MRSA INFECTIONS�basics, implications, and prevention

MRSA INFECTIONS�basics, implications, and prevention

1. MRSA INFECTIONS basics, implications, and prevention Dr.T.V.Rao MD 18-10-2016 Dr.T.V.Rao MD @ MRSA

2. Purpose of the lecture Participants will understand the differences between infection control and infection prevention Understand the epidemiology of MRSA Understand risk factors for MRSA Review current MRSA management trends Discuss MRSA prevention and control strategies 18-10-2016 Dr.T.V.Rao MD @ MRSA

3. Staphylococcus aureus Staphylococcus aureus : common cause of infection in the community Lives on skin, in nose, in soil, water, dead plant material Causes colonization or infection Methicillin-resistant Staphylococcus aureus (MRSA): Increasingly important cause of healthcare-associated infections since 1970s In 1990s, emerged as cause of infection in the community 18-10-2016 Dr.T.V.Rao MD @ MRSA

4. History of MRSA Methicillin-resistance in S. aureus was first identified in the 1960s primarily among hospitalized patients • Since that time, methicillin-resistant S. aureus(MRSA) has become a predominant cause of S. aureus infections in both healthcare and community settings Primarily due to transmission of relatively few ancestral clones rather than the de novo development of methicillin resistance among susceptible strains 18-10-2016 Dr.T.V.Rao MD @ MRSA

5. Definition of MRSA Staphylococcus aureus (S. aureus) commonly colonises the skin and nose. Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a strain of bacteria that has become resistant to the antibiotics commonly used to treat ordinary staphylococcal infections. 18-10-2016 Dr.T.V.Rao MD @ MRSA

6. Definitions of different MRSA CA-MRSA : Community-acquired MRSA HA-MRSA : Healthcare-associated MRSA Nosocomia l: infection acquired while in the hospital SSTI: Skin and Soft Tissue Infection 18-10-2016 Dr.T.V.Rao MD @ MRSA

7. MRSA in Healthcare Historical Risk Factors Prolonged hospitalization Prolonged antimicrobial use Stay in an intensive care or burn unit Exposure to a colonized/infected person Residence in a nursing home Age >65 Common infections include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia 18-10-2016 Dr.T.V.Rao MD @ MRSA

8. MRSA is Contagious MRSA is usually spread by unwashed hands. Even a person who does not have an infection and is only colonized can spread MRSA. It is also spread when someone comes in contact with MRSA infected skin or touches something that has been in contact with MRSA skin. Personal items such as towels, bandages, razors, etc. If you touch your infected skin and touch other things around you before washing your hands, the item you touched can carry the MRSA bacteria – it is considered contaminated. 18-10-2016 Dr.T.V.Rao MD @ MRSA

9. Who are at Risk with MRSA People with higher risk of MRSA infection are those with skin breaks (scrapes, cuts, or surgical wounds) or hospital patients with intravenous lines, burns, or skin ulcers. In addition, MRSA may infect people with weak immune systems (infants, the elderly, people with diabetes or cancer, or HIV-infected individuals) or people with chronic skin diseases (eczema and psoriasis) or chronic illnesses. 18-10-2016 Dr.T.V.Rao MD @ MRSA

10. Treatment Options Limited Treatment options for MRSA are limited and less effective than options available for susceptible S. aureus infections and result in higher morbidity and mortality 18-10-2016 Dr.T.V.Rao MD @ MRSA

11. Increasing Risk with MRSA A patient acquiring MRSA colonization during a hospital stay has increased risk for MRSA infections following discharge, or during subsequent acute and long-term care admissions 18-10-2016 Dr.T.V.Rao MD @ MRSA

12. Colonization Sites Dr.T.V.Rao MD @ MRSA Infections 18-10-2016

13. Common Infections with MRSA 18-10-2016 Dr.T.V.Rao MD @ MRSA

14. MRSA can cause Severe Infections I n the right setting MRSA can cause severe and at times fatal infections such as bloodstream infection (BSI), infective endocarditis, pneumonia and skin and soft tissue infections (SSTI 18-10-2016 Dr.T.V.Rao MD @ MRSA

15. Factors that Facilitate Transmission Cleanliness Contaminated Surfaces and Shared Items Defense Offense Frequent Contact Crowding Compromised Skin Antimicrobial Use 18-10-2016 Dr.T.V.Rao MD @ MRSA

