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ACTIVE DETECTION AND ISOLATION FOR MRSA IN MAINE

Humans can have MRSA germs two ways. Some of us with healthy immune systems can carry MRSA in our noses or other parts of our bodies and have absolutely no symptoms. The first time we are aware of it is if a MRSA screening culture is done, perhaps before a hospital admission. This carriage of MRSA is called colonization. This form of MRSA is usually found when screening cultures are done and before there are any signs or symptoms of actual infection. Although this form of MRSA is benign, it increases a person’s risk of actual infection about 7 times over.
The second way we can have MRSA is during actual MRSA infection with the accompanying symptoms. MRSA can affect skin, bones, hearts, lungs, joints or any other part of the body. Infection usually occurs when the patients is vulnerable because of certain risk factors and/or because of inadequate infection prevention in hospital settings. Certain lifestyles can make one more vulnerable to Community Acquired MRSA, but it is Hospital acquired MRSA that I am addressing here.
The signs of infection are according to what part of the body it affects. If it is Respiratory MRSA, like my own father contracted in his hospital, the symptoms can be fever, profound weakness, loss of appetite, somnolence, and coughing with sputum. If the infection is in a wound, the symptoms can be fever, swelling or redness of the wound, drainage from the wound, pain, profound weakness, and loss of appetite. Sometimes if the infection is inside the body because it has been sewn up inside there during surgery, the symptoms are extreme pain, malaise, and fever. This is called MRSA infection. These infections are found by “clinical cultures”. This means the culture is done as a diagnostic measure, AFTER he patient already has an infection.
My proposal for Maine LD 1038 was written with the goal of getting Active Detection and Isolation in all hospitals in the State of Maine. This means each and every hospital would have a standard approach to MRSA prevention that starts with MRSA screening of high risk patients.
First step is having a list of high risk patients. There is a pretty standard list of patients who are considered to be at high risk for MRSA. All of those high risk patients will be screened on or just before admission for MRSA carriage or infection. The purpose of screening is to find all colonized and /or infected patients on admission. Both colonized and infected MRSA patients can be a reservoir of MRSA germs and can spread disease. These patients can also spread MRSA from their colonized body part into a surgical site, a central IV line, up a urinary catheter, or into their own lungs,
Second step is to isolate those patients who test positive for MRSA. This step is to keep infected or colonized patients separate from patients who do not carry the MRSA germ.
Third step is to initiate precautions to include hand washing, gloves, gowns and masks as necessary before and between patient contacts.
Forth step is to attempt decolonization for patients who will undergo certain procedures that are known to be risky for acquisition of MRSA infections, such as joint replacements, cardiac surgery, or central line placement. Also, an admission to certain departments in hospital puts patients and higher risk.
In addition to the above steps, decontamination of the patient’s immediate area is necessary.
And to strengthen and enforce these steps, we need concise, standard and easy to understand education for every single level of staff who are involved in direct patient care and contact. Compliance with and standardization of these steps is not possible without proper education and an attempt to change the culture in hospitals
My meaning of culture change is one of having the goal be PREVENTION of MRSA rather than REACTION to MRSA. Also, when this approach is proven successful, the staff will develop an “ownership” of the process. Just think how wonderful it will be to be able to tell Maine Consumers that we have dropped the numbers of infections by 30% or 50% or even more in just one year or two.
It can happen. It MUST happen. We know the current approach is not working. About 5% of infections…central line infections…. has decreased. That was old news from 2007 that was just recently brought out for bragging rights by the CDC. It is really just a small number of MRSA infections. All reductions of MRSA infections are desirable, but our goal is to have zero infections, in as short a time as possible.

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