MRSA in Assisted Living Facilities

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MRSA in Assisted Living Facilities

• MHCA Fall 2006
• DPHHS/QAD/Licensure Bureau
• Ruth M. Burleigh, RN/BSN, MA

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Which multidrug-resistant organisms are most
commonly seen in non-hospital settings?

• MRSA and VRE are the most commonly encountered
  multidrug-resistant organisms in patients
  residing in non-hospital healthcare facilities,
  such as nursing homes and other long-term care
  facilities.

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MRSA

• methicillin/oxacillin-resistant Staphylococcus
  aureus

VRE
vancomycin-resistant enterococci
http//www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.htm
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Is MRSA dangerous?

• MRSA ( or VRE) rarely, if ever, presents a danger
  to the general public.
• Antibiotic resistant bacterium is difficult to
  treat and found in vulnerable or debilitated
  patients.
• MRSA does not pose a risk to the health of staff
  who follow the facility infection control
  policies for hand washing.
• Friends or family of such a patient need to wash
  hands when leaving the residents room or using
  the bathroom.

http//www.amm.co.uk/files/factsabout/fa_mrsa.htm
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What is the difference between colonization and
infection?

• COLONIZATION means that the organism is present
  in or on the body but is not causing illness.
• INFECTION means that the organism
• is present and is causing illness.

http//www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.htm
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What conditions increase the risk of acquiring
these organisms?

• severity of illness
• previous exposure to antimicrobial agents
• underlying diseases or conditions, particularly
• chronic renal disease
• insulin-dependent diabetes mellitus
• peripheral vascular disease
• dermatitis or skin lesions

http//www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.htm
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What conditions increase the risk of acquiring
these organisms?

• invasive procedures, such as
• dialysis
• presence of invasive devices
• urinary catheterization
• repeated contact with the healthcare system
• previous colonization of by a multidrug-resistant
  organism
• advanced age

http//www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.htm
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Should patients colonized or infected with these
organisms be admitted to non-hospital healthcare
facilities?

• Non-hospital healthcare facilities, such as
  Nursing Homes and Assisted Living Facilities can
  safely care for and manage these patients by
  following appropriate infection control
  practices.
• Persons with MRSA, VRE, and other infections may
  be protected by the Americans with Disabilities
  Act or other applicable state or local laws or
  regulations.

http//www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.htm
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So What are The regulations?And What is it that
Assisted Living Facilities are expected to do?
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INFECTION CONTROL REGULATIONS

• ARM 37.106.313 MINIMUM STANDARDS FOR ALL HEALTH
  CARE FACILITIES COMMUNICABLE DISEASE CONTROL
• (1)All health care facilities shall develop
  and implement an infection prevention and control
  program. At minimum the facility shall develop,
  implement, and review, at least annually, written
  policies and procedures regarding infection
  prevention and control which must include, but
  not be limited to, procedures to identify high
  risk individuals and what methods are used to
  protect, contain or minimize the risk to
  patients, residents, staff and visitors.
• (2) The administrator, or designee, shall be
  responsible for the direction, provision, and
  quality of infection prevention and control
  services.
• (History Sec. 50-5-103 and 50-5-404, MCA IMP,
  Sec. 50-5-103, 50-5-204 and 50-5-404, MCA NEW,
  1980 MAR p. 1587, Eff. 6/13/80 TRANS, from DHES,
  2002 MAR p.185 AMD, 2004 MAR p. 582, Eff.
  3/12/04.)

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INFECTION CONTROL REGULATIONS

• ARM 37.106.2843 PERSONAL CARE SERVICES (2)
  Evidence that the facility is meeting each
  resident's needs for personal care services
  include the following outcomes for residents
• (v) risk of accident, injury and infection
  has been minimized and

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INFECTION CONTROL REGULATIONS

• ARM 37.106.2855 INFECTION CONTROL (1) The
  assisted living facility must establish and
  maintain infection control policies and
  procedures sufficient to provide a safe
  environment and to prevent the transmission of
  disease. Such policies and procedures must
  include, at a minimum, the following
  requirements
• (a) any employee contracting a communicable
  disease that is transmissible to residents
  through food handling or direct care must not
  appear at work until the infectious diseases can
  no longer be transmitted. The decision to return
  to work must be made by the administrator or
  designee, in accordance with the policies and
  procedures instituted by the facility

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INFECTION CONTROL REGULATIONS

• ARM 37.106.2855 INFECTION CONTROL (continued)
• (b) if, after admission to the facility, a
  resident is suspected of having a communicable
  disease that would endanger the health and
  welfare of other residents, the administrator or
  designee, must contact the resident's
  practitioner and assure that appropriate safety
  measures are taken on behalf of that resident and
  the other residents and
• (c) all staff shall use proper hand washing
  technique after providing direct care to a
  resident.

