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Staphylococcus aureus: MSSA (Methicillin sensitive Staph aureus)MRSA (Methicillin resistant Staph aureus)

Maureen Spencer, RN,M.Ed., CICInfection Control ManagerNew England Baptist HospitalBoston, Ma. Email: mpspence@nebh.org617 754-5332

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What is Staphylococcus aureus? Staphylococcus

aureus, "staph," are bacteria commonly carried on the skin or in the nose of healthy people.

They are gram positive (purple colored) cocci in clusters on gram stain

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Staph aureus Antibiotic Resistance

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Overview of Antibiotic Resistance Unnecessary antibiotic use. excessive

and unnecessary antibiotic use. Antibiotics in food and water.

Antibiotics in livestock find their way into municipal water systems when the runoff from feedlots contaminates streams and groundwater.

Germ mutation. Antibiotics don't destroy every germ they target. Germs learn to resist others and mutate much more quickly than new drugs can be produced.

Transfer Factors – survival of the fittest – quantum communication

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Past 60 years – Resistance

50-70’s Staph aureus developed Penicillin resistance (blocking enzyme called penicillinase)

70’s Pencillinase resistant antibiotics (methicillin, oxacillin)

Early 1980’s – first cases of MRSA - Methicillin-Resistant Staphylococcus aureus in US

Early 1990’s Vancomycin Resistant Enterococci (VRE)

Early 2000’s CA-MRSA (USA300) Now - V.I.S.A. & V.R.S.A.Vancomycin intermediate and Vanco

resistant strains

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What is MRSA?

MRSA is the term used for a subgroup of bacteria of the Staphylococcus aureus species that are resistant to the usual antibiotics used in the treatment of infections

Not just resistant to Methicillin - often have resistance to many antibiotics traditionally used against S.aureus.

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How Does it Get Resistant?

Presence of the mec gene in the bacteria.

This alters the site at which methicillin binds to kill the organism.

Hence, methicillin and other antibiotics are not able to effectively bind to the bacteria.

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Penicillin Binding Protein 2a MRSA carry a unique protein called

PBP 2a (penicillin-binding protein) on the cell membrane that plays a key role in helping to defend against antibiotics.

Sspecific components of the bacterial cell wall interact with PBP 2a to form a chemical barricade.

New antibiotics will deactivate the protein so they succumb to the antibiotic.

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CA-MRSA and HA-MRSA CA-MRSA Community-acquired

Methicillin resistant Staph aureus Unique microbiologic and genetic properties

compared with HA-MRSA may allow the community strains to spread more easily or cause more skin disease

HA-MRSA Healthcare-acquired Methicillin resistant Staph aureus

Many hospitals now seeing CA-MRSA in healthcare associated infections

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Differences in Strains HA-MRSA

Pulse field gel electrophoresis (PFGE) USA 100, 200 & 500

Less mobile Panton valentine leucocidin

(PVL) gene rare More resistant to antibiotics

CA-MRSA Pulse field gel electrophoresis

(PFGE) USA 300, 400, 1000 &1100

More mobile PVL gene more common

Less resistant to abx Clindamycin resistance

developing in USA 300 strains

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Community-acquired (CA)-MRSA

Susceptible to Clindamycin, Tetracyclines, and Bactrim

Genotypes of CA-MRSA most common in US is clonal cluster ST-8

classified by the CDC as "USA 300." CA-MRSA has a novel methicillin-resistance

cassette element: type SCC mec IV, which has not been found in HA-MRSA isolates

CA-MRSA is more likely to encode for the Panton-Valentine leukocidin (PVL) toxin virulence factor associated with severe necrotizing

pneumonia and skin and soft-tissue infections.

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Severe CA-MRSA – Not PVL Most scientists believed the cause of severe

CA-MRSA infection was Panton-Valentine leukocidin (PVL) toxin released by the organism

However, a study indicating that PVL does not play a major role in CA- MRSA infections was published in 2006

Question: what does????

