What is a Methicillin-Resistant Staphylococcus Aureus (MRSA) infection? MRSA stands for methicillin-resistant Staphylococcus aureus (S. aureus) bacteria. MRSA causes skin infections in addition to many other difficult-to-treat infections, and is the most commonly identified multidrug-resistant strain of staph aureus worldwide. Multidrug-resistant means the bacteria have become resistant to the antibiotics commonly used to treat staph infections. MRSA is prevalent in community settings, especially among people whose risk factors include frequent healthcare exposure for chronic illnesses, those whose lifestyles include exercising in gyms, contact with equipment that is hard to clean, exposure to insect bites, and living in close quarters with inadequate hygiene. Also, people with conditions such as diabetes, vascular disease, renal failure, and other chronic illnesses may also be at a greater risk of acquiring MRSA. Staph infections can start mildly enough, but can spread quickly through the bloodstream to the lungs, bones, kidneys, or heart to produce extensive, potentially fatal infections. Most MRSA infections occur in people who have been in hospitals or other healthcare settings, such as nursing homes and dialysis centers. Although ICUs are the most common site of infectious outbreaks, MRSA can show up anywhere in healthcare facilities.
In 1974, MRSA infections accounted for just two percent of the total number of staph infections. Today, MRSA accounts for approximately 50% of staph infections, with increased focus on the community MRSA strains that occur in healthy individuals. Labeled a “super bug,” its incidence has been declining at Baystate Health in the past three years.
The epidemiology of MRSA has changed in recent years, as people colonized with MRSA can be asymptomatic. Best practices for prevention of MRSA include hand hygiene, cleaning and disinfection of patient care equipment and environment, and wearing barrier attire to prevent transmission to staff and other patients. Literature sources identify the principal mode of spreading MRSA in hospitals is through the contaminated hands of caregivers.
To prevent an increase in MRSA, BH facilities have adopted best-practice recommendations into daily clinical care:
- Use of effective hand hygiene practices by all caregivers. The BH Hand Hygiene Task Force has validated through direct observation an increased compliance with hand hygiene. Unit and area based hand hygiene champions educate, observe, and provide feedback to peers on compliance to increase awareness of this basic practice. Hand hygiene rates of compliance are reported as healthcare worker specific, providing feedback to reinforce best practices.
- Decontamination of the environment and equipment. The Infection Prevention and Environmental Services staffs have partnered to establish and maintain a clean and safe environment, performing walking rounds and monthly meetings to identify gaps in practice and reinforcement of processes. A multidisciplinary subgroup charged with assuring a clean and safe care environment was developed in 2009, and finalized recommendations in 2011, introducing a new cleaning chemical and generating a list of cleaning responsibilities and products to support healthcare workers to perform the tasks safely and effectively.
- Active surveillance cultures of high-risk patients. The Massachusetts Department of Public Health (MDPH) no longer mandates surveillance cultures. BH does not routinely culture patients on admission, those undergoing surgery, or as part of a surveillance process.
- Other practices include: Use of contact precautions for infected patients with non-contained infected body fluids, and implementation of device-related infection prevention bundles, such as the Central Line-Related Bloodstream Infection (CL-BSI) Prevention Bundle and the Ventilator-Associated Pneumonia (VAP) Prevention Bundle. Device-related MRSA rates for BMC critical care units are low and continue to decrease, with some units having no MRSA device-related infections.
After a continuous increase during 1998-2004, our performance in preventing MRSA has been successful. At the 2011 Division of Healthcare Quality and Department of Medicine Annual MRSA meeting it was announced that BMC has achieved success in lowering the incidence of device-related MRSA infections. A recent requested presentation to the MDPH technical advisory group demonstrated a very low to zero rate of hospital-acquired infections associated with MRSA and acknowledged our program of reduction without culturing, by isolating all patients with colonization or contained body fluids with MRSA infections.
Our antibiogram has also confirmed that MRSA non-susceptible isolates rates have declined and that we have sustained that decline for non-susceptible isolates across the Springfield based care centers. Internal stakeholders will meet later this fall to review strategies and reaffirm our success in preventing infections associated with MRSA using evidence-based practices and sound infection prevention measures.
BH has made prevention and control of MRSA infections a top priority, and will continue to integrate best-practice guidelines into daily clinical care and staff education. Patient and family education on the prevention of MRSA is included in our bedside booklet, providing them with the information necessary to help prevent MRSA in their private lives. Hand hygiene adherence, cleaning and disinfection of equipment, and containment of body fluids continues to be a system-wide focus. Current processes include collaborating with nearby healthcare facilities to publish our practices and outcomes.
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