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BEST PRACTICES: MRSA PRECAUTIONS Dr. Elizabeth Bryce
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Topics to Be Covered Devising Risk Strategies Risk Assessment for Level of Precautions Determining the Need for Additional Precautions
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Devising Risk Strategies: Waxing Philosophical To develop effective prevention strategies must understand 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 VS Little CMRSA + little HCMRSA + low facility rates
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Risk management strategies… BUT also consider: Your Patient Population Your Environment Impact of implementation plan/procedures Feasibility Probability of Effectiveness of measures What is the goal of your strategy? MRSA EradicationMRSA Control?
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But Wait …..There’s More! Who will you target? The Facility Population? Just Inpatients? Or Residents? Pre-Admit Population (prior to admission) The Community?
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Risk Assessment Transmission and persistence determined by: Vulnerable patients Selective antimicrobial pressure Colonization pressure Impact of implementation strategies Continued adherence to prevention (long- term investment)
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Risk Assessment Two components to remember Organizational risk assessment which sets policy and procedure Individual risk assessment with each patient interaction
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General Control Interventions Administrative Support Antimicrobial Stewardship Surveillance Environmental Cleanliness Routine/Contact Precautions Education Additional Precautions Critical Review of implementation strategies
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Administrative Support Fiscal Resources Human Resources Implementing System Changes Physical Plant Changes Promoting Adherence/Role Modeling Fostering a Safety Climate
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Antimicrobial Stewardship Shortest duration possible Narrowest spectrum possible Treat the patient, not the report! Formulary Reviews Built-in Compliance features in Pharmacy Practice Guidelines
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Environmental Cleanliness Correct Agent/Dilution Correct method Avoid Clutter Focus on frequently touched surfaces Isolation Cleaning Protocols Don’t forget shared equipment
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Education Many different strategies Facility-wide versus focused Informational, interactive, training, campaigns Ideally behaviour change oriented And trying to effect a culture change
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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
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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 areas Unresolved: Duration of CP Impact of CP on patient well-being and care Use of CP preemptively
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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
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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
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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.
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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
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