Community Acquired MRSA

Community Acquired MRSAA SECOND LOOK AT HOW TO COMBAT THIS THREAT

JOHN WOODCOX RN CRRN

What is CA-MRSA?Organism presents itself primarily as a Skin and Soft Tissue InfectionsPulmonary associated infections-Necrotizing PneumoniaLess resistant to Antibiotics than its counterpart HA-MRSA

Community versus Hospital AcquiredCommunity Acquired is less resistant, More virulentPrimarily SSTIs, less often pulmonary, blood, and UTIsOther presentations include: Osteoarticular, Endocarditis, Sepsis, OsteomyelitisApproaching 155 cases per 100,00010% is acquired in homes with another infected personHospital Acquired isMore resistant and harder to treatPrimarily Pneumonia, UTI, Bloodstream

DiagnosisPulsed-Field Gel Electrophoresis Sorts isolates into categoriesDetermines CA-MRSA from HA-MRSAMore Accurately Addresses Appropriate Antibiotic

TransmissionDirect ContactPerson to PersonIndirect ContactSurfaces Harboring the OrganismDropletThrough organisms propelled into the airPrevious ColonizationBloodstream/Incision infections of the same strain

Promoting FactorsIndiscriminate Prescription of AntibioticsEducational GapsPoor HygienePoor Infection Control PracticesNonselective use of Antibiotics in LivestockOvercrowdingExtended Hospitalizations

PreventionProper Hand WashingHand SanitizersSoaps and Chemicals usedIsolationHospitals are more stringentLong term care facilities less stringentProper Isolation protocols neededEmployee proficiency with Isolation precautionsIncreased educational effort neededCommunication gaps in known carriers, active/inactive

Active surveillance CulturingAntimicrobial Stewardship TeamsPatient Identification MethodsClassic Reporting CommunicationEMR TaggingAdmission Assessment IdentificationDecolonizationRecurrent InfectionsImpending Surgery

EducationPatient EducationAge appropriateEducational Level AppropriateLearning BarriersReadiness to LearnSensory Communication IssuesCognitive Status

Community EducationHigh SchoolsHealth FairsFree ClinicsAppropriate Cleaning TechniquesSchool StaffHospital Staff

So Whats NewCommunication Awareness Amongst StaffAdmission Profile AlertsExpand Admission Assessment to Include ExposuresMRSA and Other MDROsEMR FlaggingCarriersActive InfectionAntibiotic AppropriatenessHeightened Awareness of Effective Cleaning ProductsHand SanitizersHand SoapsDisinfectants

Active Surveillance Culturing Identify and Isolate as appropriatePre-surgical Risk IdentificationAntimicrobial Surveillance TeamsDiscretionary Antibiotic UseIncorporate EMR Monitoring Pharmacy InvolvementTeaching the CommunityAthletesParents

Isolation Protocol UpdatesProper PPE useIncreased Isolation NeedsPre-Surgical PrepAcross the Board Pre-op ProtocolsEducation UpdatesNot Sharing Personal ItemsIncorporate Learning StyleLevel of EducationCommunication Barriers

ConclusionCA-MRSA is a growing problemPrevention is EssentialAntibiotic ResearchPrevention interventionsEducation

ResourcesHerman, 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.

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.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.2009.181958Yang, 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.