Reference: J Voyich et al. Is Panton-Valentine leukocidin the major virulence determinant in community-associated methicillin-resistant Staphylococcus aureus disease? The Journal of Infectious Diseases 194(12), 2006

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Phenol Soluble Modulin Protein Newly described proteins in CA-MRSA

members of the phenol-soluble modulin (PSM) protein family

CA-MRSA strains attract and then destroy protective human white blood cells eliminates immune defense

mechanisms production of the protein was typically

higher in CA-MRSA strains Release Panton Valentine Leukocidin

virulence toxin to destroy tissue

Identification of novel cytolytic peptides as key virulence determinants of community-associated MRSA. Wang, Otto et al.Nature Medicine 2007 Nov 11 epub.

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Vancomycin Resistance

In 1996, the first clinical isolate - Japan In June 2002, Vancomycin Resistant Staph

aureus (VRSA) isolated from a intravenous catheter site Michigan resident aged 40 years with

diabetes, peripheral vascular disease, and chronic renal failure

It contained the Van A resistance gene – from VRE

vanA in this VRSA - acquired through exchange of genetic material from the vancomycin-resistant enterococcus also isolated from the swab culture

MMWR July 5, 2002 / 51(26);565-567

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New, lethal MRSA strain emerges……

A new strain of methicillin-resistant Staphylococcus aureus (MRSA) is emerging

Researchers with Henry Ford Hospital say the USA600 strain is partially immune to vancomycin

Half of the USA600-infected patients in the study died within a month, a death rate five times that of those infected with known MRSA strains. (Ordinarily, 11 percent of patients infected with MRSA die within 30 days)

Factor may be age - those with the strain were, on average, 64 years old, as compared with 52 years old for other MRSA-infected people.

Source: Presentation at the Infectious Diseases Society of America, October 29, 2009

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Epidemiology and Populations at Risk

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Epidemiology of MRSA CDC - nearly 19,000 Americans died in 2005 from MRSA,

and about 95,000 were infected. Incidence of invasive MRSA infections in 2005 was 31.8 per

100,000 people. CDC estimate of 94,360 invasive infections in 2005 was

three times as high as the previous estimate of 31,440 hospitalizations for MRSA bacteremias in 2000 derived from discharge coded data rather than

surveillance. CDC investigators projected 18,650 MRSA-related deaths

in 2005 these deaths would exceed the total number of deaths

attributable to human immunodeficiency virus/AIDS in the United States.

Source: Bancroft EA "Antimicrobial Resistance: It's Not Just for Hospitals" JAMA 2007;298:1803-1804.

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MRSA Cases in California Skyrocket

Cases of Methicillin-resistant Staphylococcus aureus infections (MRSA) increased four-fold in California hospitals between 1999 and 2007 to 52,000 cases

Annual number of MRSA deaths are 3.2 times more than estimates for seasonal influenza

The largest increase in MRSA cases came in young to mid-range adult aged patients, who were admitted from home with infections of the skin

Over that eight-year period - patients admitted to hospitals from prisons or jails saw a greater than 2000% increase

Also - 540% increase in newborns with resistant strains and a 120% increase in MRSA admissions from long-term care facilities.

Source: http://www.oshpd.ca.gov/

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Populations at Risk for CA-MRSA

CA-MRSA do not have the usual risk factors associated with nosocomial MRSA.

Populations at greater risk include: children and day care centers persons in correctional facilities military personnel native populations gay men HIV-infected persons Sports: football, basketball, baseball,

wrestlers, fencing, soccer injection drug users homeless

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Pets can carry MRSA German woman - multiple deep abscesses

Strain of drug-resistant MRSA Cured after the family's cat was tested and treated.

Husband and two children carriers of MRSA Treated and tested negative, she still was infected Three apparently healthy cats screened One tested positive for MRSA 4 weeks after the cat was treated with antibiotics, the

woman was also free of MRSA "We conclude that pets should be considered as

possible household reservoirs of MRSA that can cause infection or reinfection in humans”.

