2. A SECOND LOOK AT HOW TO COMBAT THIS THREAT JOHN WOODCOX RN CRRN

3. What is CA-MRSA? Organism presents itself primarily as a Skin and Soft Tissue Infections Pulmonary associated infections-Necrotizing Pneumonia Less resistant to Antibiotics than it’s counterpart HA-MRSA

4. Community versus Hospital Acquired Community Acquired is less resistant, More virulent Primarily SSTI’s, less often pulmonary, blood, and UTI’s Other presentations include: Osteoarticular, Endocarditis, Sepsis, Osteomyelitis Approaching 155 cases per 100,000 10% is acquired in homes with another infected person Hospital Acquired is More resistant and harder to treat Primarily Pneumonia, UTI, Bloodstream

5. Diagnosis Pulsed-Field Gel Electrophoresis Sorts isolates into categories Determines CA-MRSA from HA-MRSA More Accurately Addresses Appropriate Antibiotic

6. Transmission Direct Contact Person to Person Indirect Contact Surfaces Harboring the Organism Droplet Through organisms propelled into the air Previous Colonization Bloodstream/Incision infections of the same strain

7. Promoting Factors Indiscriminate Prescription of Antibiotics Educational Gaps Poor Hygiene Poor Infection Control Practices Nonselective use of Antibiotics in Livestock Overcrowding Extended Hospitalizations

8. Prevention Proper Hand Washing Hand Sanitizers Soaps and Chemicals used Isolation Hospitals are more stringent Long term care facilities less stringent Proper Isolation protocols needed Employee proficiency with Isolation precautions Increased educational effort needed Communication gaps in known carriers, active/inactive

9. Active surveillance Culturing Antimicrobial Stewardship Teams Patient Identification Methods Classic Reporting Communication EMR Tagging Admission Assessment Identification Decolonization Recurrent Infections Impending Surgery

10. Education Patient Education Age appropriate Educational Level Appropriate Learning Barriers Readiness to Learn Sensory Communication Issues Cognitive Status

11. Community Education High Schools Health Fairs Free Clinics Appropriate Cleaning Techniques School Staff Hospital Staff

12. So What’s New Communication Awareness Amongst Staff Admission Profile Alerts Expand Admission Assessment to Include Exposures MRSA and Other MDRO’s EMR Flagging Carriers Active Infection Antibiotic Appropriateness Heightened Awareness of Effective Cleaning Products Hand Sanitizers Hand Soaps Disinfectants

13. Active Surveillance Culturing Identify and Isolate as appropriate Pre-surgical Risk Identification Antimicrobial Surveillance Teams Discretionary Antibiotic Use Incorporate EMR Monitoring Pharmacy Involvement Teaching the Community Athletes Parents

14. Isolation Protocol Updates Proper PPE use Increased Isolation Needs Pre-Surgical Prep Across the Board Pre-op Protocols Education Updates Not Sharing Personal Items Incorporate Learning Style Level of Education Communication Barriers

15. Conclusion CA-MRSA is a growing problem Prevention is Essential Antibiotic Research Prevention interventions Education

16. Resources Herman, R., Kee, V., Moores, K., & Ross, M. (2008). Etiology and treatment of community-associated methicillin-resistant Staphylococcus aureus. American Journal Of Health-System Pharmacy, 65(3), 219-225. doi:10.2146/ajhp060637. Fritz, S., Long, M., Gaebelein, C., Martin, M., Hogan, P., & Yetter, J. (2012). Practices and procedures to prevent the transmission of skin and soft tissue infections in high school athletes. The Journal of School Nursing, 28(5), 389- 396. doi: 10.1177/1059840512442899. Karash, J. (2010). MRSA: hospitals step up fight. Will it be enough?. H&HN: Hospitals & Health Networks, 84(7), 50.

17. Montgomery, K., Ryan, T., Krause, A., & Starkey, C. (2010). Assessment of athletic health care facility surfaces for MRSA in the secondary school setting. Journal Of Environmental Health, 72(6), 8-11. Patel, M. (2009). Community-associated methicillin- resistant staphylococcus aureus infections: epidemiology, recognition, and management. Drugs, 69(6), 693-716. doi: 10.2165/00003495-200969060-00004.

18. Sievert, D., Wilson, M., Wilkins, M., Gillespie, B., & Boulton, M. (2010). Public health surveillance for methicillin-resistant Staphylococcus aureus: comparison of methods for classifying health care and community associated infections. American Journal Of Public Health, 100(9), 1777-1783. doi:10.2105/AJPH.2009.181958 Yang, Y., McBride, M., Rodvold, K., Tverdek, F., Trese, A., Hennenfent, J., & Schumock, G. (2010). Hospital policies and practices on prevention and treatment of infections caused by methicillin-resistant Staphylococcus aureus. American Journal Of Health-System Pharmacy, 67(12), 1017-1024. doi:10.2146/ajhp090563.