Management of Suspected Mrsa Colonised Patient

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Infection control policy

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38.5Title / Description:

MANAGEMENT OF SUSPECTED MRSA COLONISED PATIENT

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All Doctors and nursing staffPREPARED DATE07/02/2011REVIEW DATE

07/02/2013DEFINITION

This policy describes the steps needed to prevent the spread of Methicillin

Resistant staphylococcus Aureus (MRSA ) to patient staff & visitors

Screen all patients who are :

Admitted to the ICU

Transfers from other hospitals or patients treated in another hospital or clinic with in thepast six months

Continuous ambulatory peritoneal dialysis (CAPD

Known to be previously MRSA positive

Room mates of positive patients not on precautions

Additional populations of patients as designated at the individual facility

(direction to come from IC):

Sites to screen are

Anterior nares

Kingdom of Saudi ArabiaMinistry of HealthAl Zulfi General Hospital


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Any indwelling catheter sites

Open skin areas (e.g . tracheostomy ,pressure sores or surgical wounds )

Neonates & patients for liver transplant should also have groins & both axilla screened

Specimen collection

Use sterile swab stick with transport medium

Moisten swab in transport medium before swabbing the site

Use same swab for identical sites :one swab for both nares ,one swab for both axilla &

one swab for both inguinal areas

Use separate swabs to screen other sites

NB :The accompanying requisition should request MRSA SCREEN

Patient placement

Initiate empiric contact isolation precautions during the screening process

Request single room for contact isolation from bed co ordination .Two or more MRSA

patient for screening may be corhorted if needed , after consultation with infectioncontrol

Observe contact isolation precautions in addition to standard precautions

Place contact isolation sign on the outside of isolation room door

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Ensure that all staff understand & compare with the isolation precautions & hand hygienepolicy

Cohort noncritical items such as stethoscope & pressure cuff with the patient

Store minimum amount of ( daily ) supplies in patient room

Limit pt activities out side of the ward

Notify receiving departments /wards ( eg . radiology ,endoscopy , clinics ,O.R ) of pts

isolation status when pt must be transported for treatments / tests

If pt is positive refer to management of MRSA positive pts below

MICROBIOLOGY LABORATORY MUST

Notify the ward of positive MRSA cultures

Notify ICP of all new positive MRSA cultures

MANAGEMENT OF PATIENTS CONFIRMED POSITIVE MRSA :

NURSING

Request a single room for contact isolation from bed coordination

Two or more MRSA positive pts can be cohered if needed after consultation with

infection control.

Notify infection control staff that patient is placed in contact isolation

Maintain standard precautions with all patient care activities

Place pt in a single room . only neutral room air pressure is indicated

Put contact isolation sign on door

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Supplies needed :

PPE must be readily available for use

Wear gown and gloves when anticipating contact with pt or before entering ptenvironment

Cohort non critical items such as stethoscopes and pressure cuffs with the patients

Store minimum amount of supplies in a pt room

Use an isolation cart for extra needed supplies ( keep outside the room )

Strict hand hygiene is the most important means of preventing or reducing contact

transmission of micro organisms

Screen all pts for MRSA who have shared a room with the MRSA positive pts for more

than 48 hrs ( nares & all open sites )

Encourage the patient to observe strict hand hygiene with the personal hygiene

Restrict internal and external movement of patient

When transferring patient the receiving department / facility ( eg . x ray ) must be

informed of patient isolation status to permit implementation of proper precautions

Patients body fluids must be contained & wound covered etc .

Equipement ( wheel chairs , stretchers ) used must be cleaned before use on other

patients

Explain the purpose of precautions to the patients & visitors in the order to solicit theircooperation

Handle / discard contaminated items as per standard precautions

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Maintain control isolation until a consultation with infection control regarding decolonization oor dis continuation of isolation is made

Initiate the flagging system for MRSA positive patients

MEDICAL

Restrict antibiotic use ( especially broad spectrum )& invasive devices where possible

Discharge patient when medical condition allowes

Use broad spectrum systemic antimicrobials only when there is evidence of activeinfection

Seek infectious diseases consultants / ICPs advise regarding possible decolonization

DECOLONIZATION PROTOCOL

Infection control staff assess if pt is suitable for decolonization protocol

Treat nares topically for periods not exceeding 7 days with bactroban ( mupirocin ) cream

only if organism is mupirocin sensitive . Restrict use as resistance to this agent is welldocumented

