John Muir Health

According to an October 2007 report from CDC researchers¹, more people in the United States now die from an MRSA infection than from AIDS. About 85% of MRSA infections in 2005 were acquired in the healthcare setting. Those at highest risk for an MRSA infection in the healthcare setting are patients who undergo invasive medical procedures, patients with weakened immune systems and are being treated in hospitals, and patients in nursing homes and dialysis centers. Approximately 15% of invasive MRSA infections were in people with no known health care risk or exposure. Those over age 65 were four times more likely and Blacks twice as likely to get an MRSA infection than the general population. Males were more likely to become infected than females. Those at lowest risk were children over the age of 4 and teenagers.

Transmission of MRSA tend occur in 5 general situations referred to as the 5 C's: Crowding, frequent skin-to-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness. Healthcare workers' hands are most often cited as the primary means of person to person MRSA transmission. Therefore, basic patient care dictates all healthcare workers wash all surfaces of their hands frequently; when personal protective equipment (PPE), such as gloves, are removed; when the hands become visibly soiled; and after contact with the patient or patient's environment. Gloves, PPE, contaminated bandages and other materials should be discarded in a covered container or a sealed plastic bag. If infectious material is also contaminated with blood, then disposal is according to blood borne pathogen regulations.

Preventing MRSA transmission in the healthcare setting requires a multi-pronged approach.

1. Good Hand Hygiene: prior to performing a procedure on a patient ask - Am I going to come into contact with any body fluids, blood, open skin, or mucous membranes? If yes, then appropriate PPE should be donned. Use lotion to maintain healthy hands.
2. Good skin hygiene: patients should be assisted in maintaining clean and intact skin - by bathing or showering several times a week and washing hands frequently. Skin tends to dry and crack in the wintertime. The skin of geriatric and immuno-compromised patients tend to tear and bruise easily.
3. Dedicated Medical Equipment: if dedicating equipment is not possible, disinfect reusable equipment prior to use on another patient. The necessity of urinary catheters and other devices should be well-considered before placement and removed as soon as possible.
4. Good Housekeeping should ensure regular and routine cleaning of patient's room; and deep cleaning and disinfection when a patient is discharged or returned to Standard Precautions; and after an outbreak.
5. Laundry should ensure availability of fresh, clean clothes or gowns for patients' daily wear.
6. Reservoirs, patients who are colonized or actively infected, should be closely monitored and any potential drainage controlled and covered.
7. Antibiotic use should be targeted and prudent.

¹ See Journal of the American Medical Association 2007;298(15):1763-1771