Implementing the MDH Recommendations for Prevention and Control of MRSA in Acute Care Facilities

1
Implementing the MDH Recommendations for
Prevention and Control of MRSA in Acute Care
Facilities

• Mayo Clinic Rochester
• Infection Prevention and Control
• Barbara Lecy RN , CIC
• April 10, 2008

2
MRSA trends

• MRSA trends
• 2001 17
• 2002 28
• 2003 32

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MRSA program

• Isolating known colonized or infected patients
  using gown / gloves
• Electronic flagging of all positive patients
• Enhanced environmental cleaning of isolation
  rooms
• MRSA continued to increase
• ?????????

4
Periodic risk assessment

• 2003-risk assessment at Saint Marys Hospital
• Medical units
• Staff nurses screened all admissions for 3 weeks
• Asked if NH, dialysis , transfers from outside
  hospitals, hospitalized in last 6 months
• 11 of all admissions were found to be MRSA
  carrier, 35 of NH patients had MRSA
• Patients admitted from a NH were 7 times more
  likely to have MRSA than non NH patients

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MRSA trends

• ASC begins for Nursing home patients
• 65.1 compliance with completing the nasal swab
• Added pre-emptive isolation ,unpopular but
  increased compliance
• Some delays in stopping isolation
• 2004 41
• 2005 38.7
• 2006 34.9
• 2007 32.2

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Risk assessment

• March 2008 risk assessment of all adult
  admissions on 4 days at the St Marys hospital
  site (471)
• Trained RN group screened every adult admission
  to the hospital on 4 days
• Asked questions regarding status ie NH , dialysis
  , transferring from , hospitalized
• Excluded patients with known colonization
• Data will be analyzed to determine need for ASC
  program . Preliminary quick look suggested no
  need to change current program.

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Surveillance

• Ongoing surveillance for MRSA in colonized or
  infected sites
• Bacteremia surveillance in ICUs
• Surgical site infections in all specialties
• Review of all microbiology daily
• Isolates reviewed for trends quarterly
• Enhancing surveillance documentation tool to
  include query for all infected sites , CA and
  Noso

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Transmission based isolation

• Mayo Clinic Rochester has utilized contact
  transmission precautions requiring gown and
  gloves upon room entry for many years. Termed it
  Strict
• Compliance is critical to success. Compliance is
  seen as a burden by staff.
• Recent pilot ( VRE) one unit was allowed to
  reduce use of gowns . Gown only for direct
  patient care , not for every room entry.
  Increased transmission was clearly demonstrated.
  Unit staff now supportive of the value of
  strict use of barriers.

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Transmission based isolation

• Communicating the change to 3 negative cultures
  from 2, in the past, for removal
• Infection Prevention and Control removes the flag
• Reviewing all isolation policies
• Incorporating some of the language used in MDH
  document
• For Ex. Transporter guidelines
• Is cleaning product available for between patient
  disinfecting?
• Are staff understanding the use of barriers as
  patients are transported to testing areas?

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Transmission based isolation

• Monitoring high isolation utilization patient
  care units for compliance
• Feedback and education given to units with less
  than 50 compliance
• Repeat monitoring
• Continue to educate physicians and allied health
  staff on the correlation between identification
  of colonized patients and early isolation to
  reduce the pool of unknown colonized patients in
  our hospital setting
• Annual online education to staff includes
  isolation/ transmission content

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Standard Precautions

• Reinforce to outpatient areas
• Use of assessment skills..
• Use of barriers as needed
• Use of hand hygiene as simple line of defense

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Hand hygiene compliance

• Campus wide quality initiative to improve
  compliance to 100
• Pilot units utilizing various interventions
• Communicate feedback on monitored compliance
  results to all staff-we are a team
• Assess access to waterless hand rub / gloves
• Increase knowledge base of staff- Why , When ,
  How
• Unit based hand hygiene promoters to coach staff
  and champion the behavior change

13

• New MDH document and public interest / mandatory
  reporting in other states has peaked interest at
  many levels in our facility
• What an exciting time to be in infection
  prevention and control
• Questions ?