Protocols, equipment prevent spread of MRSA

Infection control training should be ongoing

Although standard precautions are taught to home health employees, the importance of precautions rises with the increasing number of patients coming to home care with multidrug-resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus (MRSA).

To combat the spread of MRSA or any other infection from one patient home to another or from a patient to a staff member's family, the employees at Northwest Community Home Care in Arlington Heights, IL, follow very specific infection control protocols, says Judie Truelsen, RN, BSN, interim co-director of the agency.

"Each clinician has a personal protection pack that includes gowns, gloves, masks, an eye shield, and booties," she says. "If an employee knows that the patient requires this level of infection control precautions, they are all prepared," she explains.

Even with patients who may not require employees to wear gowns and masks, nurses always follow a specific protocol to prevent transmission of infection from one patient to another through contact with shared equipment, Truelsen says. "Nurses carry a nonpermeable barrier, a piece of plastic, to place on the surface on which they are placing their nurses' bags," she says. "They also place a barrier on the surface that they might place their stethoscope or other equipment to prevent picking up an organism from the table or other surface."

Before the nurse removes an item from the bag, hands are cleaned with an antibacterial wipe, and any time the nurse reaches back into the bag, hands are cleaned with a wipe, says Truelsen. Before any item, such as a stethoscope, is placed back into the bag, it is wiped with an antibacterial wipe as well, she adds.

Nurses' bags can be a source of transmission, so it is important to pay attention to infection control protocols related to the bags, says Irena L. Kenneley, PhD, APRN-BC, CIC, professor at Case Western University in Cleveland and lead investigator of a study that examined the role of home health nurses' bags in infection control. Even with good infection control precautions, MDROs present additional challenges that require extra precautionary steps, Kenneley suggests. "Enhanced environmental cleaning is vital, stressing the use of dedicated equipment, and leaving the nurses' bag out of the patients' homes," she says.

When identifying what equipment you will leave in the home, don't just focus on items such as pulse oximeters or stethoscopes, suggests Marcia R. Patrick, RN, MSN, CIC, director of infection control for Multicare Health Systems in Tacoma, WA. "The gait belt used by a physical therapist can transmit organisms that live on clothing or other surfaces the belt may touch," she explains. If it is not possible to leave some equipment in the patient's home, develop a process to disinfect the equipment before using it with another patient, Patrick suggests. "MRSA can live on the surface of the skin, so even blood pressure cuffs might transmit the organism," Patrick says.

"Don't forget items such as rolls of bandage tape, bandage scissors, and other supplies that many nurses will just throw back into their bags," she says. "Whenever possible, leave supplies in the patient's home to be used only for that patient."

Kenneley says, "Educating the clinical importance of MRSA, and in fact, all multidrug-resistant organisms [MDROs], to clinical staff, patients, informal caregivers, and families is a high priority." She suggests that educational emphasis should begin with the following facts:

• Options for treatment are limited.

• MDROs have been associated with increased lengths of stay, increased cost, and increased morbidity and mortality.

• Outcomes are worse patients with resistant organisms that include not only MRSA, but also vancomycin-resistant Enterococcus (VRE), Pseudomonas, Acinetobacter, Enterobacter, E. coli, and Klebsiella pneumoniae.

"A review of standard precautions and contact precautions is also important, along with stressing appropriate hand washing," Kenneley adds. Patients and all family members should be included in the teaching, she suggests.

Patrick says, "We include infection control practices in orientation, but we also have supervisors go on visits with the field staff to observe their techniques." The review of infection control practices is part of every employee's annual assessment, she adds.