1. MRSA in Corrections Danae Bixler, MD, MPH
Infectious Disease Epidemiology Program
West Virginia Bureau for Public Health
West Virginia Department of Health and Human Resources

2. West Virginia Department of Health and Human Resources
Objectives
Participants should understand
Staphylococcus aureus
MRSA
Surveillance (documentation via line list)
Diagnosis and treatment
Prevention
Outbreak management guidance
Educational materials
February 2009
West Virginia Department of Health and Human Resources

3. February 2009
West Virginia Department of Health and Human Resources

4. Staphylococcus aureus
Common skin organism
~ 1 in 3 persons are … carriers
Mild skin infections common
Severe, life threatening infections
Very young
Very old
Chronic conditions
February 2009
West Virginia Department of Health and Human Resources

5. Methicillin resistant Staphylococcus aureus
S. aureus resistant to most commonly used effective antibiotics
The most common cause of skin infections:
Children
Young adults
Severe, life-threatening infections:
Very young
Very old
Chronic conditions
February 2009
West Virginia Department of Health and Human Resources

6. Factors that Facilitate Transmission Source: CDC
Defense
Offense
Frequent Contact
Crowding
Antimicrobial
Use
Compromised Skin
Contaminated Surfaces
and Shared Items
Cleanliness
February 2009
West Virginia Department of Health and Human Resources

7. West Virginia Department of Health and Human Resources
Screening and Surveillance Federal Bureau of Prisons Clinical Practice Guidelines, 2005
Intake
Recently hospitalized inmates
Inmates at risk during routine medical evaluation
Diabetes
Dialysis
Skin compromise
Monitor bacterial culture results
Observations by correctional workers
Document ongoing surveillance (line list)
February 2009
West Virginia Department of Health and Human Resources

8. West Virginia Department of Health and Human Resources
Diagnosis and Treatment Federal Bureau of Prisons Clinical Practice Guidelines, 2005
Diagnosis
Skin examination
Culture
Treatment
Warm soaks
Incision and drainage
Remove foreign devices
Antibiotic therapy
Warm soaks should be routinely considered in the treatment of minor skin and soft tissue infections minutes per day, 2-3 times per day.
February 2009
West Virginia Department of Health and Human Resources

9. West Virginia Department of Health and Human Resources
Primary Prevention (prevention activities BEFORE you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005
Education
Correctional standard precautions
Regular hand hygiene
Assume all body fluids are infectious / use gloves:
Blood
Feces
Urine
Saliva / mucous / sputum
Wound drainage
Safe disposal of sharps
Safe placement of inmates
February 2009
West Virginia Department of Health and Human Resources

10. West Virginia Department of Health and Human Resources
Primary Prevention (2) (prevention activities BEFORE you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005
Hand hygiene program
Oversight
Training
Sanitation
Routine cleaning
Terminal cleaning
Sanitation inspections
Antibiotic prescribing practices
February 2009
West Virginia Department of Health and Human Resources

11. West Virginia Department of Health and Human Resources
Secondary Prevention (prevention activities AFTER you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005
Correctional contact precautions
Hand hygiene before and after EVERY contact
Single cell if drainage cannot be contained
PPE (gloves / gown ) for contact with contaminated items or blood/body fluids
Sanitation
Daily and terminal cleaning
Safe disposal of sharps and bandages
Transfers
Contain drainage
Inform escort officers and receiving institution clinical director
February 2009
West Virginia Department of Health and Human Resources

12. West Virginia Department of Health and Human Resources
Secondary Prevention (prevention activities AFTER you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005
Surveillance
Interview index case
Risk factors
Contacts
Evaluate contacts
History of food handling?
Increased surveillance at routine visits
Bacterial cultures
Document (line list)
February 2009
West Virginia Department of Health and Human Resources

13. West Virginia Department of Health and Human Resources
Outbreak Management Federal Bureau of Prisons Clinical Practice Guidelines, 2005
Laboratory confirmation – save isolates
Tracking – line list
Containment
Transfers
Evaluate each inmate before transfer
Infection control
Hand hygiene
Intensified correctional contact precautions
Intensified inspections
February 2009
West Virginia Department of Health and Human Resources

14. West Virginia Department of Health and Human Resources
Outbreak Management (2) Federal Bureau of Prisons Clinical Practice Guidelines, 2005
Surveillance
Common source
Evaluate all potentially exposed inmates
Sustained or involving multiple inmates
Consider targeting high risk inmates
Decolonization (caution)
Education
Inmates
Corrections staff
Health care personnel
February 2009
West Virginia Department of Health and Human Resources

15. West Virginia Department of Health and Human Resources
Conclusions
Cornerstones of prevention
Hand hygiene
Correctional standard precautions
Surveillance (document on your line list)
Cornerstones of control
Correctional standard and contact precautions
February 2009
West Virginia Department of Health and Human Resources