Source: March 13 2007, New England Journal of Medicine

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College student in Whatcom County, WA, died from a rare case of MRSA pneumonia,

20 yr old a student at Western Washington University, died MRSA pneumonia, contracted after getting the flu.

MRSA pneumonia - during the 2003-04 influenza season – 15 cases linked to the flu were diagnosed across the country.

Between December 2006 and January 2007, there were 10 reported cases of severe MRSA pneumonia, including six deaths, in previously healthy children and adults in Louisiana and Georgia

Source: February 25, 2008 Seattle Post Intelligencer

2008MRSA pneumoniaCollege Students

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2006-2007: Child Deaths Due to MRSA Between Oct. 1, 2006, and Sept.

30, 2007, the CDC received a total of 73 reports of child deaths due to influenza.

In 22 of these cases, the children were also infected with some form of the staph bug, mostly MRSA

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MRSA Hitting Gay Men

Gay men are 13 times more likely to be infected with a multi-drug-resistant strain of MRSA.

USA300 MRSA clone manifested itself most often in the genitals, buttocks, and perineum, leading to fears it has become a sexually transmitted disease among gay men

Source: January 2008 Annals of Internal Medicine.

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Buffalo teenager participated in sports before complaining of headaches June 13, 2009

Within a few days, the 15-year-old student arrived seriously ill at Women & Children’s Hospital

On admission, he was seriously ill with the flu, as well as co-infected with methicillin-resistant staphylococcus aureus

He died June 28, 2009

Source: Buffalo News, June 23, 2009

H1N1, MRSA can be dangerous combination

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CDC – H1N1 Co-infections Confirmed fatal cases of 2009 pandemic influenza A (H1N1:

Respiratory specimens (i.e., lung, trachea, and large-airway specimens) collected at autopsy

77 patients who had 2009 pandemic influenza A (H1N1) virus infection confirmed before death (N = 41) or after death (N = 36).

Of the 77 confirmed cases evaluated, 22 (28%) had histopathologic, immnohistochemical, and molecular evidence of co-infection with an identified bacteria: 10 cases with S. pneumoniae 7 with S. aureus (9%) 6 with S. pyogenes 2 with Streptococcus mitis 1 with H. influenzae 4 four involved multiple pathogens Median age of the 22 patients was 31 years (range: 2 months--56

years); 11 (50%) were male. The cases were reported from eight states: California, Hawaii, Illinois,

New Jersey, New York, Texas, Utah, and Virginia.

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Dramatic Increase in Ocular MRSA Documented

MRSA ocular infections increased by almost 60% in the first six years of the decade

MRSA as a proportion of all S. aureus isolates increased by 59% from 2000 through 2005

74 of the 141 MRSA isolates (52%) exhibited multidrug resistance.

Source: Miller D, Alfonso ED, "Prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) among ocular MRSA isolates" AAO Meeting 2007; Abstract PO293.

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2007 - More MRSA news Death of a Virginia teenager due to MRSA 17-year-old high school student died after a

weeklong hospitalization from a MRSA infection that spread quickly to his kidneys, liver, lungs, and the muscle around his heart

There were five reported cases of MRSA in the school system that fall

Student's death prompted officials to close 21 schools for a thorough cleaning of the facilities

Source: The New York Times. Oct 15 2007

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MRSA Skin/Soft Tissue NEJM – August 17, 2006 Emergency departments in 11 university-

affiliated August 2004 Researchers enrolled adult patients with

acute, purulent skin and soft-tissue infections MRSA found to be the most common

causative agent S. aureus was isolated from 320 of 422

patients (76%) with skin and soft-tissue infections, with the prevalence of MRSA being 59% overall.

