1. HANDling MRSA in Outpatients By Anne M. Hendricks What are the barriers to utilization of best practice guidelines to care for MRSA patients in the outpatient infusion clinic? Recommendations  Hand hygiene is the single most effective way to control spread of MRSA  Convenience of alcohol based hand rubs Is important for hand hygiene compliance  Linen carts with closing lids in the isolation rooms decrease exposure of staff and patients to contamination  Making sure hands are dry prior to contact with patients decreases spread of organisms  3 ways to isolate patients to decrease the spread of MRSA.  Single room isolation is preferred  Followed by co-horting  Followed by barrier (e.g. curtain,> 3ft spacing from other patients).  Hand lotion compatible with alcohol based hand rub decreases skin barrier breakdown  Multifaceted hand hygiene education  Wear a new gown and gloves each time exposed to patient, dispose of gown/gloves before exiting room Literature Analysis: (One article)  In 2003 a systematic review by Picheansathian occurred over a 10 year period.  41/58 met inclusion criteria assessed based on Cochrane Collaboration. and Centre for Reviews and Dissemination.  26/41 related to effectiveness in reducing microorganisms.  7/41 to compliance with hand hygiene.  14/41 to skin problems.  3/41 to time involved in using alcohol- based hand rubs. Conclusions:  3ml. Of alcohol based hand rub for 15-20 seconds is the most effective way to decrease spread of MRSA.  Availability of alcohol hand rubs increases compliance  Hand rubs with alcohol decrease hand washing time over soap and water  Alcohol based hand rubs with emollients, or lotions compatible with hand rub protect the skin barrier and are less irritating than soap and water References: 1. Cooper, B. S., Stone, S. P., Kibbler, C. C., Cookson, B. D., Roberts, J. A., Medley, G. F. et al. (2003). Systematic review of isolation policies in the hospital management of methicillin-resistant staphylococcus aureus: A review of the literature with epidemiological and economic modelling. Health Technology Assessment, 7(39), 1-194. 2. Nicol, P. W., Watkins, R. E., Donovan, R. J., Wynaden, D., & Cadwallader, H. (2009). The power of vivid experience in hand hygiene compliance. Journal of Hospital Infection, 72, 36-42. Picheansathian, W. (2004). A systematic review on the effectiveness of alcohol-based solutions for hand hygiene. International Journal of Nursing Practice, 10, 3-9. 3.Picheansathian, W. (2004). A systematic review on the effectiveness of alcohol-based solutions for hand hygiene. International Journal of Nursing Practice, 10, 3-9. 4.Pittet, D., Allegranzi, B., Sax, H., Dharan, S., Pessoa-Silva, C. L., Donaldson, L. et al. (2006, October). Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infectious Disease, 6, 641-652.  Modifications:  Teach staff how to isolate infected patients, and keep neutropenic patients separate  Have hand lotion approved for hand cleaner available for staff  Place linen carts with lids in each patient room and convenient to patient care areas  Increase the number of isolation gowns to meet the demand for a new gown for each contact with isolation patient  Place alcohol-based hand-rub dispensers by each patient room and convenient to patient care areas and waiting room  Develop early recognition and consistent recognition of patients with MRSA prior to arrival in clinic Limitations:  Limited research on cost analysis  Limited evidence from outpatient setting  No current measurement kept in outpatient setting  Inconsistency on isolation outcomes. Strengths  The suggested changes are relatively easy to employ with little cost  Decrease in healthcare costs when compliance increases  JCAHO positive interest in MRSA control.  Medicare reimbursement ensured if decreased readmits from MRSA.  Improved patient and staff safety