Danae Bixler, MD, MPHInfectious Disease Epidemiology Program

West Virginia Bureau for Public HealthWest Virginia Department of Health and Human

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ObjectivesObjectivesParticipants should understand

Staphylococcus aureusMRSASurveillance (documentation via line list)Diagnosis and treatmentPreventionOutbreak management guidanceEducational materials

February 2009 2West Virginia Department of Health and Human

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February 2009 3West Virginia Department of Health and Human Resources

Staphylococcus aureusStaphylococcus aureusCommon skin organism

~ 1 in 3 persons are … carriersMild skin infections commonSevere, life threatening infections

Very youngVery oldChronic conditions

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Methicillin resistant Methicillin resistant Staphylococcus aureusStaphylococcus aureusS. aureus resistant to most commonly used effective

antibioticsThe most common cause of skin infections:

ChildrenYoung adults

Severe, life-threatening infections:Very youngVery oldChronic conditions

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Contaminated Surfacesand Shared Items

Frequent Contact

Cleanliness

Crowding

Compromised Skin

Antimicrobial Use

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Screening and SurveillanceScreening and SurveillanceFederal Bureau of Prisons Clinical Practice Guidelines, 2005

IntakeRecently hospitalized inmatesInmates at risk during routine medical evaluation

DiabetesDialysisSkin compromise

Monitor bacterial culture resultsObservations by correctional workersDocument ongoing surveillance (line list)

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Diagnosis and TreatmentDiagnosis and Treatment Federal Bureau of Prisons Clinical Practice Guidelines, 2005

DiagnosisSkin examinationCulture

TreatmentWarm soaksIncision and drainageRemove foreign devicesAntibiotic therapy

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Primary PreventionPrimary Prevention

(prevention activities BEFORE you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005

EducationCorrectional standard precautions

Regular hand hygieneAssume all body fluids are infectious / use gloves:

Blood Feces Urine Saliva / mucous / sputum Wound drainage

Safe disposal of sharpsSafe placement of inmates

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Primary Prevention (2)Primary Prevention (2) (prevention activities BEFORE you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005

Hand hygiene programOversightTraining

SanitationRoutine cleaningTerminal cleaningSanitation inspections

Antibiotic prescribing practices

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Secondary PreventionSecondary Prevention(prevention activities AFTER you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005

Correctional contact precautionsHand hygiene before and after EVERY contactSingle cell if drainage cannot be containedPPE (gloves / gown ) for contact with contaminated items

or blood/body fluidsSanitation

Daily and terminal cleaning Safe disposal of sharps and bandages

Transfers Contain drainage Inform escort officers and receiving institution clinical director

February 2009 11West Virginia Department of Health and Human

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Secondary PreventionSecondary Prevention(prevention activities AFTER you get a case) Federal Bureau of Prisons Clinical Practice Guidelines, 2005

SurveillanceInterview index case

Risk factors Contacts

Evaluate contactsHistory of food handling?Increased surveillance at routine visitsBacterial cultures

Document (line list)

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Outbreak ManagementOutbreak Management Federal Bureau of Prisons Clinical Practice Guidelines, 2005Laboratory confirmation – save isolatesTracking – line listContainmentTransfers

Evaluate each inmate before transferInfection control

Hand hygieneIntensified correctional contact precautionsIntensified inspections

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Outbreak Management (2)Outbreak Management (2) Federal Bureau of Prisons Clinical Practice Guidelines, 2005

SurveillanceCommon source

Evaluate all potentially exposed inmatesSustained or involving multiple inmates

Consider targeting high risk inmatesDecolonization (caution)Education

InmatesCorrections staffHealth care personnel

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ConclusionsConclusionsCornerstones of prevention

Hand hygieneCorrectional standard precautionsSurveillance (document on your line list)

Cornerstones of controlHand hygieneCorrectional standard and contact precautionsSurveillance (document on your line list)

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