Special Edition on Infection Prevention & Control | Page 31

TIER 1: STANDARDIZED SUPPLIES, PROCEEDURES, AND PROCESSES
(Complete all interventions: review and audit compliance with tier 1 measures before moving to tier 2)
Conduct basic MRSA
risk assessment for
facility infection
burden and
transmission risk
Conduct case
reviews of NHSN HO
MRSA bacteremia
laboratory-identified
events (cases) to
guide source-specific
interventions
Monitor and alert
staff of patients with
MRSA
Promote and
monitor hand
hygiene compliance
Initiate contact
precautions for
both colonized and
infected patients and
monitor adherence
Assess effectiveness
of cleaning and
disinfection of
environment of care
and reusable patient
care equipment
Perform HO MRSA
bacteremia needs
assessment with GPS
TIER 2: ENHANCED PRACTICES
(If MRSA bacteremia rates remain elevated, start with the MRSA GPS, and then proceed with additional interventions)
Implement daily
chlorhexidine bathing for
populations at risk for
MRSA bacteremia
Consider decolonization for
patients with MRSA and at
high risk for infection
Active surveillance testing
for high-risk patient
populations
Consider gowning and
gloving for all intensive
care unit patients
event. Finally, these data can inform preventive measures that
need to be reinforced or implemented. For example, if case
reviews identify that MRSA bacteremia is occurring in patients
with ventilator-associated pneumonia (VAP), introduction or
compliance with evidence-based VAP prevention strategies,
such as subglottic secretion suction or chlorhexidine oral
rinses, can be considered in high-risk populations. Similarly,
in cases of other sites, hospitals may use data from the case
review to ensure that evidence-based prevention guidelines
are consistently being followed for surgical-site infections,
peripheral intravenous catheter and central line-associated
bloodstream infections, and dialysis-related infections, because
these are the most common sources of MRSA bacteremia in
healthcare settings.
Tier 1, Intervention 3: Monitor and Alert Health Care
Personnel About Patients With MRSA: In addition to audit
of cases, tier 1 recommended institution of a prospective
monitoring program for MRSA. Hospitals should establish a
program to identify and track patients from whom MRSA has
been identified. Components of this program may include a
mechanism for rapid recognition of patients with MRSA so as
to enforce MRSA prevention strategies in accordance with a
hospital’s policy. For instance, a hospital should have in place
a laboratory alert system that can rapidly notify appropriate
personnel (such as care providers or infection prevention and
control) when MRSA is identified in a specimen sample. Intraand
interfacility communication is an important component
of alerting healthcare personnel of a patient’s MRSA status.
Engaging leadership and frontline healthcare personnel with
feedback about rates of hospital-onset MRSA can help foster
continued vigilance in reducing MRSA and motivate personnel
to encourage adherence to infection control policies in place
at that facility.
Tier 1, Intervention 4: Promote and Monitor Hand
Hygiene Compliance: Hand hygiene (with soap and water or
an alcohol-based hand gel) before and after patient contact or
contact with the patient care environment remains an essential
cornerstone of any hospital’s infection control program.
Nevertheless, compliance by health care personnel with hand
hygiene is known to be variable. Healthcare personnel need to
be educated on the importance of hand hygiene compliance
and how breaches in hand hygiene can promote transmission
of MRSA, particularly in settings with high carriage rates of
MRSA, because there is increased opportunity for healthcare
workers to contaminate themselves and transmit MRSA to other
patients. Regular audits of healthcare personnel compliance
should be performed. Providing feedback on hand hygiene
compliance to healthcare workers has been associated with
significant increases in compliance, and a reduction in MRSA
bacteremia has been observed with increased adherence with
hand hygiene. An added benefit to ensuring high compliance
of healthcare personnel with hand hygiene is that the beneficial
effects extend to prevention of transmission of other organisms
(that is, it is a horizontal infection control strategy). However,
because multiple methods are available to measure compliance
and it remains unclear what the most effective strategy is, no
single approach was emphasized.
Tier 1, Intervention 5: Initiate Contact Precautions
for Patients Colonized or Infected With MRSA: Patients
who are colonized or infected with MRSA may be placed in
private, single-occupancy rooms or co-horted with similar
patients to reduce the spread of MRSA. Contact precautions
(gloves and gowns) are used during clinical encounters with
patients who are colonized or infected with MRSA because
these may reduce the risk for spread of MRSA to healthcare
workers and other patients. One study observed healthcare
worker contamination rates for gloves, gowns, and gloves
and/or gown with MRSA of 17.7 percent, 6.2 percent, and
18.5 percent, respectively, suggesting that an infection control
practice, such as contact precautions, might be beneficial
for reducing spread of MRSA. If hospital policy recommends
contact precautions for patients colonized or infected with
MRSA, appropriate personal protective equipment (PPE) should
be readily available. In addition, facilities need to confirm that
healthcare personnel have received training on proper use of
PPE and consider audits of adherence with feedback provided to
www.healthcarehygienemagazine.com • IP&C Special Edition June 2020
31