MRSA AN UPDATE

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for several difficult-to-treat infections in humans. It is also called Oxacillin-resistant Staphylococcus aureus (ORSA). Community-associated MRSA infections (CA-MRSA) are MRSA infections in healthy people who have not been hospitalized or had a medical procedure (such as dialysis or surgery) within the past one year.

1. Presented by : DR S aba Guided by : Dr Hemant Kumar DEPARTMENT OF COMMUNITY MEDICINE ,AJIMS& RC,MANGALORE 1 MRSA –AN UPDATE

2. WHAT ARE MRSA Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for several difficult-to-treat infections in humans . It is also called O xacillin-resistant Staphylococcus aureus (ORSA). MRSA is any strain of Staphylococcus aureus that has developed, through the process of natural selection, resistance to beta-lactam antibiotics, which include the penicillins (methicillin, dicloxacillin , nafcillin , oxacillin, etc.) and the cephalosporins.

3. WHAT IS CA-MRSA? Community-associated MRSA infections (CA-MRSA) are MRSA infections in healthy people who have not been hospitalized or had a medical procedure (such as dialysis or surgery) within the past one year .

4. MRSA COLONIZES S . aureus most commonly colonizes the anterior nares (the nostrils ). The rest of the respiratory tract, open wounds, intravenous catheters, and the urinary tract are also potential sites for infection. Healthy individuals may carry MRSA asymptomatically for periods ranging from a few weeks to many years.

5. HOW IS IT TRANSMITTED?

6. RISK FACTORS FOR CA-MRSA Participating in contact sports . MRSA can spread easily through cuts and abrasions and skin-to-skin contact . Living in c rowded or unsanitary conditions. Outbreaks of MRSA have occurred in military training camps, child care centres and jails . Men having sex with men. Homosexual men have a higher risk of developing MRSA infections.

7. MRSA: ENHANCED VIRULENCE? A ssociated with severe and recurrent SSTI , often in individuals without predisposing risk factors. A ssociated with necrotizing pneumonia. A ppears to be easily transmitted in hospitals, households, and the community

8. PRESENTATION OF MRSA INFECTION CA-MRSA infections generally begin as skin infections. They first appear as reddened areas on the skin , or can resemble pimples that develop into skin abscesses or boils causing fever, pus, swelling, or pain.

9. COMPLICATIONS WITH MRSA Since MRSA resist many common antibiotics sometimes these become life-threatening. This can allow the infections to affect your: Bloodstream Lungs Heart Bones Joints

10. IMMUNE COMPROMISED AT INCREASED RISK WITH MRSA Patients with compromised immune systems are at a significantly greater risk of symptomatic secondary infection.

11. MRSA INFECTION CONTROL STRATEGIES

12. MRSA INFECTION CONTROL STRATEGIES Contact precautions S creening D ecolonization

13. CONTACT PRECAUTIONS

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15. 17 SCREENING

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17. 19 DECOLONISATION

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19. AJIMS/AJHRC HOSPITAL POLICY FOR MRSA CONTROL HIPAC Dept A. J. Hospital and Research Centre

20. SCREENING Screening is performed to significantly decrease transmission. Active surveillance testing: On admission - patients received from other hospitals Periodic screening of healthcare workers during health care check-ups is done to detect colonization. Routine testing in high risk areas (e.g. ICUs)

21. BODY SITES TESTED Nares – most common Other sites include :- wounds axillae groin 25

22. ASSESS HAND HYGIENE PRACTICES

23. IMPLEMENT CONTACT PRECAUTIONS 27

24. RECOGNIZE PREVIOUSLY COLONIZED PATIENTS 28

25. RAPIDLY REPORT MRSA LAB RESULTS 29

26. PROVIDE MRSA EDUCATION FOR HEALTHCARE PROVIDERS 30

27. DECOLONIZATION OF CARRIERS 2% Intranasal mupirocin ointment BD x 5-7 days Chlorhexidine baths Bath: 30 ml. Shower: 10 ml applied neat and then washed off. Bed-bath: 3 ml in a bowl of water. Using disposable wipes, the skin should be moistened and the solution applied thoroughly to all areas, with particular attention to axillae and groin.

28. ON COMPLETION OF TREATMENT The patient is given clean nightwear, linen and towels / flannels. Repeat MRSA screening swabs are taken 48 hours after completion of treatment, provided the patient is not on any antibiotics (except metronidazole ) as this may negate the results. Screens thereafter at weekly intervals for three consecutive weeks whilst the patient is in hospital.

29. ADVICE ON CLEARANCE Three clear screens at weekly intervals must be obtained before the patient may be moved out of an isolation facility and barrier nursing is discontinued. Individual cases should be discussed with the ICN before patients are moved. Weekly follow-up screening cultures must be taken if the patient remains in hospital .

30. MUPIROCIN RESISTANT MRSA Mupirocin should be replaced with the following products depending on the antibiotic sensitivities. If neomycin-sensitive strain use naseptin If neomycin-resistant strain use polyfax ointment + fucidin ointment for five days only.

31. PROPHYLAXIS FOR SURGICAL / INVASIVE PROCEDURES For patients currently MRSA positive, or known to have been positive in the past, intravenous vancomycin may be indicated for pre-operative prophylaxis. The patient should also receive topical MRSA decolonization therapy pre- and post-operatively to cover the period when the risk of MRSA infection is greatest.

32. GENERAL MEASURES Wherever possible - nursing in a single room with standard isolation precautions, or cohort nursing in a bay or part of a ward. The door should always be closed during procedures that may generate staphylococcal aerosols ( eg : Chest physiotherapy, Bed-making and Redressing wounds).

33. PPE and alcohol hand rub must be available outside the room. Masks when giving respiratory care - MRSA in their sputum bed-making - exfoliating skin condition. Wherever possible - dedicated equipment.

34. All staff must make every effort to maintain high standards of hygiene and cleaning within the ward to minimize environmental contamination. All rooms and bays should be cleaned at least daily with Chlor -Clean / hypochlorite (1,000 ppm ) Domestic staff must wear gloves and aprons when cleaning such rooms / bays. 38

35. THANK YOU 39