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Florida Professionals in Infection Control
Control, Education, Prevention, Surveillance  
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MRSA recommendations for Long Term Care

by FPIC Board on 10/30/16

What is the protocol in the State of Florida for MRSA in the urine of continent short term rehab nursing home residents? Are these residents able to 1) leave their rooms; 2) participate in rehabilitation therapies in the rehab department? Thank you.


kathyeisenhut@msn.com


There is no mandated, state of Florida protocol for MRSA prevention in long term care.  A few resources frequently referred to are CDC, APIC and SHEA.  MRSA is a complex problem difficult to be controlled with any one single intervention. Here are some resources for your review:

·         http://www.cdc.gov/hicpac/pubs.html

·         http://www.cdc.gov/longtermcare/index.html

·         APIC has a text, Guide to the Elimination of MRSA in Long-Term Care, published in 2009. It is available for purchase for $15.00.

http://apic.org/APICStore/Products/Category?id=long-term-care  APIC provides other Long Term Care resources as well.  

 

CDC provides guidelines and APIC and SHEA helps provide the “how to” for meeting or implementation those CDC guidelines.

  

First, a decision about a colonized patient vs. an infected patient would be recommended to distinguish separate population protocols, for any MDRO. Define each group. Colonized patients would have no signs and symptoms of infection. Infected patient would show signs and symptoms of infections.  Example: fever, elevated WBC’s, draining wounds, diarrhea. UTI symptoms such as urine cloudy with odor, fever, suprapubic tenderness, and/or change in mental status / confusion in the elderly may be considered in your protocol as ‘signs’ of infection. Engage your medical director for clarification to define this and their support for this distinction.

 

A patient colonized with MRSA may be colonized for a very long time. There are different protocols followed throughout the state. By your question, you are well aware this occurs. A risk assessment of your high risk population (ie. +MRSA/MDRO patients) will support your decisions for your protocol.  Standard precautions, including hand hygiene prior to participation in group activities, may be recommended, for all participants includes colonized +MRSA patients. Patients are there for rehabilitation. Patients have the right to therapy if they are colonized +MRSA and others have the right to be protected from known risks. Identification of MRSA carriers may be indicated. A risk assessment is warranted. How significant of a population is your +MRSA patients or other +MDRO patients? Infected patients vs. colonized patients? Are separate groups warranted?

 

Studies show approximately 1/3 of people carry staph in their nose, usually without any illness. Two in 100 people carry MRSA. http://www.cdc.gov/mrsa/healthcare/index.html

 

Once your risk assessment is completed. Then identify those +MRSA that have a lower risk to your environment, ie: colonized patients. Remember the basics about MRSA.  This bacteria can live a long time in the environment, months, if not disinfected.  However, it is easily killed with standard healthcare cleaners and wipes. Good environmental control is an important part of your plan. MRSA is a bacteria that is more of a risk for some patients, for example, those with impaired skin integrity (cover open or broken skin) or the immunocompromised. Protection of these patients may also be an important consideration in your plan.

 

Patient education is vitally important, and may positively impact their habits at home once discharged. Empower them to understand how to MRSA is spread. Teach patients how they can:

1) minimize their risk of exposure (#1 Hand Hygiene and #2 clean what is frequently touched. When was the last time they wiped down their TV remote control?) and;

2) decolonize or minimize colonization of +MRSA patients. (15 – 30 second soap contact is not just for the hands, it works when bathing, too!) There are other options for decolonization published you may wish to consider if you have a large percentage of high risk patients +MRSA or other +MDRO.

 

Finally, monitoring MRSA in your facility will help evaluate if your protocol is working.

 

Dr. Jernigan of CDC said it best, “MRSA is a complex problem that cannot be controlled by any single intervention.”


This is my own professional opinion and does not represent the opinion of the FPIC board. other comments and suggestions welcome.


Holly Craddock, RN, BSN, CIC, LHRM

FPIC Communication Board Chair


C difficile cleaning

by FPIC Board on 01/28/16

Questions received:


I work in Behavioral Health Care. We just had an AHCA audit. We were told that we need to use a cleaning agent for our hospital that includes protection from Cdiff.  We presently use [a Quat cleaner.]  They could not give a product recommendation. Can anyone suggest a product that you are using that covers MDRO's?


The FPIC Board thanks you for your excellent question.

Quaternary cleaners are generally not adequate for cleaning after C difficile, however, they are historically an adequate cleaner against other MDRO's including MRSA.  There are two options available currently on the market adequate for killing C difficile. Use of a bleach based product is one that has been widely used and remains in use in many healthcare facilities for terminal cleaning for this organism. Bleach wipes may be used for equipment cleaning, however, you must check with manufacturer's recommendations to see if that is an approved cleaner. The alternative option is a peroxide based cleaner.  Peroxide has been reported as having less surface corrosive effects than bleach and some facilities have moved to using a peroxide based cleaner for all rooms. This is a newer product to healthcare and not as widely used as bleach currently.  FPIC does not endorse any one particular product.

Wound anyone be willing to share their protocols with Jane?

What are the MRSA Precautions in an OutPt Clinic?

by FPIC Board on 11/26/14

The optimal approach to MRSA transmission prevention has been a topic of great debate. The question asked was regarding the practice in an outpatient cardiac setting. The primary history of enhanced transmission based precautions has largely been used in the inpatient setting. Today, inpatient isolation practices are varied by facility. However, each healthcare facility should have an establish policy regarding the prevention of high risk infective agents including MRSA.

The 2007 CDC Guidelines recommend Contact Precautions in addition to standard precautions for MRSA, major draining wounds, and major + non-resistant Staph aureus (with no dressing or dressing that do not contain drainage). There has been newer published reports that question the details of these recommendations. Policies have become varied from the published guidelines although the guidelines have not been changed to date. However, remember, this was largely written for inpatient settings. http://www.cdc.gov/hicpac/2007ip/2007ip_appenda.html

In 2014, CDC issued a "Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care."  A primary key to this is careful standard precautions adherence.  Each ambulatory care facility must evaluate the services provided and assure that sufficient number of and appropriate personal protective equipment (PPE) is available to staff.  Training in proper use is an expectation. I encourage you to look at this reference and share it.  

Remember, CDC are guidelines to expected standards, not regulations. Each facility must make the determination of transmission risk.  I recommend the evaluation of how much direct patient contact with staff or facility equipment occurs. Than follow these new 2014 Guidelines.

Thank you for your inquiry. This is my own professional recommendation, it has not been evaluated by the FPIC Board. 

I ask for others, including our Board, to comment.

Holly Craddock, RN, BSN, CIC
FPIC Internet Chair

FPIC Board Welcome

by FPIC Board on 11/12/14

Welcome FPIC members! Looking forward to blogging with our members around the state of Florida. 

Welcome to FPIC's new Discussion Board

by FPIC Board on 11/12/14

Your board wants to ask you ....

What other services would you like to see from FPIC?