Guidelines for Managing MRSA (Methicillin-Resistant
Staphylococcus Aureus
PDF Version of DQA 08-025 (PDF,
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Guidelines for Managing MRSA (Methicillin-Resistant
Staphylococcus Aureus)
This memo provides guidance for managing MRSA when present in residents
of assisted living facilities, including Community-based Residential
Facilities (CBRFs), Adult Family Homes (AFHs) and Residential Care Apartment
Complexes (RCACs). This memo will specifically address MRSA as the most
commonly encountered multidrug-resistant organism encountered in assisted
living.
BACKGROUND
MRSA is a form of staph bacterium that can cause serious infection and is
known to have developed resistance to the more commonly used antibiotics,
which makes infections caused by MRSA difficult and costly to treat. The
increasing prevalence of MRSA led providers to ask questions of the Division
of Quality Assurance (DQA) about the care of residents diagnosed with MRSA.
Assisted living facilities can safely care for these residents and
prevent transmission by implementing appropriate infection control
practices. Isolation of residents colonized or infected with MRSA may not be
necessary as long as the source of infection can be contained. With wounds,
this means controlling drainage by keeping a clean, dry bandage over the
wound.
Limited movement outside the resident's room is indicated only if the
source of infection cannot be contained. Any resident with uncontained body
secretions or wound drainage, regardless of diagnosis / infection status,
should have limited movement outside his/her room until secretions/drainage
can be contained.
DEFINITIONS
"Colonization" means that the organism is present in or
on the body but is not causing illness. Usual sites include the nose, skin,
lungs and bladder. Nasal colonization with MRSA can occur either permanently
or intermittently in many persons with histories of MRSA infection.
Colonized persons are sources of transmission.
"Contact Precautions" are used in addition to standard
precautions and are designed to prevent the spread of infection by direct or
indirect contact with the resident or the resident's environment. Contact
Precautions are indicated for residents with active MRSA infections and when
a resident with an active MRSA infection has uncontrolled wound drainage or
difficulty controlling body fluids.
Contact Precautions consist of a private room for the resident with
active MRSA, when possible, and the wearing of gown and gloves by staff for
all interactions that may involve contact with the resident or with
potentially contaminated areas in the resident's environment. Staff don gown
and gloves upon resident room entry, remove them before exiting the
resident's room and perform hand hygiene immediately upon exiting.
"Infection" means that the organism has penetrated
tissue and is causing illness such as a boil or abscess on the skin,
pneumonia in the lungs, a urinary tract infection or an infection in the
bloodstream. Infected persons are sources of transmission.
"Personal Protective Equipment (PPE)" is defined by the
Occupational Safety and Health Administration (OSHA) as "specialized
clothing or equipment worn by an employee for protection against infectious
materials." Types of PPE include gloves, gowns, masks, goggles and face
shields.
"Standard Precautions" are the infection control
strategies to prevent transmission of known or unknown infectious agents
when giving personal care to all residents when contact with blood, body
fluids, secretions and excretions (except sweat), non-intact skin and mucous
membranes is anticipated. In addition to hand hygiene, depending on the
anticipated exposure, standard precautions also include the use of personal
protective equipment, laundry/linen handling techniques, waste disposal,
cleaning/disinfection, respiratory hygiene/cough etiquette and safe
injection practices.
The application of Standard Precautions during resident care is
determined by the nature of the staff - resident interaction and the extent
of anticipated contact with blood, body fluids, secretions and excretions,
non-intact skin and mucous membranes. For some interactions, only gloves may
be needed; during other interactions, use of additional personal protective
equipment (PPE) may be needed.
PRECAUTIONS TO PREVENT TRANSMISSION OF MRSA WHEN A RESIDENT HAS THE
FOLLOWING:
Nasal Colonization with MRSA
Contained MRSA Wound Drainage, Body Secretions or Excretions
- Standard Precautions
- Private room for resident with active MRSA infection. If a private
room is unavailable, the roommate should be another resident who also
has MRSA or who is at low risk of becoming infected. The roommate should
not have an open wound or an indwelling device such as an IV, catheter
or feeding tube.
- Promotion of hand hygiene practices by resident in the following
situations: after using the restroom, after coughing/sneezing, before
eating, before leaving his/her room and before participating in social
activities.
- Resident's clothing should be clean and free of body fluids before
leaving his/her room.
- Individual (dedicated) use of medical equipment or care items, when
possible, or proper disinfection of all medical equipment or care items
shared by residents.
- Routine cleaning/disinfection of high touch surfaces and common areas.
- In multi-resident rooms, it is recommended to maintain a > 3 feet
separation between beds to reduce the opportunities for inadvertent
sharing of items between the infected/colonized resident and other
residents.
- Prevention of cross-contamination. Staff caring for a resident
colonized or infected with MRSA should practice meticulous hand hygiene
before and after care delivery to the infected/colonized resident and
before and after delivering care to the resident's roommate.
Non-contained MRSA Wound Drainage, Secretions or Excretions
- Contact precautions in addition to standard precautions.
- Private room for resident with active MRSA infection. If a private
room is unavailable, the roommate should be another resident who also
has MRSA or who is at low risk of becoming infected. The roommate should
not have any type of open wound or indwelling device such as a Foley or
IV catheter or feeding tube.
- Limited movement by resident outside of his/her room. If resident does
leave the room, ensure that the source of infective material is
adequately covered and all secretions are contained.
- Gloves must be worn when entering the resident's room. Change after
contact with infected material, perform hand hygiene and re-glove to
continue with care or have contact with other items in the room. Remove
gloves and perform hand hygiene before leaving the room.
- In addition to gloves, gowns must be worn when entering the resident's
room if skin or clothing will have contact with the resident,
uncontained wound drainage, secretions or excretions or potentially
contaminated areas in the resident's environment. Remove gown before
leaving the room.
- Individual (dedicated) use of medical equipment or care items, when
possible, or proper disinfection of all medical equipment or care items
shared by residents.
- In multi-resident rooms, it is recommended to maintain a > 3 feet
separation between beds to reduce the opportunities for inadvertent
sharing of items between the infected/colonized resident and other
residents.
- Prevention of cross-contamination. Staff caring for a resident
colonized or infected with MRSA should practice meticulous hand hygiene
before and after care delivery to the infected/colonized resident and
before and after delivering care to the resident's roommate.
- Ensure that the rooms of residents on Contact Precautions are
prioritized for daily cleaning with a focus on frequently touched
surfaces to include equipment in the immediate vicinity of the resident.
FURTHER INFORMATION
The information in this memo was adapted from the Centers for Disease
Control and Prevention and from the Wisconsin Department of Public Health.
Refer to the sources listed for further detailed information.
ADDITIONAL RESOURCES
Guideline for Hand
Hygiene in Health-Care Settings
Management
of Multidrug-Resistant Organisms in Healthcare Settings, 2006
Guideline
for Isolation Precautions: Preventing Transmission of Infectious Agents in
Healthcare
Settings 2007
Community
Associated Methicillin Resistant Staphylococcus Aureus (CA MRSA) Guidelines
for Clinical Management and Control of Transmission
Wisconsin
Division of Public Health, Bureau of Communicable Diseases and Preparedness
-Guidelines for Prevention and Control of Antibiotic Resistant Organisms in
Health Care Settings
Selected
EPA-registered Disinfectants
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