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Hospital MRSA prevention, control requires multitude of measures
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While it is certain that health care-associated methicillin-resistant Staphylococcus aureus infections lead to increased mortality, length of hospital stay and costs, the evidence is mixed regarding standard procedures to prevent and control MRSA infections that occur in the health care setting.
“It is important to recognize that there are a few ways to prevent MRSA infections,” C. Buddy Creech, MD, MPH, associate professor of pediatric infectious diseases and associate director of the Vanderbilt Vaccine Research Program at Vanderbilt University School of Medicine, told Healio Infectious Disease. “Infection is the key word, since 30% to 40% of the population are colonized in the nose and on the skin with S. aureus, and as many as 5% to 10% of individuals are colonized asymptomatically with MRSA.”
C. Buddy Creech
Although policies and procedures for MRSA infection vary across hospital settings, many experts agree that it takes a bundle approach to effectively prevent and control MRSA. This includes the identification of high-risk patients, measures to limit the spread of infection including hand hygiene and education of patients and their families.
Identifying high-risk patients
“The first [approach] is to identify high-risk patients so that appropriate infection control maneuvers can occur,” Creech said.
In a 2008 study published in Infection Control and Hospital Epidemiology, researchers implemented a bundle procedure that included universal nasal swab surveillance at the time of hospital admission as well as at discharge to identify patients asymptomatically colonized with MRSA.
Patients with a prior history of MRSA infection or colonization within the previous 2 years or who had cultures that tested positive for MRSA were placed under contact precautions. Results indicated that during the study period, there was a 60% decrease in MRSA infection rates on the surgical unit and a 75% decrease in rates in the ICU.
Karen Hendrickson, BSN, from the the department of Veteran Affairs of the Salt Lake City Health Care System, said infection and transmission rates have both decreased since her institution implemented the MRSA bundle in 2007.
“There is a difference between infection and colonization and it is important to know that when a patient has an infection, they are showing active signs and symptoms, but when the patient is only colonized with MRSA, they do not show any signs or symptoms and can pass MRSA on to other people,” she told Healio Infectious Disease. “Our infection and transmission rates have both decreased since the initiative began in 2007.”
Limiting the spread of MRSA
The spread of MRSA has been shown to significantly decrease with the use of gowns, gloves and careful hand hygiene.
“Stopping the spread of MRSA requires a coordinated response,” Creech said. “[At Vanderbilt], we do this through the strict use of contact precautions, gowns and gloves for those entering the room, and through careful attention to our infection control bundles. On occasion, we will do targeted surveillance of high-risk populations or medical units to interrupt any health care transmission that could possibly occur.”
In a 2013 study, Hendrickson and colleagues compared MRSA transmission rates after the implementation of a bundle of control measures at two similar VA hospitals. One hospital full contact precautions recommended by the CDC including the use of gloves and cover gowns and the other hospital employed a glove-only measure.
According to the study results, compliance with nasal swabbing and hand hygiene was high at both hospitals and significant reductions were observed in health care-associated MRSA infection rates at both facilities. However, Hendrickson noted that MRSA infection rates were similar with or without the use of cover-gowns.
“The evidence that barrier precautions reduce infection or transmission rates of multi-drug-resistant organisms is mixed,” Hendrickson and colleagues wrote. It takes a multitude of changes, she said.
“We started with initially implementing disposable equipment for patients; we worked with the Union and EMS to develop a checklist for cleaning so that each room was cleaned from top to bottom. We removed the ‘old-time rag mop’ and replaced our mops with microfiber mop heads as well as use microfiber cloths for cleaning.”
Hand hygiene and education
Both Creech and Hendrickson reiterated the significance of consistent hand hygiene.
“Hand hygiene is an everyday occurrence and a constant reminder,” Hendrickson said. “It is the ‘golden rule’ as far back as Florence Nightingale and her practice during the 1800s. Nightingale was able to reduce death rates from 46% to 2% within a 6-month interval by implementing hand hygiene and cleaning protocols. These are our key measures we place emphasis on and what we do on a daily basis. We also have a ‘stop the line’ rule at which time anyone can stop something if they see it not going the way it should in terms of preventing the spread of infection.”
Creech said that what the Hungarian-born father of infection control, Ignaz Semmelweis, MD, discovered in the 19th Century still rings true today: hand hygiene is a critical part of health care and affects not just MRSA transmission, but other health care pathogens as well.
The education of patients and their families on MRSA transmission is also paramount.
“There are a tremendous number of families who have experienced the spread of MRSA, particularly community-associated MRSA, from one family member to another. We can prevent the spread of MRSA through education and simple decolonization,” Creech said. – by Jennifer Southall
For more information:
C. Buddy Creech, MD, MPH, can be reached at the Department of Pediatrics, Vanderbilt University School of Medicine, Division of Infectious Diseases, D-7235 MCN, Nashville, TN 37232-2581; email: buddy.creech@vanderbilt.edu.
Karen Hendrickson, BSN, can be reached at VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148; email: karen.hendrickson@va.gov.
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