NURSING AT McLEAN

This is one 'Staph' you don't want around
by: Paula Bolton, RN/NP, Infection Control

There is increasing evidence that bacteria are becoming more and more resistant to antibiotics that were once used to kill them. One prime example of this is Staphylococcus aureus ("staph"). This bacterium is a common cause of infections in hospitalized patients and skin infections for people in the community. Staph that has developed a resistance to antibiotics in the class related to penicillin and oxacillin is called MRSA (Methicillin resistant Staphylococcus aureus).

MRSA infections in hospitalized patients often include serious and potentially life threatening infections like bloodstream infections, surgical site infections, or pneumonia. MRSA occurs most frequently in patients who undergo invasive medical procedures, have weakened immune systems, or are being treated in hospitals and healthcare facilities such as nursing homes and dialysis centers. Once a hospitalized patient develops an infection due to Hospital-Acquired MRSA, it is difficult to treat, often requiring the intravenous medication, Vancomycin.

According to the Centers for Disease Control and Prevention (CDC) data, the proportion of infections that are antimicrobial resistant has been growing. In 1974, MRSA infections accounted for 2% of the total number of staph infections; in 1995 it was 22%; in 2004 it was 63%.

Unfortunately, MRSA infections are now being found in relatively healthy people in the community. This type of MRSA, called Community-Acquired MRSA, is a frequent cause of skin infections, abscesses and boils. Community-Acquired MRSA infections are usually spread through contact with someone's skin infection or personal items they have used, like towels, bandages, or razors that touched their infected skin. These infections are most likely to be spread in places where people are in close contact with others -schools and locker rooms where athletes might share razors or towels - or on a psychiatric unit where patients live in close quarters and fail to attend to either personal hygiene or sharing of personal space. When these MRSA skin infections do occur, they are often treated by opening the wound to allow it to drain and using other effective antibiotics such as Clindamycin or Bactrim.

The good news is that MRSA infections are preventable. The first step to prevent MRSA is to identify patients on admission who may be actively infected with MRSA and place them on Contact Precautions. As you know, a patient on Contact Precautions is placed in a private room (if possible). Staff performing direct physical care wear gloves and then remove gloves and wash/disinfect hands when done. Patients may participate in all aspects of the milieu but should be instructed to wash or disinfect their hands after leaving their rooms and after using the bathroom. They should also be requested to refrain from physically touching other patients. Only patients with ACTIVE MRSA infections need to be placed on Contact Precautions.

Often, after patients resolve their initial infection with MRSA, they may still harbor the staph bacteria somewhere on or in their bodies (often in their nose). These patients can be managed with Standard Precautions, but should be encouraged to use proper hand hygiene and be monitored for signs of active infection.

Caregivers are often concerned about their own risk of infection when a patient on their unit has MRSA. Fortunately, staph is generally not particularly virulent (i.e., easily transmissible and contagious). Good hand hygiene and making sure any open wounds are covered are usually sufficient to prevent the spread of staph infections. Being alert for patients with either active MRSA infection or carriers of MRSA helps to manage them appropriately on the unit.

Infection Control measures can be summarized as -1) identify patients who may be infected with or carriers of MRSA; 2) watch for early signs of infection so treatment can begin promptly; 3) instruct patients on how to contain body fluids and how to use good hand hygiene; 4) wash/disinfect hands before and after any physical contact with patients (especially someone known to have MRSA).