MRSA coverage when antimicrobial therapy is needed for the treatment of skin and soft-tissue infections

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Risk Factors for Acquiring HA-MRSA

Break in natural skin barrier: Surgery – especially implants Bedsores

Invasive devices and procedures Intravenous catheters Urinary catheters Intubation

Overuse of antibiotics Patients with co-morbidities

obesity, diabetes, steroids

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Other Risk Factors Certain factors can put some patients at

higher risk for MRSA including prolonged hospital stay receiving broad-spectrum antibiotics being hospitalized in an intensive care or

burn unit spending time close to other patients with

MRSA carrying MRSA in the nose (colonization)

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Hospital Equipment Contaminated

shared equipment Contaminated hands

of healthcare workers – especially if presence of contact dermatitis and other skin conditions

Contaminated environment

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Colonization vs Infection

and Treatment

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Staph aureus Colonization Colonization: Staph bacteria are present

on or in the body without causing illness. Approximately 25 to 30% of the

population is colonized in the nose with sensitive Staph aureus at a given time NEBH is finding 23% are colonized

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MRSA Colonization

~2-10% general population colonized with MRSA NEBH is finding 5% are colonized

~0.9%-13.2% healthcare workers are colonized with MRSA

Higher rates in prison (~10%), among drug users, day care centers, professional sports teams and high schools

Once colonized for more than three months, it becomes much more difficult to clear

Rate of MRSA and MSSA in Surgeons and Residents

Schwarzkopf, et al: MRSA and MSSA in nares of physicians at the Hospital for Joint Diseases in New York. Ran Schwarzkopf, Richelle C. Takemoto, Igor Immerman, James D. Slover, and Joseph A. Bosco Prevalence of

Staphylococcus aureus Colonization in Orthopaedic Surgeons and Their Patients: A Prospective Cohort Controlled Study J Bone Joint Surg Am. 2010;92:1815-1819

74 surgeons and 61 residents screened

Surgeons: MRSA 2.7% and MSSA 23.3% Residents: MRSA 0% and MSSA 59%

Control Group of Patients: MRSA 2.17% and MSSA 35.7%

Previous studies - 3% of MRSA outbreaks are caused by asymptomatic colonized health-care workers.

Vonberg RP, Stamm-Balderjahn S, Hansen S, Zuschneid I, Ruden H, Behnke M, Gastmeier P. How often do asymptomatic healthcare workers cause methicillin-resistant Staphylococcus aureus outbreaks? A systematic evaluation. Infect Control Hosp Epidemiol. 2006;27:1123-7

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Higher Rate of Infection if Colonized

Colonized patients have a 30-60% risk of infection following colonization.

Host factors influence the onset of infection. Immunosuppression, steroids, diabetes,

invasive devices and procedures, surgery, skin breakdown, pneumonia, obesity, hematoma, etc.

Reference: Graham P, Lin S, Larson E (2006). "A U.S. population-based survey of Staphylococcus aureus colonization". Ann Intern Med 144 (5): 318-25.

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Infection with MRSA Infection occurs when the

staph bacteria interact with the host and there is a battle that ensues pneumonia, skin lesions, and

wound infection. Signs of infection may fever,

chills, purulent excretions or secretions, and increased white blood cell count.

Pus represents dead WBC and Bacteria

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CA-MRSA – “Spider Bite”

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Treatment of Soft Tissue Infections

Boils or abscesses - incision and drainage Antibiotic treatment - guided by the

susceptibility profile of the organism Add MRSA coverage to broad spectrum

antimicrobial therapy until sensitivities available

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Antimicrobial Agents for Treating MRSA

Systemic/PO Topical DecolonizationVancomycin Chlorhexidine body wasClindamycin 2% Mupirocin ointmentBactrim (Bactroban)Rifampin poZyvox (Linezolid)IV or poDaptomycin

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New Antibiotics for MRSA

ETX1153 (e-Therapeutics plc) found to be highly potent against the most common epidemic strain of MRSA in the UK (EMRSA-16) and effective against V.I.S.A. strains

Platensimycin (Merck) blocks the enzymes that produce fatty acids - essential for the construction of the membranes of bacteria – still under investigation

Daptomycin (Cubist) can be used in combination regimens when infection with a gram-negative or anaerobic organism is either suspected or confirmed. This drug's action is rapidly bactericidal.

