1. Infection Control in ANesthesia
BPW Annual Review

2. Outline
Review of the problem
MRSA
C-Diff

3. The Problem of Antibiotic Resistance
Antibiotic resistance is a worldwide problem New forms of antibiotic resistance can cross international boundaries and spread between continents with ease. Many forms of resistance spread with remarkable speed. World health leaders have described antibiotic-resistant microorganisms as “nightmare bacteria” that “pose a catastrophic threat” to people in every country in the world.

4. Each year in the United States, at least 2 million people acquire serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections.
At least 23,000 people die each year as a direct result of these antibiotic-resistant infections. Many more die from other conditions that were complicated by an antibiotic-resistant infection.

5. 250,000 people each year require hospital care for Clostridium difficile (C. difficile) infections. In most of these infections, the use of antibiotics was a major contributing factor leading to the illness.
At least 14,000 people die each year in the United States from C. difficile infections..

6. In most cases, antibiotic-resistant infections require prolonged and/or costlier treatments, extend hospital stays, necessitate additional doctor visits and healthcare use, and result in greater disability and death compared with infections that are easily treatable with antibiotics

7. Up to 50% of all the antibiotics prescribed for people are not needed or are not optimally effective

8. The other major factor in the growth of antibiotic resistance is spread of the resistant strains of bacteria from person to person, or from the non-human sources in the environment, including food.

9. There are four core actions that will help fight these deadly infections:
preventing infections and preventing the spread of resistance
tracking resistant bacteria
improving the use of today’s antibiotics
promoting the development of new antibiotics and developing new diagnostic tests for resistant bacteria

10. MRSA

11. Pathogenicity
MRSA bacteria have many virulence factors that enable them to cause disease.
MRSA is a cause of healthcare-associated bloodstream and catheter-related infections
MRSA is also a common cause of community-associated infections, especially skin and soft tissue infections, and can also cause necrotizing pneumonia.

12. Limited Treatment Options
MRSA is resistant to first-line antibiotics, leaving limited treatment options. CDC identifies MRSA as a “serious” threat to health.

13. Spread
MRSA is primarily spread through direct and indirect contact with infected or colonized patients Poor adherence to standard infection control precautions leads to transmission between patients Adherence to infection control measures is critical to preventing MRSA outbreaks

14. Studies show that about one in three (33%) people carry staph in their nose, usually without any illness. Two in 100 people carry MRSA. There are not data showing the total number of people who get MRSA skin infections in the community.

15. CDC Guidelines
Per the CDC: “ Standard Precautions MUST be used for all patient care” :

16. Which disinfectants should be used against MRSA?
Disinfectants effective against Staphylococcus aureus or staph are most likely also effective against MRSA.
Check the disinfectant product’s label on the back of the container. Most, if not all, disinfectant manufacturers will provide a list of germs on their label that their product can destroy

17. Using Disinfectants
Cleaners and disinfectants have instructions on the label that tell you :
How to apply the product to a surface.
How long you need to leave it on the surface to be effective (contact time).
If the surface needs to be cleaned first and rinsed after using.
If the disinfectant is safe for the surface.
Whether the product requires dilution with water before use.
Precautions you should take when applying the product, such as wearing gloves or aprons or making sure you have good ventilation during application.

18. Surfaces to Clean
Focus on surfaces that touch people’s bare skin each day and any surfaces that could come into contact with uncovered infections. ( Large surfaces such as floors and walls have not been directly associated in the spread of staph and MRSA)
There is no evidence that spraying or fogging rooms or surfaces with disinfectants will prevent MRSA infections more effectively than the targeted approach of cleaning frequently touched surfaces and any surfaces that have been exposed to infections.

19. Anesthesia
Things like B/P cuffs, EKG leads, and pulse oximeters can be common carriers
Blade handles that are laid on the patient’s bed after intubating are also a risk
Any equipment that is handheld during a case must be considered to be contaminated if it contacts the patient in any way
Glove wearing and hand washing are vital

20. Tracking the Spread
CDC scientists track the number and kind of MRSA infections throughout the country This information provides the CDC, other Federal agencies such as CMS, health departments and healthcare facilities information to better understand where MRSA infections are happening
This information allows the CDC to see how healthcare facilities overall are performing against national infection prevention goals.  It also allows CDC, health departments and facilities the ability to identify, report, and help specific facilities and units with high infection rates.
Using information from several locations throughout the country, CDC estimates the national burden of MRSA and can identify people most at risk. This system includes MRSA infections that happen in both the general community and in healthcare facilities.

21. Although MRSA is still a major patient threat, the CDC published a statement in the Journal of the American Medical Association Internal Medicine showed that invasive (life-threatening) MRSA infections in healthcare settings are declining.
Invasive MRSA infections that began in hospitals declined 54% between 2005 and 2011, with 30,800 fewer severe MRSA infections.
In addition, the study showed 9,000 fewer deaths in hospital patients in 2011 versus 2005.

22. The National Healthcare Study found rates of MRSA bloodstream infections occurring in hospitalized patients fell nearly 50% from 1997 to 2007.
These studies provide evidence that rates of hospital-onset, severe MRSA infections in the United States are declining.

23. MRSA
The big conclusion is that good hand washing, good disinfectant use, and strict standard precautions are key to decreasing the spread

24. C-Diff

25. Transmission
Clostridium difficile is shed in feces. Any surface, device, or material that becomes contaminated with feces may serve as a reservoir for the Clostridium difficile spores
Clostridium difficile spores are transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item
Clostridium difficile can live for long periods on surfaces.

26. Treatment Whenever possible, other antibiotics should be discontinued
Treatment of primary infection caused by C. difficile is an antibiotic such as metronidazole, vancomycin, or fidaxomicin. While metronidazole is not approved for treating C. difficile infections by the FDA, it has been commonly recommended and used for mild C. difficile infections
A concern with antibiotics used to treat primary C. difficile infection is that the infection returns in about 20 percent of patients. In a small number of these patients, the infection returns over and over and can be quite debilitating.

27. Treatment
Again…good hand washing is the key

28. References
CDC, US Department of Health and Human Resources, Antibiotic Resistant Threats in the US, 2013.