Mrsa Pp In Word

MRSABy Danielle GillPharmD CandidateUC 2011

Methicillin-Resistant Staphylococcus aureusBackgroundDiscovered in 1961 in a strain of Staph aureus in a hospital in the United KingdomResistant to broad spectrum antibiotics (penicillin, methicillin, and cephalosporins)Through plasmids, can infect other strains of regular staph to create resistant strains (more MRSA and VRE)Many healthy individuals harbor MRSA and show no illness (can pass on)

MRSA… continuedMRSA is a skin soft tissue infection that can infiltrate respiratory tract, open wounds, IV cathetersImmunocompromised patients are at highest riskIn 2007, CDC said MRSA treatment cases doubled from 1999-2005MRSA is responsible for 94,360 serious infections and 18,650 hospital stay related deaths in 2005These results were adjusted to consider the underlying disease of the pt.

MRSA Symptoms (moderate to severe)Red BumpsSkin lesionsBoilsDeep, painful abscessesImpetigoPneumoniaLife threatening infections (bones, surgical wounds, bloodstream, heart, lungs, and joints)EndocarditisToxic shock syndromeDEATH

MRSA… continuedPatients with MRSA had both 3X length of hospital stay and costPatients also experienced 5X risk for in hospital deathCosgrove et. al. concluded that MRSA is associated with increased mortality compared with methicillin susceptible staphylococcus aureusWhere is MRSA located in a hospital setting?

Research at Plateau Medical Hospital, Oak Hill, WV9/11/08Testing SitesDrug Cart in PharmacyPatient Transfer WheelchairVending Machine Buttons1st Floor Medical Room LocksDrug Counter in Medical Preparation room (1st floor)Keyboards on 1st Floor Pyxis MachinesCounter in ER lobbyPayment Clerk WindowNurses Stethoscope HeadMedical Preparation Counter in ICUNurses Computer Keyboard/Mouse in ICUNurses Station 1st FloorStairwell RailingsAnesthesia Boxes in PharmacyWalls and Gloves in Isolator Chamber Room

ResultsMRSA FoundICUKeyboards of Pyxis MachinesMedication Preparation Counter in ICU

SuggestionsSpoke with Nursing, Housekeeping, and Pharmacy for resolutionsImmediatelyClean the ICU with ONLY ANTI-MRSA agents!!!(Switched from Virex II to Virex TB)Change out the Pyxis plastic Keyboard Covers

Re-Test on 10/02/08Restricted to Plateau Medical ICUTesting SitesPatients Bed Table 2 (just cleaned with anti-MRSA)Medication Preparation CounterPatients Bedside Table 1 (patient occupancy)Medication Preparation Counter in Medication Preparation RoomPyxis Machines (keyboards)Pyxis Machines (screens)Patients Bed rail (patient occupancy)IV drip dispenser

ResultsPatients Bed Table (just cleaned)Staphylococcus*Patients Bedside Table 1 (patient occupancy)Staphylococcus aureusMedication Preparation Counter by PyxisStaphylococcus aureus

What does this mean?Positive Steps toward MRSA control in the hospital :Loop Holes:Medication Counter in the Medication Preparation Room (by Pyxis) is cleaned 1 time/dayHousekeeping can’t clean nursing areasSmall ICU, easier transmission of infections

MRSA = “BAD APPLE”Only 5% of medical harm is caused by incompetent or poorly intended care, meaning 95 % of errors that cause harm involve conscientious, competent individuals trying hard to achieve a desired outcome.Barbie Covelli, RPhCAMC Pharmacy TJC Coordinator

CommunicationRadiologyLaboratoryMaterials ManagementAdministrationNursingPharmacyMaintenanceDoctorsHousekeepingAdmissionsMedical RecordsDietaryPhysical TherapySurgeryRespiratory TherapyBusiness OfficeVolunteersAdministration

Current MRSA control…Listed on patients chartIsolation (if available)Pharmacy knowsRooms are cleaned after every patient leavesPossible problems: Do not know whether pts have MRSA Same nurses/doctors Housekeeping Laboratory workers Dietary

Short Term StrategiesHand washing (easiest and cheapest) before and after touching patients (with or without gloves)Switch out plastic keyboard covers (when MRSA patient leaves)Put anti-MRSA wipes by the nurses stations and any medication preparation tables (in store)Alert Infection Control of all MRSA patients

Long Term StrategiesPeriodic MRSA testingComputer keyboard covers on all computers and change regularlyMouse covers in ICUStethoscope covers (color coded)Autoclave/ disposable mats used in medication preparation Screen all patients coming in for MRSA (standing MRSA order) CA MRSA can’t controlEducational seminars (TJC, University speakers, other medical institutions)

Some Good ExamplesScreening has been found to be effective in reducing the number of MRSA at Veterans Affairs Hospital in Pittsburgh, PA, Davis Memorial Hospital, and in hospitals in Denmark, Finland, and NetherlandsIn 2006 CDC stopped short of recommending screening, but they did want more research

ConclusionMRSA is everywhere we need to stop fearing it and take control Small hospital, we should be able to control infection and make a model for other hospitals We can make a difference in the lives of our patients!

Follow Up at Plateau MedicalChecked up in 3 weeks, found that none of the suggestions were taken into consideration.Decided to switch focus from everyone helping to the infection control nurse taking charge.Spoke with the CEO, Infection Control Nurse, and Housekeeping - will require pts who meet high risk to be screened.

ResourcesCDC.gov [homepage on the Internet]. Atlanta, GA: Centers for Disease Control and Prevention: [updated 2008 October; cited 2008 October 20]. Available from: www.cdc.gov. Covelli, Barbie. Developing a Comprehensive Patient Safety Program. Patient Safety Lecture. University of Charleston School of Pharmacy Spring 2008. Hartel, Paul. The Changing Biology and Epidemiology of Common Pathogens: Methicillin-resistant Staphylococcus aureus and Clostridium difficile. Proceedings of Davis Memorial Hospital Conference on MRSA/C-diff; Fall 2008; Elkins, WV: pg 1-5.

Mrsa Pp In Word

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