Transcript Community-Associated MRSA vs. Hospital Acquired MRSA

Infection Prevention
Stephanie Langdon, MSN, CIC
Infection Control Practitioner
Presbyterian Novant Health
Charlotte, NC
Medical asepsis vs. Surgical
asepsis
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Asepsis the freedom from disease causing
microorganisms. Two types Medical and
Surgical.
Medical asepsis practices intended to
confine a specific organisms to a specific
area. Can be clean or dirty.
Surgical asepsis or sterile technique
practices intended to destroy all
microorganisms
Types of Microorganisms
Causing Infections
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Bacteria (MRSA and VRE)
Viruses (Flu and Parvo)
Fungi (Aspergillus)
Parasites (Intestinal Worms)
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Germs live everywhere!
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Most microbes that live in our environment
perform functions essential to our survival, a
small percentage of them enter our bodies to
cause an infection, and a smaller proportion
cause a drug resistant infection.
Because microbes have extremely high
replication rates, they can also mutate
quickly to enable them to adapt to
changing conditions.
Bacteria
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Most common infection causing
microorganism
Lives on your skin and surfaces
Can live and be transported through air,
water, food, soil, body tissues and
fluids.
Staph Aureus to MRSA
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In the beginning Staph Aureus
Emergence of MRSA (1960’s)
Emergence of CA-MRSA (1990’s)
Terms You Might Hear
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Community Acquired MRSA (CA-MRSA)
Methicillin-Resistant Staph Aureus (MRSA)
Hospital Acquired MRSA (HA-MRSA)
Methicillin-Susceptible Staph Aureus (MSSA)
Colonized MRSA
Infected MRSA
CA-MRSA Control Measures
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Also Try to Prevent
Know the difference between Cleaning
and Disinfecting
First you clean then you disinfect
Use correct products
Skin
Surfaces
Disinfectants that Kill Germs
on Skin
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Alcohol based hand Sanitizers
Antibiotics Soaps and wipes made for
skin
Good old soap and water (Doesn’t have
to be antibiotic soap)
Disinfectants that Kill Bacteria
on Surfaces
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Sani-wipes (Kill time 10 minutes)
Virex (Kill time 3 minutes)
Dispatch (Kill time 1 minute)
Bleach kills everything (see handout)
Ultraviolet Waves
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Ultraviolet waves are effective in killing
bacteria and viruses. Hospitals use
equipment that produce these waves to
sterilize equipment, water and air in
rooms. It is also used to treat acne and
psoriasis. These are the same waves
used in tanning beds.
CA-MRSA Control Measures
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Cover all wounds
Train athletes in first aid for wounds and
signs of infection
Encourage Good hygiene Practices
Discourage sharing of items
Establish routine cleaning schedules for
shared equipment
Encourage players to report skin lesions
Investigational
Findings
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Increase number of Spider Bites
reported in the Emergency Rooms
cultures revealed MRSA.
CA-MRSA median Age is 23
HA-MRSA median Age is 68 (Naimi, T.S. et al.
JAMA 2003, 290:2976-2984.)
Hospital vs. Community
Acquired Infections
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Hospital (Nosocomial) Acquired MRSA :
defined by the CDC as MRSA acquired after
48 hours stay in the hospital with no previous
documentation of a positive MRSA culture
Community Acquired MRSA: defined by
the CDC as MRSA acquired in the community.
If we test within 48 hours of admission and
patient is positive this is a community
acquired MRSA
How to Recognize an
Inflammatory Response
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1st Stage: Vascular and Cellular
Responses
2nd Stage: Exudate Production
3rd Stage: Reparative Phase
Types of Infections
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Colonized: defined as a carrier of the
bacteria but you are not sick. Cultures
(screening) are from nares or perirectal
area.
Infected: defined as someone with a
wound (infected area) that has been
cultured and is positive for an infection
Off the Beaten Path
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VRE - Vancomycin Resistance
Enterococus
C diff- Clostridium difficile or CTOX
ESBLs - extended-spectrum betalactamases (which are resistant to
cephalosporin's and monobactam’s)
Chain of Infection (Six Links)
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Etiologic Agent (Microorganism)
Reservoir
Portal of Exit from the Reservoir
Method of Transmission
Portal of Entry to the Susceptible Host
Susceptible Host
Isolation Types
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Airborne
Droplet
Contact
Contact Enteric
Isolation Precautions
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Airborne to prevent the transmission of
highly contagious or virulent infections spread
by small airborne droplets (smaller than 5
microns) examples know or suspected TB,
chicken pox.
