Sheila Dunn, D.A. and Sarah E. Alholm, M.A.S.
This is the second in a series of Featured Articles that cover MRSA infections in the medical setting. In this article, contributing authors, Sheila Dunn, D.A. and Sarah Alholm, M.A.S., explain how to prevent MRSA transmission. Be sure to read the first article in the series: A Guide to MRSA Infections for Healthcare Workers: Part I - MRSA Basics.
How Is MRSA Transmitted?
Staphylococcus can spread from one part of the body to another. It can also be spread from person to person with direct contact with skin or by direct contact with contaminated environments or equipment.
The main mode of transmission of MRSA is via hands (especially healthcare workers' hands), which may become contaminated by contact with:
- Colonized or infected patients,
- Colonized or infected body sites of the personnel themselves, or
- Devices, items, or environmental surfaces contaminated with body fluids containing MRSA.
Other factors contributing to transmission in a community setting include skin to-skin contact, crowded conditions, and poor hygiene.
What About Patient Contact?
When possible, schedule any patient who is known to have MRSA as the last appointment of the day. Patients can be cared for safely, however “Contact Precautions” are necessary to prevent cross contamination to other patients and healthcare workers:
- Wear gloves when touching blood, body fluids, secretions, excretions, and contaminated items. During the course of providing care for a patient, change gloves after having contact with infective material that may contain high concentrations of MRSA (e.g., non-intact skin, fecal material and wound drainage, and mucous membranes). Because environmental surfaces may be contaminated, don gloves before or upon entry to the patient area. Remove gloves before leaving the patient area and wash hands immediately with an antimicrobial agent. Dry hands completely. After glove removal and hand washing, ensure that hands do not touch potentially contaminated environmental surfaces or items in the patient's room to avoid transfer of microorganisms to other patients and environments.
- Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.
- Wear a gown to protect skin and prevent soiling of clothes during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions or cause soiling of clothing. Examples are: patient incontinence, diarrhea, ileostomy, colostomy, or wound drainage not contained by a dressing. Don the gown upon entry to the patient area and remove it before leaving.
- Disinfect reusable patient-care equipment or discard single-use items that are soiled with blood, body fluids, secretions, and excretions. An appropriate disinfectant is a 1:10 solution of ordinary household bleach, made up fresh daily or an equivalent commercial product.
- Handle, transport, and process used linen soiled with blood, body fluids, secretions, and excretions in a biohazardous waste container.
Patients Without Signs of Active Infection
Individuals who become colonized with MRSA tend to remain colonized for months or even years. Those colonized with MRSA serve as reservoirs for MRSA and transmit the bacteria to others, just as those actively infected with MRSA.
This is why medical facilities choose to treat patients colonized with MRSA as potentially contagious. Consider flagging patient records to ensure contact precautions resume when patients previously treated for MRSA infections return to your facility. Consider obtaining nasal cultures for MRSA screening to determine whether former MRSA patients are still colonized. Discontinue contact precautions when three or more surveillance cultures are negative.
Cleaning Exam Rooms after Treating a MRSA Patient
Clean the exam room using a hospital-level disinfectant following the manufacturer's instructions. Focus on obviously soiled surfaces and frequently touched surfaces (e.g., exam table, switches, doorknobs). There is no need to routinely clean and disinfect walls, window drapes, and other vertical surfaces unless visibly soiled. Also, don’t fog the room with a disinfectant. Discard solutions used for cleaning and disinfection after use. Consider using disposable patient care items (blood pressure cuffs, tourniquets) for a known MRSA patient.
Staff Training
Provide education and training on risks and prevention of MRSA transmission during orientation and periodic educational updates for healthcare personnel. Include information on organizational experience with resistant bacteria and prevention strategies.
In healthcare facilities without epidemiologic expertise, such as freestanding ambulatory centers, the CDC suggests identifying experts who can provide consultation as needed.
What About Healthcare Workers Infected with MRSA?
Nurses and other healthcare workers who do not have active infections or who have wounds that can be covered and controlled with dressings are permitted to work. Colonization alone does not prevent healthcare workers from working unless they are linked to transmission of an infection. The Healthcare Infection Control Practices Advisory Committee (HICPAC) guidance recommends obtaining cultures of healthcare personnel only when there is epidemiologic evidence linking the healthcare staff member to ongoing transmission.
What’s the Bottom Line?
Be proactive. The steps to protect against MRSA are essentially the same as those used to protect yourself against other infections. Ensure your facility has effective staff protection and infection control measures in place.
About the authors:
Dr. Sheila Dunn, president and CEO of Quality America, Inc., holds a doctoral degree in clinical laboratory science. Sarah Alholm, an occupational safety professional, is the OSHA product manager at Quality America.