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INFECTION CONTROL REGULATIONS

• ARM 37.106.2855 INFECTION CONTROL (continued)
• (2) The facility, where applicable, shall comply
  with applicable statutes and rules regarding the
  handling and disposal of hazardous waste.
• (History Sec. 50-5-103, 50-5-226 and 50-5-227,
  MCA IMP, Sec. 50-5-225, 50-5-226 and 50-5-227,
  MCANEW, 2002 MAR p. 3638, Eff. 12/27/02 AMD,
  2004 MAR p. 1146, Eff. 5/7/04.)

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REMEMBER THE ORIGIN

• MRSA Staphylococcus aureus is a bacterium often
  found in 20-30 of the noses of normal healthy
  people and is also commonly found on people's
  skin.
• VRE Enteroccocci is normally present in the
  human intestines, in the female genital tract and
  are often found in the environment.

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BREAK THE CHAIN OF INFECTION

• ALL STAFF MUST always wash hands thoroughly after
  using the bathroom and before preparing food.
• Clean hands after close contact with persons who
  have MRSA or VRE.
• Wash with soap and water (particularly when
  visibly soiled) or clean with alcohol-based hand
  cleaner.
• Frequently clean areas of the facility such as
  the residents bathrooms. Use a household
  disinfectant or a mixture of one-fourth cup
  bleach and one quart of water to clean those
  areas and surfaces that are touched frequently.

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BREAK THE CHAIN OF INFECTION

• Wear gloves if there is a risk of contact with
  body fluids that may contain MRSA or VRE, such as
  used tissues or stool. Always wash hands after
  removing gloves. NEVER reuse gloves.
• Use good hand washing techniques (sing happy
  birthday twice and use a clean dry disposable
  towel to shut off water)

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BREAK THE CHAIN OF INFECTION

• Linens should be changed and washed if they are
  soiled and on a routine basis.
• The residents environment should be cleaned
  routinely and when soiled with body fluids.

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If a patient in a facility is colonized or
infected with MRSA or VRE, what do their
visitors/family members need to know?

• In general, healthy people are at low risk of
  getting infected with MRSA or VRE. Therefore,
  casual contact - such as kissing, hugging, and
  touching - is acceptable.
• Visitors need to be reminded to wash their hands
  before leaving an infected person's room.

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If a patient in a facility is colonized or
infected with MRSA or VRE, what do their
visitors/family members need to know?

• A friendly reminder posted by the residents
  door and above the residents sink are helpful in
  facilitating this process. The reminders do not
  have to be institutional-can be decorative and
  attractive.

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If a patient in a facility is colonized or
infected with MRSA or VRE, what do their
visitors/family members need to know?

• Disposable gloves should be worn if contact with
  body fluids is expected. (If excessive contact
  with body fluids is expected, gowns should also
  be worn.)
• It is also acceptable for infants and children to
  have casual contact with these patients.

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Last, but not least

• Maintain communication with residents health
  care providers and physicians and each other.
• Be alert to the residents general conditions
  illness, aging, hospitalization, intrusive
  procedures, etc.
• DO NOT ISOLATE the resident.
• Keep up-to-date Resident Health Care and Service
  Plans

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Last, but not least

• Orientate and train staff on correct hand washing
  and communicable disease policies and procedures
• If staff are ill-send them home.
• Call the local public health nurse if you have
  addition questions or the Licensure Bureau

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Last, but not least

• Review information provided by the CDC at
• http//www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.htm
  l
• OR
• Go to the Assisted Living Infection Control Web
  page at
• http//www.dphhs.mt.gov/qad/assistedliving/
• infectioncontrol.shtml

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Consistent routine properhand washing is the
first line of defense in any infection control
practice.