16. MRSA Skin and Soft Tissue Infections 18-10-2016 Dr.T.V.Rao MD @ MRSA

17. Antibiotic resistance in S. aureus Penicillin, 1950 Methicillin (= all β -lactam antibiotics) , 1961 Tetracycline, Co-trimoxazol, rifampin, clindamycin, macrolides, quinolones Vancomycin, intermediate-R, 2000 Vancomycin, high-level-R, 2002 Linezolid, Daptomycin? 18-10-2016 Dr.T.V.Rao MD @ MRSA

18. Cardo et al. Infection Control and Hospital Epidemiology , Vol. 31, No. 11 (November 2010), pp. 1101-1105 How we can work on this Matter 18-10-2016 Dr.T.V.Rao MD @ MRSA

19. Staff/ Medical Staff Visitors and Family 18-10-2016 Dr.T.V.Rao MD @ MRSA

20. Standard Precautions Apply to all patients Integrate and expand Universal Precautions to include organisms spread by blood and also Body fluids, secretions, and excretions except sweat, whether or not they contain blood Non-intact (broken) skin Mucous membranes 18-10-2016 Dr.T.V.Rao MD @ MRSA

21. Elements of Standard Precautions Handwashing Use of gloves, masks, eye protection, and gowns Patient care equipment Environmental surfaces Injury prevention 18-10-2016 Dr.T.V.Rao MD @ MRSA

22. Preventing Transmission in the Community Persons with skin infections should keep wounds covered, wash hands frequently (always after touching infected skin or changing dressings), dispose of used bandages in trash, avoid sharing personal items. Uninfected persons can minimize risk of infection by keeping cuts and scrapes clean and covered, avoiding contact with other persons’ infected skin, washing hands frequently, avoiding sharing personal items. Dr.T.V.Rao MD @ MRSA 18-10-2016

23. Preventing Transmission in the Community Exclusion of patients from school, work, sports activities, etc should be reserved for those that are unable to keep the infected skin covered with a clean, dry bandage and maintain good personal hygiene. In general, it is not necessary to close schools to “disinfect” them when MRSA infections occur. In ambulatory care settings, use standard precautions for all patients (hand hygiene before and after contact, barriers such as gloves, gowns as appropriate for contact with wound drainage and other body fluids). Dr.T.V.Rao MD @ MRSA 18-10-2016

24. Role of Screening and Decolonization Pre-operative screening High risk screening Universal screening Decolonization of skin Decolonization of nose 18-10-2016 Dr.T.V.Rao MD @ MRSA

25. Prevention and control 18-10-2016 Dr.T.V.Rao MD @ MRSA

26. Responsibilities of Health care Workers Screening - Infection prevention and control measures in the acute hospital setting - MRSA in the non-acute healthcare setting - MRSA in obstetrics and neonates - Community-associated MRSA - MRSA decolonisation - Antimicrobial stewardship and the prevention and control of MRSA - Occupational health aspects of MRSA 18-10-2016 Dr.T.V.Rao MD @ MRSA

27. Preventing Healthcare Transmission: Standard Precautions Hand Hygiene Contain body fluids Transmission Based Precautions Contact Precautions Gown and gloves Appropriate use of antibiotics 18-10-2016 Dr.T.V.Rao MD @ MRSA

28. Environmental Decontamination Adequate surface disinfection Validation of cleaning efficacy New technology 18-10-2016 Dr.T.V.Rao MD @ MRSA

29. Core Prevention Strateg ies: Hand Hygiene Hand hygiene should be a cornerstone of prevention efforts – Prevents transmission of pathogens via hands of healthcare personnel • As part of a hand hygiene intervention, consider: – Ensuring easy access to soap and water/alcohol-based hand gels 18-10-2016 Dr.T.V.Rao MD @ MRSA

30. Why Is Hand Hygiene Important? Hands are the most common mode of pathogen transmission Reduce spread of antimicrobial resistance Prevent health care-associated infections 18-10-2016 Dr.T.V.Rao MD @ MRSA

31. Hands Need to be Cleaned Wh en Visibly dirty After touching contaminated objects with bare hands Before and after patient treatment (before glove placement and after glove removal)

32. Hand Washing Procedure for Washing Hands: Wet hands with warm, running water and apply liquid, bar or powder soap. Rub hands together vigorously to make a lather and scrub all surfaces. Scrub well for 15-20 seconds! It takes that long to dislodge and remove stubborn germs. To time yourself, sing the ABCs once or the “Happy Birthday” song twice. Rinse the soap off under running water. Dry hands with a paper towel or air dryer. If possible, turn the faucet off with the paper towel. 18-10-2016 Dr.T.V.Rao MD @ MRSA

