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BEST PRACTICES: MRSA PRECAUTIONS

BEST PRACTICES: MRSA PRECAUTIONS. Dr. Elizabeth Bryce. Topics to Be Covered. Devising Risk Strategies Risk Assessment for Level of Precautions Determining the Need for Additional Precautions. Devising Risk Strategies: Waxing Philosophical. To develop effective prevention strategies must

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BEST PRACTICES: MRSA PRECAUTIONS

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  1. BEST PRACTICES: MRSA PRECAUTIONS Dr. Elizabeth Bryce

  2. Topics to Be Covered • Devising Risk Strategies • Risk Assessment for Level of Precautions • Determining the Need for Additional Precautions

  3. 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

  4. Risk management strategies… BUT also consider: • Your Patient Population • Your Environment • Impact of implementation plan/procedures • Feasibility • Probability of Effectiveness of measures MRSA Eradication What is the goal of your strategy? MRSA Control?

  5. But Wait …..There’s More! Who will you target? • The Facility Population? • Just Inpatients? Or Residents? • Pre-Admit Population (prior to admission) • The Community?

  6. 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)

  7. Risk Assessment Two components to remember • Organizational risk assessment which sets policy and procedure • Individual risk assessment with each patient interaction

  8. General Control Interventions • Administrative Support • Antimicrobial Stewardship • Surveillance • Environmental Cleanliness • Routine/Contact Precautions • Education • Additional Precautions • Critical Review of implementation strategies

  9. Administrative Support • Fiscal Resources • Human Resources • Implementing System Changes • Physical Plant Changes • Promoting Adherence/Role Modeling • Fostering a Safety Climate

  10. Antimicrobial Stewardship • Shortest duration possible • Narrowest spectrum possible • Treat the patient, not the report! • Formulary Reviews • Built-in Compliance features in Pharmacy • Practice Guidelines

  11. Environmental Cleanliness • Correct Agent/Dilution • Correct method • Avoid Clutter • Focus on frequently touched surfaces • Isolation Cleaning Protocols • Don’t forget shared equipment

  12. Education Many different strategies • Facility-wide versus focused • Informational, interactive, training, campaigns • Ideally behaviour change oriented And trying to effect a culture change

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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.

  18. 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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