Linezolid (Zyvox) is active against gram-positive organisms, such as VRE and MRSA

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Transmission

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MRSA Transmission

MRSA is transmitted by:

Direct Contact with body fluids, skin, secretions, excretions – during patient care and procedures, during sports, in close quarters

Indirect contact by contaminated inanimate objects – such as BP cuffs, oximeter sensors, thermometers, environment, contaminated hands, stethoscopes, otoscopes, commodes, bedside curtains, towels, locker rooms, prisons, toys in daycare

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Outbreaks in Sports Teams An outbreak of methicillin resistant Staphylococcus

aureus infection in a rugby football team. British Journal of Sports Medicine, Vol 32, Issue 2 153-154, 1998

Methicillin-Resistant Staphylococcus aureus in a High School Wrestling Team and the Surrounding Community Arch Intern Med. 1998;158:895-899.

Cutaneous Community-acquired Methicillin-resistant Staphylococcus aureus Infection in Participants of Athletic Activities. Southern Medical Journal. 98(6):596-602, June 2005.

National Athletic Trainers' Association, Inc.Outbreak of Community-Acquired Methicillin-Resistant Staphylococcus aureus Skin Infections Among a Collegiate Football Team. J Athl Train. 2006; 41(2): 141–145.

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CA-MRSA in Sports Teams

Washington Redskins Toronto Blue Jays San Francisco Giants Celtics Basketball Miami Dolphins Dutch Soccer Team Many high school football

teams

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Sources for Transmission Hands number one! Close contact sports Cuts, abrasions and bruises

– wound care Bandages, soiled towels Locker rooms, Jacuzzi, hot

tub Benches, chairs, exercise

equipment Sharing items: towels,

razors, drinks, weights, bikes, etc.

Transmission: Hands Most CommonWhere have your hands been?

Prevention: Wash and SanitizeAlcohol Foam, Liquid and Hand Wipes

At NEBH all patients admitted receive package of alcohol wipes

In each patient room, outside rooms, cafeteria and other areas

Wash hands often – before eating, before leaving work, after contamination, after bathroom

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Why so much MRSA in young people now?

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Could it be due to the Increase in Sugar Consumption

48 grams: recommended daily limit of grams of sugar.That’s about all the liver can handle

189.5grams: the number of grams of sugar the average American consumes each day

152 lbs: the number of lbs of sugar the average American consumes each year

(in 1980 it was only 3 lbs per American)

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High-Calorie Beverages

Nationwide Food Consumption Surveys (1965, 1977 to 1978) and the National Health and Nutrition Surveys (1988 to 1994, 1999 to 2002) quantify both trends and patterns in beverage consumption

among 46,576 American adults 19 and older. For six broad beverage groups:

total energy intake percent consuming such beverages calories per consumer determined total intake in fluid ounces for each beverage

group during each exam year.

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High-Calorie Beverages

From 1965 through 2002 daily per capita intake of calories from

beverages increased 94% average of 21% of daily energy intake or an

additional 222 calories from all beverages daily among U.S. adults.

Article: Duffey K, Popkin B, "Shifts in patterns and consumption of beverages between 1965 and 2002" Obesity 2007.

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Sugar Depresses Immunity

Excess sugar depresses immunity

Consuming 75 to 100 grams of a sugar solution (about 20 teaspoons of sugar, or the amount that is contained in two average 12-ounce sodas) can suppress the body's immune responses.

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Sugar and Immune Cells

Sugar suppresses many immune cells, particularly macrophages and NK cells.

