Presentation on theme: "BEST PRACTICES: MRSA PRECAUTIONS Dr. Elizabeth Bryce."— Presentation transcript:
BEST PRACTICES: MRSA PRECAUTIONS Dr. Elizabeth Bryce
Topics to Be Covered Devising Risk Strategies Risk Assessment for Level of Precautions Determining the Need for Additional Precautions
Devising Risk Strategies: Waxing Philosophical To develop effective prevention strategies must understand the components responsible for the current state in your facility: Rates of Community acquired MRSA Rates of Healthcare Acquired MRSA Rates in your Facility The same situation? Very high rates of CMRSA+ high incidence of HCMRSA + endemic in facility VS Little CMRSA + little HCMRSA + low facility rates
Risk management strategies… BUT also consider: Your Patient Population Your Environment Impact of implementation plan/procedures Feasibility Probability of Effectiveness of measures What is the goal of your strategy? MRSA EradicationMRSA Control?
But Wait …..There’s More! Who will you target? The Facility Population? Just Inpatients? Or Residents? Pre-Admit Population (prior to admission) The Community?
Risk Assessment Transmission and persistence determined by: Vulnerable patients Selective antimicrobial pressure Colonization pressure Impact of implementation strategies Continued adherence to prevention (long- term investment)
Risk Assessment Two components to remember Organizational risk assessment which sets policy and procedure Individual risk assessment with each patient interaction
General Control Interventions Administrative Support Antimicrobial Stewardship Surveillance Environmental Cleanliness Routine/Contact Precautions Education Additional Precautions Critical Review of implementation strategies
Administrative Support Fiscal Resources Human Resources Implementing System Changes Physical Plant Changes Promoting Adherence/Role Modeling Fostering a Safety Climate
Antimicrobial Stewardship Shortest duration possible Narrowest spectrum possible Treat the patient, not the report! Formulary Reviews Built-in Compliance features in Pharmacy Practice Guidelines
Education Many different strategies Facility-wide versus focused Informational, interactive, training, campaigns Ideally behaviour change oriented And trying to effect a culture change
Routine Precautions Have an essential role in preventing transmission – always Particularly important vis a vis undetected cases Hand Hygiene particularly important here as is Risk Assessment
Additional Precautions Very important to consider the context and the situation Contact Precautions : Evidence: Consensus versus evidence based recommendation. Elements: single/isolation rooms or cohorting, use of gown and gloves for potential patient contact or contact with contaminated areas Unresolved: Duration of CP Impact of CP on patient well-being and care Use of CP preemptively
Other Barriers For the most part; as per Routine Precautions Mask – anticipated exposure to droplets/secretions Respirator – generally not specifically for MRSA Facial Protection – anticipated exposure to droplets/secretions
Other Measures Notifying others of patient transfers or diagnostic procedures Ensuring patients clean hands and cover open wounds when outside room Visitors informed of appropriate precautions Education of patient
Finally…… Control of MRSA should be Dynamic Systematic Tailored to reflect the epidemiology/environment Flexible – can be scaled up or down Measured Strive to: Assess the problem, evaluate the effectiveness of the measures implemented.
References Taconnelli E: MRSA: risk assessment and infection control policies. Clin Microbiol Infect 2008 Humphreys H National guidelines for the control and prevention of MRSA – what do they tell us? Clin Microbiol Infect 2007:13:846- 853 PICNet revised ARO guidelines Dec 2007 Sigel J Management of multidrug-resistant organisms in healthcare settings, 2006 Am J Infect control 2007;35:S165-193 Coia JE Guidelines for the ontrol and prevention of MRSA in healthcare facilities. J Hosp Infect 2007;63S:S1-S44