Transmission of Healthcare-Associated MRSA HA-MRSA

2. Transmission of Healthcare-Associated MRSA (HA-MRSA) Patients colonized or infected with MRSA are the major reservoir from which transmission occurs HA-MRSA is most often transmitted from patient to patient via the hands of healthcare workers (HCWs) who have transiently contaminated their hands Persistently colonized or infected HCWs can also be a source of transmission Contaminated environmental surfaces may also serve as source of MRSA transmission

3. MRSA Hand Hygiene Topics How do HCWs contaminate their hands with MRSA? Does hand hygiene remove MRSA from hands? What evidence is there that hand hygiene contributes to control of MRSA? How can we improve hand hygiene practices?

4. How Do HCWs Contaminate Their Handswith MRSA? Touching colonized or infected patients Touching contaminated environmental surfaces in the immediate vicinity of affected patients For HCWs who are persistently colonized with MRSA, touching their own nose or mucous membranes

9. Hand Contamination Following Contact with Patients or Their Environment HCWs who entered MRSA patient rooms were enrolled in a prospective study After patient contact, cultures were performed One gloved hand was cultured first Both gloves were removed and hands were washed Second hand was cultured to assess efficacy of washing 17% of HCWs who touched the patient, patient�s clothes, or bed contaminated their gloves with MRSA

10. Hand Contamination Following Contact with Patients or Their Environment 14% of HCWs who did not wear gloves contaminated their hands with MRSA HCWs who did not wear gloves were 5.2 times more likely to have MRSA on their hands AFTER handwashing than those who wore gloves (p = 0.3)

11. Hand Contamination from Medical Items All 5 nurses who changed dressings of infected patients had MRSA on their hands All 5 personnel who handled specimen containers or medical equipment removed from patient rooms had MRSA on their hands 5 (42%) of the 12 nurses who had no direct contact with patients, but touched surfaces near affected patients contaminated their gloves with MRSA

12. Hand Contamination from Environment After decontaminating their hands, volunteers touched Bedside rails for 5 seconds and Bedside tables for 5 seconds Hands were cultured for nosocomial pathogens Hand imprints were culture-positive for pathogens, including MRSA After touching surfaces in 53% of occupied pt rooms After touching surfaces in 24% of rooms that had been cleaned after a patient discharge

13. MRSA Contamination of HCW Hands Hands of HCWs involved in caring for patients have been cultured in a variety of other circumstances Contamination of HCWs� hands with MRSA has been documented in multiple studies

14. Do Hand Hygiene Practices RemoveMRSA from Hands of HCWs? 7 nurses who cared for infected patients decontaminated their hands with hexachlorophene/ alcohol emulsion, and 6/7 hand cultures were negative after hand antisepsis 8/10 employees who redressed wounds infected with MRSA had hand cultures that were negative before care, but positive after manipulating wounds None had positive hand cultures after washing hands with soap and water

15. Efficacy of Antiseptic Solutions inReducing MRSA on Hands Relative effectiveness of antiseptics (listed in order of decreasing efficacy) in reducing MRSA counts on artificially-contaminated hands Study A 10% povidone-iodine (too harsh for routine use) 70% ethyl alcohol Plain soap 4% chlorhexidine gluconate (may be more effective after multiple applications) Study B 80% ethyl alcohol 7.5% povidone-iodine

16. Is Improving Hand Hygiene Compliance Likely to Reduce Transmission of MRSA? At least 4 studies have used mathematical modeling of MRSA transmission to estimate the impact of various control measures on the spread of MRSA All 4 studies suggested that improving hand hygiene compliance was one of the most effective means of reducing MRSA transmission

18. Prevalence of Nosocomial Infections and Incidence of MRSA, University of Geneva Hospitals, 1993-98 In addition to improving hand hygiene compliance, screening patients for MRSA colonization was performed Result: substantial reduction in incidence of new MRSA cases and nosocomial infections

19. Impact of Hand Hygiene Promotion onIncidence of MRSA Acquisitions in 3 ICUs 1995 � 1999 (Period 1) Screening cultures on Adm & weekly Contact Precautions 2000 (Period 2) Alcohol-based hand rub promoted for hand hygiene Result: significant reduction in rate of MRSA acquisitions

20. Impact of Hand Hygiene Promotion onIncidence of MRSA Transmission

21. Impact of Hand Hygiene Promotion onIncidence of MRSA Transmission Several other studies have reported decreased MRSA transmission after implementing multimodal programs that included: Hand hygiene promotion campaign Screening high risk patients for MRSA Contact precautions for colonized/infected patients +/- additional cleaning of environment

24. New Emphasis on Controlling HA-MRSA 1. Hand hygiene 2. Decontamination of the environment and equipment 3. Active surveillance cultures 4. Contact precautions for infected and colonized patients 5. Device bundles (Central Line Bundle and Ventilator Bundle)

26. Educational Activities Give examples of clinical activities that can result in contamination of HCWs� hands Touching MRSA patients or objects in their room Use visual methods for illustrating contamination of HCWs� hands Hand culture plates Fluorescent dyes

38. Summary Colonized and infected patients and their immediate environment are sources of MRSA hand contamination Wearing gloves reduces risk of hand contamination Performing hand hygiene appropriately should remove most MRSA from transiently contaminated hands There is considerable epidemiologic evidence that improving hand hygiene contributes to MRSA control Multimodal programs are needed to improve hand hygiene