1. Sanchez, A., et al. Role of Sugars in Human Neutrophilic Phagocytosis, American Journal of Clinical Nutrition. Nov 1973;261:1180_1184. Bernstein, J., al. Depression of Lymphocyte Transformation Following Oral Glucose Ingestion. American Journal of Clinical Nutrition.1997;30:613

2. Ringsdorf, W., Cheraskin, E. and Ramsay R. Sucrose, Neutrophilic Phagocytosis and Resistance to Disease, Dental Survey. 1976;52(12):46_48.

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Remember: November 2007

Phenol-soluble modulin (PSM) protein family attract and then destroy protective human white blood cells eliminates immune defense

mechanisms production of the protein was typically

higher in CA-MRSA strains known for severe virulence

Then release Panton Valentine Leukocidin virulence toxin to destroy tissue

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Sources in Hospital Settings

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MRSA Patient Rooms

Brigham and Women’s Hospital - environmental contamination and the accompanying relative odds of infection acquisition.

Newly-admitted patients housed in a room in which the most recent occupant was MRSA-positive or VRE-positive, “significantly increased the odds of acquisition” for a MRSA-related or VRE-related infection.

MRSA room 3.9 percent of new patients acquired an infection.

VRE room 4.5 percent acquired a VRE infection.

Huang SS, Datta R, Platt R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med. 2006 Oct 9;166(18):1945-51.

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Computers on Wheels, Dynamaps, Rollboards, IV Poles, Phones

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Environmental Surfaces

Japanese study - MRSA contamination on environmental surfaces:

40.2% bed linen 22.4% bedside tables 20.9% bed siderails 2.7% door handles   29.6% from the palm of 98 patients Concluded MRSA in the patient’s palms had the most marked

influence on MRSA contamination of their surrounding environmental surfaces.7

Oie S, Suenaga S, Sawa A, Kamiya A. Association between Isolation Sites of Methicillin-Resistant Staphylococcus aureus (MRSA) in Patients with MRSA-Positive Body Sites and MRSA Contamination in Their Surrounding Environmental Surfaces. Jpn J Infect Dis. 2007 Nov;60(6):367-9.

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GI Colonization with MRSA Hospital of Saint Raphael, New Haven, Conn. found

that patients with diarrheal stools and heavy GI colonization with MRSA are associated with significantly greater environmental MRSA contamination.

The items most commonly contaminated in this instance are bedside rails, blood pressure cuffs, television remote controls, and toilet seats

Boyce JM, Havill NL, Otter JA, Adams NM. Widespread environmental contamination associated with patients with diarrhea and methicillinresistant Staphylococcus aureus colonization of the gastrointestinal tract. Infect Control Hosp Epidemiol. 2007 Oct;28(10):1142-7.

MRSA contamination in precaution rooms

Ref: Boyce, Infec Cont Hosp Epid 197770% of rooms had environmental contamination when the patient was colonized or infected 42% of nurses’ gloves cultured were contaminated after touching environmental surfaces WITHOUT touching the patient!

Ref: Boyce, et. Al. SHEA 1998 AbstractResults: 14 (40%) of 35 HCWs gowns were culture + for MRSA on exiting room. Clothing underneath was negative. 11 (69%) of 16 HCWs wearing freshly laundered lab coats had detectable contamination. 3 of 11 developed positive hand cx after touching the coat.

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Environment of Care

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Clean Patient Care Equipment

• Outsource the annual cleaning of large pieces of equipment

• Ultrasonic scrub - movable carts, tables, poles and equipment

• From OR, radiology and nursing units

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Housekeeping

Cleaning schedules for departments in Patient Care Services

Single-use micro fiber mop instead of buckets – OR and patient rooms

EVS daily check sheet for room cleaning and precaution cases

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Disinfectants and Curtains

Silver Disinfectant Spray that kills organisms up to 24 hrs on surfaces (Agion Silverclene 24) Pre-surgery unit PACU Radiology ACU

Routine cubicle-curtain change policy – after each precaution case

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MRSA and MSSA Eradication Program

