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Multi-drug Resistant Organisms Strategies for Pre

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Multi-drug Resistant Organisms Strategies for Pre

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    1. Multi-drug Resistant Organisms Strategies for Prevention and Control Laurie Fish, BSN, RN, CIC APIC Indiana President

    3. Methicillin Resistant Staph aureus (MRSA) Staph that is resistant to antibiotics For effective treatment it is critical to identify early if it is a resistant strain Tends to be more virulent than sensitive staph

    4. Normal flora Microorganisms reside on our skin, mucous membranes and gut as part of our natural defense mechanisms, these are called our normal flora 25% to 30% of the population have Staph aureus as part of their normal flora (in the nose or on the skin) About 1% of the population has Methicillin Resistant Staph aureus (MRSA) as part of their normal flora (colonized)

    5. Colonization vs. Infection Colonization-bacteria is present on your skin and inside your nose but you do not have an active infection Silent reservoir People that are colonized can spread the bacteria to others Infection-bacteria is causing an active infection Antibiotics will treat the infection but will not eliminate the bacteria Once infection is cured, colonization persists

    6. Transmission of MRSA MRSA is spread primarily through skin to skin contact with those that are colonized or infected It can also be spread through touching contaminated items that have been handled by people colonized/infected with MRSA Certain types of MRSA infections increase the risk for transmission (dermatitis, chronic sinusitis)

    7. Community Acquired MRSA Populations at risk Inmates Competitive sport participants Military recruits Day Care attendees Men who have sex with men Native Americans Disproportionately affects children and young adults The prevalence is increasing Typically presents as skin/soft tissue infections-many times they will be diagnosed as a spider bite Certain strains have caused severe pneumonia in children Usually sensitive to more antibiotics than healthcare acquired strains

    8. Healthcare Acquired MRSA Population at risk for infections Patients that have been hospitalized Dialysis patients Residents of long term Care Patients develop MRSA infections in the hospital related to invasive devices and procedures that bypass their natural defense mechanisms (invasive line, urinary catheters, surgical wounds)

    9. The impact of CAMRSA on healthcare This new influx of colonized/infected patients with CA MRSA increases the risk of MRSA spread in hospitals Transmission within the hospital of MRSA strains first identified in the community are being reported with increasing frequency While the CA MRSA is most likely to cause skin infections, in the hospital it can also lead to device related infections. Infection Control will incorporate the community trend with MRSA into their risk assessment

    11. Why focus on MDRO’s and not MRSA alone?

    12. CDC-Management of MDRO in healthcare CDC has published many guidelines that can be used to guide an Infection Control Program. The Management of MDRO in Healthcare was released in 2006 Requires a dynamic approach tailored to the problem and the setting Nearly all studies reporting successful MDRO control employed a median of 7-8 interventions either concurrently or sequentially

    13. CDC Recommended Strategies Preventing infections will reduce the burden of MDRO (Central line bloodstream rates, ventilator associated pneumonia, surgical site infections) Judicious use of antibiotics Hand Hygiene Contact Precautions Active surveillance cultures (ASC) as appropriate Enhanced environmental cleaning Surveillance Education Communication within and between facilities

    14. Tiered Strategy

    15. When does the CDC recommend ASC? According to the CDC MDRO recommendations, ASC is considered when the basic (Tier 1) approaches are deemed to not be effective. There are studies that have shown that active surveillance culturing is effective but have only been tested in high risk populations and outbreak situations. The benefit of universal ASC is unproven ASC will increase the number of patients in isolation. There are unintended consequences of isolation identified through studies

    16. Unintended Consequences of Isolation Isolated patients were twice as likely as control patients to experience adverse events during hospitalization Patients in isolation were more likely to file a complaint-vital signs not recorded as ordered, more days without a physician progress note

    17. What is currently employed in Indiana Hospitals to control MDRO Institute of Healthcare Improvement- Preventing 5 millions Patients from Harm VHA- MRSA Collaborative APIC- National MRSA Prevalence and MRSA Call to Action Meetings Regenstrief Institute- Action Grant

    18. Action Grant Collaborative 18 month collaborative involving all major hospitals in Indianapolis (Community, St Francis, St Vincents, Wishard, VA and Clarian) Testing the use of systems engineering tools to the processes that prevent/control MDRO transmission. Barriers are identified and solutions tested Critical that frontline staff are involved and driving improvement so the improved outcomes will be sustained over time

    19. Action Grant Processes that are being studied: Communication of MDRO status between facilities through the use of technology Hand Hygiene Implementation of active screening on admit and discharge from test units Enhanced environmental cleaning Contact Isolation

    20. APIC Indiana Recommendations In order to reduce the risk of healthcare associated infections with MRSA and other MDRO’s every hospital shall have a program that will follow established infection prevention practices that shall at least include: Performance of a risk assessment of MDRO to determine the need for active surveillance culturing Strategies to monitor and improve hand hygiene Strategies to monitor and improve contact isolation Enhanced environmental cleaning APIC Indiana advocates partnerships with the Indiana State Department of Health to reduce the risk of CA MRSA transmission in Indiana APIC recommends that these strategies be revised as necessary in accordance with available scientific data

    21. APIC Indiana-Indiana Patient Safety Center Partnership APIC Indiana and the Indiana Patient Safety Center are launching a statewide collaborative to prevent and control the spread of MDRO’s Kick-off with a statewide meeting in early 2008 Harvest best practices from ACTION collaborative and other successes in Indiana hospitals Include regional training in system engineering tools to improve the processes in each facility This approach will foster regional networking and increase the spread of innovative solutions between facilities

    22. Where is the Balance?

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