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Community Acquired MRSA

Community Acquired MRSA. A SECOND LOOK AT HOW TO COMBAT THIS THREAT JOHN WOODCOX RN CRRN. What is CA-MRSA?. Organism presents itself primarily as a Skin and Soft Tissue Infections Pulmonary associated infections-Necrotizing Pneumonia Less resistant to Antibiotics than it’s counterpart

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Community Acquired MRSA

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  1. Community Acquired MRSA A SECOND LOOK AT HOW TO COMBAT THIS THREAT JOHN WOODCOX RN CRRN

  2. What is CA-MRSA? • Organism presents itself primarily as a Skin and Soft Tissue Infections • Pulmonary associated infections-Necrotizing Pneumonia • Less resistant to Antibiotics than it’s counterpart HA-MRSA

  3. Community versus Hospital Acquired • Community Acquired is • less resistant, More virulent • Primarily SSTI’s, less often pulmonary, blood, and UTI’s • Other presentations include: • Osteoarticular, Endocarditis, Sepsis, Osteomyelitis • Approaching 155 cases per 100,000 • 10% is acquired in homes with another infected person • Hospital Acquired is • More resistant and harder to treat • Primarily Pneumonia, UTI, Bloodstream

  4. Diagnosis • Pulsed-Field Gel Electrophoresis • Sorts isolates into categories • Determines CA-MRSA from HA-MRSA • More Accurately Addresses Appropriate Antibiotic

  5. Transmission • Direct Contact • Person to Person • Indirect Contact • Surfaces Harboring the Organism • Droplet • Through organisms propelled into the air • Previous Colonization • Bloodstream/Incision infections of the same strain

  6. Promoting Factors • Indiscriminate Prescription of Antibiotics • Educational Gaps • Poor Hygiene • Poor Infection Control Practices • Nonselective use of Antibiotics in Livestock • Overcrowding • Extended Hospitalizations

  7. Prevention • Proper Hand Washing • Hand Sanitizers • Soaps and Chemicals used • Isolation • Hospitals are more stringent • Long term care facilities less stringent • Proper Isolation protocols needed • Employee proficiency with Isolation precautions • Increased educational effort needed • Communication gaps in known carriers, active/inactive

  8. Active surveillance Culturing • Antimicrobial Stewardship Teams • Patient Identification Methods • Classic Reporting Communication • EMR Tagging • Admission Assessment Identification • Decolonization • Recurrent Infections • Impending Surgery

  9. Education • Patient Education • Age appropriate • Educational Level Appropriate • Learning Barriers • Readiness to Learn • Sensory Communication Issues • Cognitive Status

  10. Community Education • High Schools • Health Fairs • Free Clinics • Appropriate Cleaning Techniques • School Staff • Hospital Staff

  11. So What’s New • Communication Awareness Amongst Staff • Admission Profile Alerts • Expand Admission Assessment to Include Exposures • MRSA and Other MDRO’s • EMR Flagging • Carriers • Active Infection • Antibiotic Appropriateness • Heightened Awareness of Effective Cleaning Products • Hand Sanitizers • Hand Soaps • Disinfectants

  12. Active Surveillance Culturing • Identify and Isolate as appropriate • Pre-surgical Risk Identification • Antimicrobial Surveillance Teams • Discretionary Antibiotic Use • Incorporate EMR Monitoring • Pharmacy Involvement • Teaching the Community • Athletes • Parents

  13. Isolation Protocol Updates • Proper PPE use • Increased Isolation Needs • Pre-Surgical Prep • Across the Board Pre-op Protocols • Education Updates • Not Sharing Personal Items • Incorporate • Learning Style • Level of Education • Communication Barriers

  14. Conclusion • CA-MRSA is a growing problem • Prevention is Essential • Antibiotic Research • Prevention interventions • Education

  15. Resources • Herman, R., Kee, V., Moores, K., & Ross, M. (2008). Etiology and treatment of community-associated methicillin-resistant Staphylococcus aureus. American Journal Of Health-System Pharmacy, 65(3), 219-225. doi:10.2146/ajhp060637. • Fritz, S., Long, M., Gaebelein, C., Martin, M., Hogan, P., & Yetter, J. (2012). Practices and procedures to prevent the transmission of skin and soft tissue infections in high school athletes. The Journal of School Nursing, 28(5), 389-396. doi: 10.1177/1059840512442899. • Karash, J. (2010). MRSA: hospitals step up fight. Will it be enough?. H&HN: Hospitals & Health Networks, 84(7), 50.

  16. Montgomery, K., Ryan, T., Krause, A., & Starkey, C. (2010). Assessment of athletic health care facility surfaces for MRSA in the secondary school setting. Journal Of Environmental Health, 72(6), 8- 11. • Patel, M. (2009). Community-associated methicillin-resistant staphylococcus aureus infections: epidemiology, recognition, and management. Drugs, 69(6), 693-716. doi: 10.2165/00003495-200969060-00004.

  17. Sievert, D., Wilson, M., Wilkins, M., Gillespie, B., & Boulton, M. (2010). Public health surveillance for methicillin-resistant Staphylococcus aureus: comparison of methods for classifying health care and community associated infections. American Journal Of Public Health, 100(9), 1777-1783. doi:10.2105/AJPH.2009.181958 • Yang, Y., McBride, M., Rodvold, K., Tverdek, F., Trese, A., Hennenfent, J., & Schumock, G. (2010). Hospital policies and practices on prevention and treatment of infections caused by methicillin-resistant Staphylococcus aureus. American Journal Of Health-System Pharmacy, 67(12), 1017- 1024. doi:10.2146/ajhp090563.

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