33. Special Hand Hygiene Considerations Use hand lotions to prevent skin dryness Consider compatibility of hand care products with gloves (e.g., mineral oils and petroleum bases may cause early glove failure) Keep fingernails short Avoid artificial nails Avoid hand jewelry that may tear gloves 18-10-2016 Dr.T.V.Rao MD @ MRSA

34. Education of Health care workers Education for healthcare personnel and patients – Observation of practices -particularly around high-risk procedures (before and after contact with colonized or infected patients) – Feedback – “Just in time” feedback if failure to perform hand hygiene observed 18-10-2016 Dr.T.V.Rao MD @ MRSA

35. Contact Precautions Involves use of gown and gloves for patient care – Don equipment prior to room entry – Remove prior to room exit • Single room (preferred) or cohorting for MRSA colonized/infected patients 18-10-2016 Dr.T.V.Rao MD @ MRSA

36. Preventing Healthcare Transmission: Hand Hygiene 18-10-2016 Dr.T.V.Rao MD @ MRSA

37. Hospital staff Hospital staff who come into contact with patients should maintain high standards of hygiene and take extra care when treating patients with MRSA. Staff should thoroughly wash their hands before and after caring for a patient, before and after touching any potentially contaminated equipment or dressings, after bed making and before handling food .  18-10-2016 Dr.T.V.Rao MD @ MRSA

38. Soap water and common sense are best antiseptics WILLIAM OSLER Hands can be washed with soap and water or, if they are not visibly dirty, a fast-acting antiseptic solution like a hand wipe or hand gel. 18-10-2016 Dr.T.V.Rao MD @ MRSA

39. Use of Disposable Gloves Disposable gloves should be worn when staff have physical contact with open wounds – for example, when changing dressings, handling needles or inserting an intravenous drip. Hands should be washed after gloves are removed. 18-10-2016 Dr.T.V.Rao MD @ MRSA

40. General Hygiene too Matters The hospital environment, including floors, toilets and beds, should be kept as clean and dry as possible. Patients with a known or suspected MRSA infection should be isolated. Patients should only be transferred between wards when it is strictly necessary. 18-10-2016 Dr.T.V.Rao MD @ MRSA

41. Cleaning your Environment Frequently clean surfaces that touch people’s bare skin and surfaces that people touch often such as: Doorknobs, handles and light switches. Phones, remotes and keyboards. Counters, tables, sinks and toilets. Weight and locker room benches. Athletic gear and other shared equipment. Launder clothes, towels, bedding and gear regularly. Change clothes daily. Do not put clothes that have been worn with clean clothes. Wash and dry clothing in the warmest temperature listed on the clothing label. 18-10-2016 Dr.T.V.Rao MD @ MRSA

42. WHAT REALLY WE NEED TODAY Always washing your hands after using the toilet or commode (many hospitals now routinely offer hand wipes) A lways washing your hands or cleaning them with a hand wipe immediately before and after eating a meal Following any advice you're given about wound care and devices that could lead to infection (such as urinary catheters) Reporting any unclean toilet or bathroom facilities to staff – don't be afraid to talk to staff if you're concerned about hygiene 18-10-2016 Dr.T.V.Rao MD @ MRSA

43. Protecting Yourself in the Community Avoid excessive antibiotic use. Shower daily and after work outs. Wash hands or use a hand sanitizer often; especially after shopping, using the bathroom and before eating. Do not share towels, soap, razors, water bottles and other personal items with other people. Use a towel as a barrier between you and exercise equipment. Wash athletic clothing daily. Clean, disinfect and dry your gym bag. 18-10-2016 Dr.T.V.Rao MD @ MRSA

44. Education Patients and families Standardized hand outs Multi-media Staff and Medical Staff In-services Just in time Safety Fairs Make it fun, make it memorable Yourself Webinars Internet Peers 18-10-2016 Dr.T.V.Rao MD @ MRSA

45. Prevention Evaluate and implement best practice regularly Engage staff…they are smart people! Prevention doesn’t happen in an office! 18-10-2016 Dr.T.V.Rao MD @ MRSA

46. Program Created by Dr.T.V.Rao MD for Medical and Health professionals for Improving the Hygiene and Control of Hospital associated Infections Email [email protected] 18-10-2016 Dr.T.V.Rao MD @ MRSA