Keeping MRSA from Spreading

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Question: Is there an effective way to keep MRSA from spreading throughout a facility? Some fail-safe means of training staff to have good hand hygiene, for example?
 
Response: I’m not convinced that any intervention is fail-safe in the prevention and control of antibiotic resistant organisms (AROs) such as MRSA and VRE.  However, with that said, ICPS, Risk Managers, and Administrators need to examine the accumulated evidence and literature on this topic. We’ve espoused the use of ‘evidenced-based’ guidelines for years; and yet, we may neglect to accept or implement guidelines which require too much effort.  The SHEA (Society for Healthcare Epidemiology of America) Guideline for Preventing Nosocomial Transmission of Multi-Drug Resistant Strains of Staphylococcus aureus and Enterococcus1 recommends routine use of surveillance cultures to identify (and recognize) the reservoir of patients colonized with MRSA and then institution of Contact Precautions for these patients.  These guidelines, supported by numerous studies which note decreased rates of colonization and infection after use of this strategy, were effective not only in MRSA control in ICUs and entire hospitals but also in situations in which MRSA was endemic or epidemic.  Control does appear achievable.
 
In addition to Standard Precautions, The Center for Disease Control and Prevention has advocated the combined strategy of identification and containment as the most effective documented method to control AROs as well as other pathogens.  Yet, many ICPs and facilities continue to advocate Standard Precautions as the sole answer to control of MRSA.  Studies indicate the use of Standard Precautions has been significantly more likely to transmit AROs than use of Contact Precautions.  While the screening and isolation efforts may seem gargantuan initially, especially in light of scarce resources and ICP staffing ratios, the outcome—patient safety—is worth it in terms of saved morbidity, mortality and costs.  
 
As with many IC issues, this issue does not have a single answer but rather is best addressed by multidisciplinary and multimodal strategies. Some of these strategies include screening and isolation; education on proper hand hygiene2 and isolation practice; availability of hand hygiene items such as alcohol–based handrubs and soap and water; observation and feedback of practice; and a strong safety climate in the institution with role models. 
 
Be an advocate for patient safety…adopt evidenced-based guidelines for control of AROs. 

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1.      Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, Farr BM.  SHEA Guideline for Preventing Nosocomial Transmission of Multi-Drug Resistant Strains of Staphylococcus aureus and Enterococcus.  Infection Control and Hospital Epidemiology 2003; 24:362-386.


2.      Centers for Disease Control and Prevention.  Guidelines for Hand Hygiene in Health-Care Settings.  Recommendations of the Healthcare Infection Control Practices Advisory Committee…HICPAC, SHEA, APIC, IDSA. Hand Hygiene Task Force.  Morbidity and Mortality Report (MMWR) 2002;51(NO.  RR-16):  1-48.

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