococcus aureus S. aureus resistant to most commonly used effective antibiotics The most common cause of skin infections: Children Young adults Severe, life-threatening infections: Very young Very old Chronic conditions February 2009 West Virginia Department of Health and Human Resources

Factors that Facilitate Transmission Source: CDC Defense Offense Frequent Contact Crowding Antimicrobial Use Compromised Skin Contaminated Surfaces and Shared Items Cleanliness February 2009 West Virginia Department of Health and Human Resources

West Virginia Department of Health and Human Resources Screening and Surveillance Federal Bureau of Prisons Clinical Practice Guidelines, 2005 Intake Recently hospitalized inmates Inmates at risk during routine medical evaluation Diabetes Dialysis Skin compromise Monitor bacterial culture results Observations by correctional workers Document ongoing surveillance (line list) February 2009 West Virginia Department of Health and Human Resources

West Virginia Department of Health and Human Resources Diagnosis and Treatment Federal Bureau of Prisons Clinical Practice Guidelines, 2005 Diagnosis Skin examination Culture Treatment Warm soaks Incision and drainage Remove foreign devices Antibiotic therapy Warm soaks should be routinely considered in the treatment of minor skin and soft tissue infections. . . . 20 minutes per day, 2-3 times per day. February 2009 West Virginia Department of Health and Human Resources

West Virginia Department of Health and Human Resources Primary Prevention (prevention activities BEFORE you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005 Education Correctional standard precautions Regular hand hygiene Assume all body fluids are infectious / use gloves: Blood Feces Urine Saliva / mucous / sputum Wound drainage Safe disposal of sharps Safe placement of inmates February 2009 West Virginia Department of Health and Human Resources

West Virginia Department of Health and Human Resources Primary Prevention (2) (prevention activities BEFORE you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005 Hand hygiene program Oversight Training Sanitation Routine cleaning Terminal cleaning Sanitation inspections Antibiotic prescribing practices February 2009 West Virginia Department of Health and Human Resources

West Virginia Department of Health and Human Resources Secondary Prevention (prevention activities AFTER you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005 Correctional contact precautions Hand hygiene before and after EVERY contact Single cell if drainage cannot be contained PPE (gloves / gown ) for contact with contaminated items or blood/body fluids Sanitation Daily and terminal cleaning Safe disposal of sharps and bandages Transfers Contain drainage Inform escort officers and receiving institution clinical director February 2009 West Virginia Department of Health and Human Resources

West Virginia Department of Health and Human Resources Secondary Prevention (prevention activities AFTER you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005 Surveillance Interview index case Risk factors Contacts Evaluate contacts History of food handling? Increased surveillance at routine visits Bacterial cultures Document (line list) February 2009 West Virginia Department of Health and Human Resources

West Virginia Department of Health and Human Resources Outbreak Management Federal Bureau of Prisons Clinical Practice Guidelines, 2005 Laboratory confirmation – save isolates Tracking – line list Containment Transfers Evaluate each inmate before transfer Infection control Hand hygiene Intensified correctional contact precautions Intensified inspections February 2009 West Virginia Department of Health and Human Resources

West Virginia Department of Health and Human Resources Outbreak Management (2) Federal Bureau of Prisons Clinical Practice Guidelines, 2005 Surveillance Common source Evaluate all potentially exposed inmates Sustained or involving multiple inmates Consider targeting high risk inmates Decolonization (caution) Education Inmates Corrections staff Health care personnel February 2009 West Virginia Department of Health and Human Resources

West Virginia Department of Health and Human Resources Conclusions Cornerstones of prevention Hand hygiene Correctional standard precautions Surveillance (document on your line list) Cornerstones of control Correctional standard and contact precautions February 2009 West Virginia Department of Health and Human Resources