Use 4 % chlorhexidine wash ( suppressive therapy ) to reduce or inhibit MRSA skin

colonization , assess pts on an individual basis in consultation with infection control staff

Apply this protocol to those who are for organ transplant , cardiac , orthopedic surgery

and to those who regularly attend other departments for therapy such as dialysis pts orthose requiring physiotherapy

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Management of suspected MRSAcolonised

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DISCONTINUATION OF CONTACT ISOLATION

Discontinue isolation of MRSA positive patient in consultation with ICP or ICMO

Criteria to discontinue isolation

Antibiotic therapy is completed atleast 3 days prior to screening

Vancomysin level should be ZERO prior to rescreening

Three consecutive cultures ( taken 3 days apart ) from NARES and all previously

positive sites are negative

Patient should not be receiving antibiotic therapy throughout the screening process

LINEN

Keep a linen hamper in the isolation area

CLEANING OF PATIENTS ROOM

Regular cleaning as per housekeeping protocol with hospital approved disinfectant

Once cleaning is completed the room should be available for new admission

AMBULATION

Patient with infected body fluids

If pt can contain his / her body fluids ( secretions , urin , stool ) walking in the coridoors is

permissible but not allowed to visit other pt care areas

If unable to contain body fluids pt must be encourage to stay in the room

VISITORS & SITTERS

Provide information about MRSA as required

Hand hygiene must be emphasized as pt contact


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IC 38.5


patient

Barriers may be required if providing direct pt care

SCREENING OF HEALTH CARE WORKERS (HCW s ) & THE ENVIRONMENT

Do not culture HCWs or environment since it is not indicated and incurs unnecessary costs

Consult ICP before such measures are taken

OUTBREAK MANAGEMENT

Will be coordinated by the ICP & will require the cooperation of medical , nursing ,laboratory and other department s

MRSA DECOLONIZATION

Assessment for decolonization will be done by the IC practioner in consultation with

the attending physician & infectious disease consultant .

Maintain contact isolation during decolonization treatment

SUPPLIES:

Chlorhexidine 4% soap

Mupirocin / Bactroban per MD order

Clean linen for bed & pt

PPE

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Spread full strength chlorhexidine 4% solution from neck to toes ensuring you getunderarms ,groin , and between fingers & toes

Cover pt with a sheet & wait for 10 minutes

Rinse with warm water

Change bed linen & pt clothing completely after bath

Repeat this process twice a day

Shampoo hair with the chlorhexidine solution on the first ,3rd

& 7th

day of

Treatment , make sure pts hair is thoroughly dried

Apply mupirocin or Bactroban ointment to anterior nares ( inside nose ) after

chlorhexidine treatment and pt is dried & dressed as ordered by the MD

NB: mupirocin should not be applied for the open wounds

These treatment must be given to 7 consecutive days

Stop treatment & wait for 3 days ( days 8, 9, & 10 )

On day 11 , start screening the process

Do a complete set of swabs from nares & originally positive sites every 3 days (

day 11 , 14 , & 17 )

Three negative culture sites are required before pt is cleared of MRSA & can be taken

out of the isolation

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NB : This will be assessed by IC practitioner

NOTES :

The pt must be on antibiotic at the time of screening

Vancomysin level must be ZERO before screening

If any swab is positive , stop screening process until further assessment

Please complete all documentation of this form . ICP will collect form when complet

MRSA DECOLONISATION RECORD

START DATE : ----------------------------------

InitialsMupirocin/Bactroban ointmentChlorhexidine 4%Wash & shampooTreatment time

Day 1 AMPM

Day 2 AMPM

Day 3 AMPMDay 4 AM

PMDay 5 AM

PMDay 6 AM

PMDay 7 AM

PM

SCREENING 1 /DAY 11 DATE DUE : --------------------- DONE:------------------

SCREENING 2 /DAY 14 DATE DUE :------------------------DONE:--------------------

SCREENING 3/DAY 17 DATE DUE :-----------------------DONE :--------------------

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COMMENTS :

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Management of suspected MRSAcolonised

patient

Prepared by:

Nirmala Philip -Infection control practitioner

Reviewed by : Dr .R.N.ThakurInfection control Medical officer

Reviewed by:

Dr. Ammar Al AmriQ.M. Director

Approved by:

Dr. Mohd Alwan Al Shamrani Hospital Director

Management of Suspected Mrsa Colonised Patient

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