HAND ling MRSA in Outpatients By Anne M. Hendricks

1. HANDling MRSA inOutpatients By Anne M. Hendricks Whatare the barriers to utilization of best practice guidelines to care for MRSA patients in the outpatient infusion clinic? • Literature Analysis: (One article) • In 2003 a systematic review by Picheansathian occurred over a 10 year period. • 41/58 met inclusion criteria assessed based on Cochrane Collaboration. and Centre for Reviews and Dissemination. • 26/41 related to effectiveness in reducing microorganisms. • 7/41 to compliance with hand hygiene. • 14/41 to skin problems. • 3/41 to time involved in using alcohol-based hand rubs. • Limitations: • Limited research on cost analysis • Limited evidence from outpatient setting • No current measurement kept in outpatient setting • Inconsistency on isolation outcomes. • Modifications: • Teach staff how to isolate infected patients, and keep neutropenic patients separate • Have hand lotion approved for hand cleaner available for staff • Place linen carts with lids in each patient room and convenient to patient care areas • Increase the number of isolation gowns to meet the demand for a new gown for each contact with isolation patient • Place alcohol-based hand-rub dispensers by each patient room and convenient to patient care areas and waiting room • Develop early recognition and consistent recognition of patients with MRSA prior to arrival in clinic • Strengths • The suggested changes are relatively easy to employ with little cost • Decrease in healthcare costs when compliance increases • JCAHO positive interest in MRSA control. • Medicare reimbursement ensured if decreased readmits from MRSA. • Improved patient and staff safety • Recommendations • Hand hygiene is the single most effective way to control spread of MRSA • Convenience of alcohol based hand rubs Is important for hand hygiene compliance • Linen carts with closing lids in the isolation rooms decrease exposure of staff and patients to contamination • Making sure hands are dry prior to contact with patients decreases spread of organisms • 3 ways toisolate patients to decrease the spread of MRSA. • Single room isolation is preferred • Followed by co-horting • Followed by barrier (e.g. curtain,> 3ft spacing from other patients). • Hand lotion compatible with alcohol based hand rub decreases skin barrier breakdown • Multifaceted hand hygiene education • Wear a new gown and gloves each time exposed to patient, dispose of gown/gloves before exiting room • Conclusions: • 3ml. Of alcohol based hand rub for 15-20 seconds is the most effective way to decrease spread of MRSA. • Availability of alcohol hand rubs increases compliance • Hand rubs with alcohol decrease hand washing time over soap and water • Alcohol based hand rubs with emollients, or lotions compatible with hand rub protect the skin barrier and are less irritating than soap and water • References: • 1. Cooper, B. S., Stone, S. P., Kibbler, C. C., Cookson, B. D., Roberts, J. A., Medley, G. F. et al. (2003). Systematic review of isolation policies in the hospital management of methicillin-resistant staphylococcus aureus: A review of the literature with epidemiological and economic modelling. Health Technology Assessment, 7(39), 1-194. • 2. Nicol, P. W., Watkins, R. E., Donovan, R. J., Wynaden, D., & Cadwallader, H. (2009). The power of vivid experience in hand hygiene compliance. Journal of Hospital Infection, 72, 36-42. • Picheansathian, W. (2004). A systematic review on the effectiveness of alcohol-based solutions for hand hygiene. International Journal of Nursing Practice, 10, 3-9. • Picheansathian, W. (2004). A systematic review on the effectiveness of alcohol-based solutions for hand hygiene. International Journal of Nursing Practice, 10, 3-9. • Pittet, D., Allegranzi, B., Sax, H., Dharan, S., Pessoa-Silva, C. L., Donaldson, L. et al. (2006, October). Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infectious Disease, 6, 641-652.