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