By David Thill
By taking certain precautions – and with the help of some new medical equipment – providers can prevent the spread of MRSA in their facilities
After launching a MRSA prevention initiative in 2007, the Department of Veterans Affairs reports that the incidence of MRSA in its facilities decreased significantly between 2007 and 2015.
The findings, published in January in the American Journal of Infection Control, show an 87 percent decrease in monthly healthcare facility-associated infections (HAIs) in intensive care units over the eight-year span, and an 80.1 percent decrease in non-ICUs for the same time period. Additionally, MRSA HAI rates fell 80.9 percent in spinal cord injury units and 49.4 percent in long-term care facilities.
The VA MRSA Prevention Initiative included several interventions in facilities, such as universal active surveillance – or screening – of patients upon admission, unit-to-unit transfer, and discharge. The study’s authors believe that this screening was the main factor in reducing MRSA infection in healthcare facilities.
“Understanding how and why rates of MRSA have diminished in recent years is essential for the continued progress of effective prevention programs,” lead study author Martin E. Evans, M.D., said in a news release from the Association for Professionals in Infection Control and Epidemiology. “As we seek to protect patients from MRSA and other resistant organisms, our study supports the need for strong infection prevention programs at every healthcare facility.”
While the U.S. Centers for Disease Control and Prevention notes that MRSA is typically spread by direct contact with an infected wound or contaminated hands, the infection can also be spread through contact with infected surfaces in healthcare settings, says Yatao Liu, Ph.D., director of strategy, innovation and clinical affairs at Metrex. (Studies indicate that surfaces frequently touched by patients – overbed tables, bed side rails, and curtains – are particularly at risk for spreading MRSA.)
Research shows that implementing surface disinfection on hospital surfaces decreases the spread of MRSA, notes Liu. Metrex recommends U.S. Environmental Protection Agency-registered surface disinfectants to combat this spread. These products – such as CaviCide and CaviWipes from Metrex – disinfect hard non-porous surfaces, killing bacteria in as little as one minute.
Pathogens also attach to shoe soles, allowing infections like MRSA to travel along the floor and into the air, and eventually be transmitted to patients and healthcare workers. To prevent transmission from shoe soles, DETECTO – traditionally known for its medical scales – began manufacturing the HealthySole Plus last year.
According to Chris Griffith, DETECTO HealthySole product specialist, and Jonathan Sabo, DETECTO VP of marketing, the HealthySole Plus “is a UVC germicidal, chemical-free, 24/7 disinfection device for the soles of shoes or booties in any critical environment that requires high standards of cleanliness.” Recommended for use in healthcare settings including physicians’ offices and hospitals, “the goal is to reduce the environmental pathogenic load,” thus reducing the potential for HAIs, say Griffith and Sabo.
Healthcare professionals stand on the HealthySole’s scale-like platform for approximately eight seconds, in which time the device uses UVC lamps to kill pathogens such as MRSA, as well as Enterococcus, E. coli, and Clostridium difficile (CDI), that may have attached to the person’s shoes. Sabo and Griffith cite studies indicating HealthySole Plus kills over 99 percent of infection-causing organisms.
They also recommend DETECTO’s icon scale, which, by using touch-free technology, takes patient measurements without any point of contact for both the patient and healthcare professional. This touch-free use helps lower the risk of MRSA transmission, they say.
Five steps to stop the spread of MRSA in the hospital
MRSA (methicillin-resistant Staphylococcus aureus) is a common healthcare facility-associated infection, or HAI, that can be transmitted through skin-to-skin or surface-to-skin contact. As part of its 5 Million Lives Campaign, the Institute for Healthcare Improvement developed a document, “Getting Started Kit: Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) Infection How-to Guide,” which provides a list of five components of care for healthcare organizations to use in order to decrease MRSA risk in their facilities.
- Hand Hygiene: Hospitalized patients often have high concentrations of MRSA on their skin and other body sites, and “tend to contaminate their immediate environment,” according to the guide. Healthcare workers “can contaminate their hands while performing ‘low-risk’ patient care activities such as taking a pulse or blood pressure, lifting a patient up in bed, or handling items in the patient’s vicinity.”
While gloves can reduce the risk of contamination, workers’ hands often become contaminated when removing gloves. “Therefore, cleaning hands before and after having contact with MRSA patients or their immediate environment is of paramount importance in reducing transmission of MRSA in health care facilities.” (IHI has developed a “Hand Hygiene Guide” with more in-depth details for healthcare workers to follow.)
- Decontamination of the Environment and Equipment: IHI states that thorough, “regularly scheduled cleaning and disinfection of the [hospital] environment are essential.” Education is recommended for staff – including clinical staff and environmental services staff – “regarding the thorough cleaning and decontamination and the use of appropriate cleaning procedures.”
IHI recommends that hospitals implement checklists that help personnel perform all necessary components of thorough cleaning, rather than relying on memory.
- Active Surveillance: Active surveillance testing (AST) of patients’ anterior nares (nostrils) will identify 80 percent of MRSA-colonized adult patients. “Using a combination of screening specimens from the anterior nares and wounds will increase sensitivity of detecting colonized adult patients to over 92%,” according to IHI.
While some hospitals perform AST on all admitted patients, others have found success by only performing AST on patients admitted to the intensive care unit. Most hospitals that perform AST focus on patients who are considered at high risk of being colonized with MRSA. IHI’s guide states that “Each hospital should make its own determination as to whether AST is needed or will be performed and, if so, in what population.”
- Contact Precautions for Infected and Colonized Patients: Gloves and gowns can reduce the likelihood of healthcare workers contaminating their hands and clothing when caring for patients colonized or infected with MRSA. (As noted above, hand hygiene should be performed after removing gloves.)
Placing patients in single-occupancy rooms “may make it less likely that [healthcare workers] will move from an infected or colonized patient to an adjacent, uncolonized patient without removing their gloves and gown and cleaning their hands.”
- Device Bundles: According to IHI, patients with invasive devices, such as central lines and ventilators, who are colonized with MRSA are at greatly increased risk of MRSA bloodstream infection and pneumonia. Many hospitals have reduced or eliminated device-related infections through the implementation of “bundles” – “groupings of best practices that individually improve care, but when applied together result in substantially greater improvement.”
IHI provides how-to guides for the central line bundle and the ventilator bundle. These guides are linked in IHI’s how-to guide for reducing MRSA infection, which can be found at this link: http://www.ihi.org/resources/Pages/Tools/HowtoGuideReduceMRSAInfection.aspx.
CDC findings show decline of MRSA infection rates in healthcare settings
Although MRSA is still a major patient threat, a CDC study published in the Journal of the American Medical Association Internal Medicine showed that invasive (life-threatening) MRSA infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined 54 percent between 2005 and 2011, with 30,800 fewer severe MRSA infections. In addition, the study showed 9,000 fewer deaths in hospital patients in 2011 versus 2005.
This report complements data from the National Healthcare Safety Network that found a 50 percent decrease from 1997 to 2007.
Taken together and with other reports such as the March 2011 CDC Vital Signs article, and a 2013 study showing a decrease in overall central line-associated bloodstream infections, these studies provide evidence that rates of hospital-onset, severe MRSA infections in the United States are falling. While MRSA remains an important public health problem and more remains to be done to further decrease risks of developing these infections, this decrease in healthcare-associated MRSA infections is encouraging.
(Source: U.S. Centers for Disease Control and Prevention: https://www.cdc.gov/mrsa/healthcare/index.html.)