What is it?
MRSA refers to the resistance of a strain of Staphylococcus aureus to the Beta lactam class of antibiotics, which includes methicillin, nafcillin, oxacillin, cloxacillin, dicloxacillin, imipenem, and cephalosporins. (May also be resistant to clindamycin, erythromycin and aminoglycosides.) MRSA, therefore, poses a treatment problem, since the usual antibiotics used to treat Staphylococcus aureus infections (cloxacillin) cannot be used. As a result more toxic and expensive antibiotics (eg. vancomycin) must be used instead.
How is it Spread?
Direct contact via the hands of personnel from infected or colonized
patients has been clearly implicated as the most significant mode of
transmission for nosocomial MRSA infections in hospitals and nursing
homes. If hospital personnel become transiently colonized with MRSA,
there is a potential for spread to other uninfected patients. It
is important, therefore, that all cases of MRSA be identified and
contained to reduce the chances for colonization and transmission from
patient to patient; and that the Infection Control Service for the
facility be notified.
Signs and Symptoms of MRSA
MRSA can be carried by its host for long periods of time without
causing clinical consequences (colonization). This is particularly true
for persons with tracheostomies or open wounds. However, it can be
responsible for a variety of serious diseases, most notably pneumonia,
cellulitis, suppurative wound infections, abscesses, and bacteremia.
Prevention of Transmission
Approaches to the management of MRSA vary widely, in part due to the
lack of scientific data establishing the efficacy of specific control
measures. As a result, the recommendations for KGH are based on general
infection control principles, review of the literature, the individual
patient's risk of transmitting infection, the immunity of adjacent
patients, and the epidemiology of MRSA at KGH. Universal Infection
Control Precautions advocate precautions with all body substances and if
practised consistently will reduce the risk of transmission of many
pathogens, even when not identified.
Recommended practices to reduce the risk of transmission include:
*meticulous handwashing before and after any contact with an infected person, and after handling contaminated equipment or removing gloves;
*the use of barriers ( gloves, gowns) in the appropriate situations when soiling is likely;
*wearing masks for close contact if MRSA is in the sputum, and especially when suctioning;
*containing or covering draining sites;
*hospital disinfectant for each room to assist with consistent disinfection of shared equipment;
*patient and family instruction in handwashing hygiene and how to contain secretions, if applicable;
*in some situations, bathing patient with chlorhexidine or use of
mupirocin may be advised.
*placement in a private room (or cohorting with another MRSA patient) preferred, especially in the following situations:
- MRSA infections of the respiratory tract;
- when adjacent patients have had recent surgery or are immunocompromised; or
- when body substances are difficult to contain, due to the volume
and/or the patient's poor adherence to good hygiene.