نوووور
28/11/02, 11 :03 11:03:18 PM
MRSA Definition: Methicillin Resistant Staphylococcus Aureus (MRSA) is resistant to cloxacillin/ fluocloxacillin and usually to many other antibiotics, many strains of MRSA show a marked tendency to spread between patients, and many also colonise staff members who then further spread the organism within the hospital. Although most patients do not suffer from disease due to MRSA, it is as likely to cause significant infection as in any other strain of Staphylococcus aureus, and when such infection occurs they can only be treated with toxic and expensive antibiotics. It is therefore important to take all possible measures to limit the spread of MRSA. Treatment of MRSA: Affected wounds should be treated daily with iodine or chlorhexidine containing antiseptics. Nasal carriage requires the use of Naseptin cream. In cases of widespread skin colonization, the patient must be bathed daily in an antiseptic bath-concentrate (hibiscrub). This treatment should be discontinued after one week, and the patient should be reswabbed three days later. If three consecutive sets of negative swabs are obtained at weekly intervals, the patient may be considered free of MRSA. Treatment of carriers: Mupirocin nasal ointment to the anterior nares tid x 5 days. Chlorhexidine scrub applied (bed bath or shower) daily x 5 days. Chlorhexidine scrub applied as shampoo twice weekly. Mupirocin to be applied to lesions tid x 5 days. Discontinue chlorhexidine if hypersensivity occurs. Patient screening procedures: To be initiated by infection control sister or microbiologist. One or two cases in ward: screen other patients in same area. More than two cases: Screen all patients. More than three cases: Screen all ward staff. Using protective Barriers: The following must be done as soon as the patient is found to be positive, and should be in accordance with the Barrier Nursing Policy. A single room should be used and staff must wear gowns and disposable gloves. Relatives do not need protective clothing unless visiting other hospital patients. Bed linen and other fabrics such as curtains should be sent to the laundry for treatment as infected fabrics. The plastic covers of the mattress and pillows should be washed with phenolic disinfectant (e.g. 2% stericol). Wash hand basins, toilets, showers, floors, shelves curtain rails and other horizontal surfaces should be washed with a phenolic disinfectant (e.g. 2% stericol). Use separate thermometers and they should be thoroughly cleaned and then wiped over with spirit followed by tap water. Walls should be cleaned only of they are visibly soiled. Mark patient’s file: The front of patient’s file should be clearly marked that the patient has (MRSA positive). Determine the extent of colonization: The patient may have MRSA in one or several sites. Swab should be taken from the nose, axilla, groins and any skin lesions (e.g. wounds) IV sites, pressure areas; catheter, urine and sputum specimens should be sent where applicable. Do not move the patient around the hospital: The risk of spreading the organism to unaffected areas where more susceptible patients may be found. If it is impossible to avoid transferring the patient, then the receiving area should be notified of the MRSA. Before being sent to another department (e.g. theater or X-Ray) or hospital, the patient should be firstly bathed with an antiseptic bath concentrate and then put on clean gown or pajamas. The department or hospital concerned must be notified of the MRSA in advanced so that precautions may be taken. Staff carriers: Staff with skin lesions should not be assigned to care for patients with MRSA. Staff should report any abnormal skin condition to staff in charge. The infection control nurse or consultant microbiologist should initiate screening of staff. The anterior nares and abnormal skin sites should be sampled with moistened sterile swab. When carriers are detected, the staff member should be seen by occupational health and full screening (nasal, perineum, axilla and abnormal skin sites) carried out. Staffs who have been assigned to care for patients during out breaks require screening on completion of their assignment. Staff with nasal carriage only and intact skin, may continue working except in ICU or theater or in special circumstances. Staff with other colonized sites should cease working in clinical areas until negative. NooOoor