A SECOND LOOK AT HOW TO COMBAT THIS THREAT JOHN WOODCOX RN
CRRN
Slide 3
What is CA-MRSA? Organism presents itself primarily as a Skin
and Soft Tissue Infections Pulmonary associated
infections-Necrotizing Pneumonia Less resistant to Antibiotics than
its counterpart HA-MRSA
Slide 4
Community versus Hospital Acquired Community Acquired is less
resistant, More virulent Primarily SSTIs, less often pulmonary,
blood, and UTIs Other presentations include: Osteoarticular,
Endocarditis, Sepsis, Osteomyelitis Approaching 155 cases per
100,000 10% is acquired in homes with another infected person
Hospital Acquired is More resistant and harder to treat Primarily
Pneumonia, UTI, Bloodstream
Slide 5
Diagnosis Pulsed-Field Gel Electrophoresis Sorts isolates into
categories Determines CA-MRSA from HA-MRSA More Accurately
Addresses Appropriate Antibiotic
Slide 6
Transmission Direct Contact Person to Person Indirect Contact
Surfaces Harboring the Organism Droplet Through organisms propelled
into the air Previous Colonization Bloodstream/Incision infections
of the same strain
Slide 7
Promoting Factors Indiscriminate Prescription of Antibiotics
Educational Gaps Poor Hygiene Poor Infection Control Practices
Nonselective use of Antibiotics in Livestock Overcrowding Extended
Hospitalizations
Slide 8
Prevention Proper Hand Washing Hand Sanitizers Soaps and
Chemicals used Isolation Hospitals are more stringent Long term
care facilities less stringent Proper Isolation protocols needed
Employee proficiency with Isolation precautions Increased
educational effort needed Communication gaps in known carriers,
active/inactive
Slide 9
Active surveillance Culturing Antimicrobial Stewardship Teams
Patient Identification Methods Classic Reporting Communication EMR
Tagging Admission Assessment Identification Decolonization
Recurrent Infections Impending Surgery
Slide 10
Education Patient Education Age appropriate Educational Level
Appropriate Learning Barriers Readiness to Learn Sensory
Communication Issues Cognitive Status
Slide 11
Community Education High Schools Health Fairs Free Clinics
Appropriate Cleaning Techniques School Staff Hospital Staff
Slide 12
So Whats New Communication Awareness Amongst Staff Admission
Profile Alerts Expand Admission Assessment to Include Exposures
MRSA and Other MDROs EMR Flagging Carriers Active Infection
Antibiotic Appropriateness Heightened Awareness of Effective
Cleaning Products Hand Sanitizers Hand Soaps Disinfectants
Slide 13
Active Surveillance Culturing Identify and Isolate as
appropriate Pre-surgical Risk Identification Antimicrobial
Surveillance Teams Discretionary Antibiotic Use Incorporate EMR
Monitoring Pharmacy Involvement Teaching the Community Athletes
Parents
Slide 14
Isolation Protocol Updates Proper PPE use Increased Isolation
Needs Pre-Surgical Prep Across the Board Pre-op Protocols Education
Updates Not Sharing Personal Items Incorporate Learning Style Level
of Education Communication Barriers
Slide 15
Conclusion CA-MRSA is a growing problem Prevention is Essential
Antibiotic Research Prevention interventions Education
Slide 16
Resources Herman, R., Kee, V., Moores, K., & Ross, M.
(2008). Etiology and treatment of community-associated
methicillin-resistant Staphylococcus aureus. American Journal Of
Health-System Pharmacy, 65(3), 219-225. doi:10.2146/ajhp060637.
Fritz, S., Long, M., Gaebelein, C., Martin, M., Hogan, P., &
Yetter, J. (2012). Practices and procedures to prevent the
transmission of skin and soft tissue infections in high school
athletes. The Journal of School Nursing, 28(5), 389- 396. doi:
10.1177/1059840512442899. Karash, J. (2010). MRSA: hospitals step
up fight. Will it be enough?. H&HN: Hospitals & Health
Networks, 84(7), 50.
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Montgomery, K., Ryan, T., Krause, A., & Starkey, C. (2010).
Assessment of athletic health care facility surfaces for MRSA in
the secondary school setting. Journal Of Environmental Health,
72(6), 8-11. Patel, M. (2009). Community-associated methicillin-
resistant staphylococcus aureus infections: epidemiology,
recognition, and management. Drugs, 69(6), 693-716. doi:
10.2165/00003495-200969060-00004.
Slide 18
Sievert, D., Wilson, M., Wilkins, M., Gillespie, B., &
Boulton, M. (2010). Public health surveillance for
methicillin-resistant Staphylococcus aureus: comparison of methods
for classifying health care and community associated infections.
American Journal Of Public Health, 100(9), 1777-1783.
doi:10.2105/AJPH.2009.181958 Yang, Y., McBride, M., Rodvold, K.,
Tverdek, F., Trese, A., Hennenfent, J., & Schumock, G. (2010).
Hospital policies and practices on prevention and treatment of
infections caused by methicillin-resistant Staphylococcus aureus.
American Journal Of Health-System Pharmacy, 67(12), 1017-1024.
doi:10.2146/ajhp090563.