Institutional Prescreening for Detection and Eradication of Methicillin-Resistant Staphylococcus aureus in Patients Undergoing Elective Orthopaedic Surgery J Bone Joint Surg Am. 2010;92:1820-1826David H. Kim, Maureen Spencer, Susan M. Davidson, Ling Li, Jeremy D. Shaw, Diane Gulczynski, David J. Hunter, Juli F. Martha, Gerald B. Miley, Stephen J. Parazin, Pamela Dejoie, and John C. Richmond

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February 2006 Anonymous Nares Cultures

133 patients Obtained nasal culturesPurpose: to determine pre-opMRSA and MSSA colonization

Results:38 – Staph aureus (29%)

*5 - MRSA ( 4%)*all undiagnosed and no precautions used in OR or postop nursing unit

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Treatment Protocol

•5-day application of intranasal 2% mupirocin - applied twice daily - for MRSA and Staph aureus positive patients.

•Daily body wash with chlorhexidine

•MRSA Patients - Vancomycin surgical prophylaxis

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What were the outcomes?

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MRSA/MSSA Eradication Results

From July 17, 2006 through July 2010

25,025 patients screened 5770 (23%) positive for Staph aureus 1027 ( 4%) positive for MRSA

Repeat nasal screens on MRSA patients revealed 78% eradication

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Time Period Inpatient surgeries # Surgical Infections % MRSA/MSSAFY06

10/01/05-07/16/06 5293* 24 0.45%

FY0707/17/06-09/30/07 7019 6 0.08%

FY08 10/01/07-09/30/08 6323 7 0.11%

FY09 10/01/08-09/30/09 6364 11 0.17%

FY10 10/01/10-07/31/10 5397 8 0.15%

*historical controls

% MRSA and Staph aureus SSI

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Time Period Inpatient surgeries # MRSA SSI MRSA % #Screen + (%SSI) FY06

10/01/05-07/16/06 5293* 10 (NA) 0.19% NA

FY0707/17/06-09/30/07 7019 3 (3+) 0.04% 3/ 309 (0.97%)

FY08 10/01/07-09/30/08 6245 4 (2+) 0.06% 2/242 (0.83%)

FY09 10/01/08-09/30/09 6364 6* (2+) 0.09% 2/234 (0.85%)

FY10 10/01/10-07/31/10 5397 0 0.00% 0/208 (0%)

*isolates have been sent for pulse field gel electrophoresis 5 of the 6 isolates were available for PFGE and were not related genetically

% MRSA SSI in MRSA + Screened Patients

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Time Period Inpatient surgeries # MSSA SSI MSSA % #Screen + (%SSI) Historical controls

FY06 10/01/05-07/16/06 5293* 14 (NA) 0.26% NA

Screened PatientsFY0707/17/06-09/30/07 7019 3 (3+) 0.04% 3/1588 (0.19%)

FY08 10/01/07-09/30/08 6245 3 (1+) 0.05% 1/ 1422 (0.07%)

FY09 10/01/08-08/31/09 6364 5 (3+) 0.08% 3/1403 (0.21%)

FY10 10/01/10-07/31/10 5397 8 (4+) 0.15% 4/1232 (0.32%)

% Staph aureus (MSSA) SSI in Screen + Patients

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Reduction in Number of SSI and% Due to MRSA and MSSA

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In Conclusion MRSA is increasing in the community and in

hospitals Overuse of antibiotics has created some of the

problem Resistance among the species is a factor in

resistance Close quarters, equipment, environments and

contaminated hands are sources for transmission Limited antibiotics available to treat MRSA Pre-surgical screening program is an effective

method of detection for treatment and precautions

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Thank You M. R. S. A.

Make Resistance Stay Away

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How Does it Get Resistant?

This resistance to methicillin is due to the presence of the mec gene in the bacteria.

This alters the site at which methicillin binds to kill the organism.

Hence, methicillin is not able to effectively bind to the bacteria.