Droplet to prevent the transmission of
diseases spread by large droplets (larger than
5 microns) Examples are meningococcal
meningitis, pertussis, mumps
Airborne Precautions
Disease requiring Airborne Precautions:
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Mycobacterium Tuberculosis (MTB)
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Measles
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Other significant diseases (i.e. Pandemic Influenza)
For a complete list of diseases/conditions requiring Airborne Precautions
see Appendix A 1 (Linked to CDC).
N 95 respirators or PARA are required for all
employees upon entry to an Airborne Precautions
room. We do this for Every Patient, Every Time!
Monitored Negative pressure is Required
Signs and Symptoms of TB
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Night sweats
Coughing up blood
Weight loss
Why is a positive PPD not always a sign
of TB.
What does the chest x-ray look like?
Are the sputum's that are collected
every morning for three consecutive
mornings positive for Acid Fast Bacilli?
TB
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Mycobacterium tuberculosis (MTB)
All other Mycobacterium’s can be called MOTT
(mycobacterium other than tuberculosis)
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Other Pulmonary Mycobacterium’s
Mycobacterium avium complex MAC , M. kansasii,
M. absessus, M. xenopi
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Skin Mycobacterium’s
M. marinum
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Wound infections
M. fortuitum, m. chelonea and m. absessus
Genus Species
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Genus Mycobacterium (ALL Fords)
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Species
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M. Tuberculosis (Lincoln Continental)
M. Avium (Mustang)
M. kansasii (Taurus)
M. absessus (Fusion)
M. xenopi (Fiesta)
They ALL test positive for Acid Fast Bacilli
Special Airborne/Contact
Precautions
This category is for diseases that can be
transmitted to others through both the airborne and
contact route.
Examples include:
Varicella Zoster Virus (VZV):
Chickenpox
and disseminated zoster/shingles
SARS-CoV
Shingle Questions
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Who is considered immune?
Immunity comes from having the chicken pox or
having the VZIG.
How do you know if the patient has zoster
pneumonia? Positive sputum’s would be needed to
verify the present of the herpes virus and CXR
positive for pneumonia.
If the patient is positive for zoster pneumonia
and has visible lesion on more than one
dermatome is this considered disseminated
zoster shingles or is it only localized? Consider
disseminated zoster shingles.
Droplet Precautions
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Most frequent diseases we see:
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Pertussis (Whooping Cough)
Neiserria Meningitis
Parvo (5th disease)
Flu
Our current practice for Flu patients is for staff
to wear surgical mask. This may change
pending further recommendations by the CDC.
Everyone else must also don a surgical mask
upon entry to room.
Bacterium Meningitis
B for Bad
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Neiserria meningitidis (Treat
intimate exposures as well as
patient)
Only treat Patient
Hemoplus influenzae
Streptococcus pneumonia
Streptococcus group B
L. monocytogenes
Isolation Precautions
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Contact to prevent the transmission of
potential diseases that are spread by
close, direct, or indirect contact.
Examples are MRSA, VRE and ESBL.
Contact Enteric same as contact but
to remove bacteria have to wash hands
with soap and water. Examples C diff.
How it is Spread
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The primary method of MRSA transmission is
by Contact, usually from people's hands.
The organism has been recovered from
people's hands after they have touched
contaminated material and before they have
washed their hands.
The MRSA organism also is found among
health care workers who carry the organism
either in their nose or on their skin.
If a person carries MRSA in his or her nares,
it can be transferred to patients by hand
contact.
C. difficile:
Do NOT Use Purell Hand Sanitizer
When to use
PPE (Personal Protective Equipment)
When it is warm
 Wet
 Not yours
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Hand Hygiene Initiative
Which is More Dangerous?
Great White Shark
(Carcharodon carcharias)
MRSA
(Methicillin Resistant Staphylococcus aureus)
We Know What To Do!