Check out this guide to TB, MRSA, VRE

The spread of several infectious diseases that have become drug-resistant has alarmed the health care community and has threatened the safety of subacute staff and patients.

Three of the most notorious pathogens are Mycobacterium tuberculosis (TB), vancomycin-resistant Enterococcus (VRE), and methicillin-resistant Staphylococcus aureus (MRSA).

The Centers for Disease Control and Prevention (CDC) in Atlanta, the Occupational Safety and Health Administration (OSHA) in Washington, DC, and assorted experts have made recommendations about how staff can prevent the spread of these diseases. Here are some definitions of the diseases and tips on preventing their spread:

Tuberculosis: The CDC shows a steady decline of the TB infection rate from 1975 to about 1989, and then the rate climbed slightly before again declining from 1993-1994.1

The CDC describes an infectious case of TB as one in which there is the following:2

• isolation of M. tuberculosis from a clinical specimen;

• demonstration of M. tuberculosis from a clinical specimen by nucleic acid amplification test;

• demonstration of acid-fast bacilli in a clinical specimen when a culture has not been or cannot be obtained.

The CDC also notes that cases should not be counted twice in any consecutive 12-month period, but cases in which patients had previously been verified as having the disease should be reported again if the patients were discharged from treatment.2

The CDC and other health care experts recommend home care agencies take the following precautions:

— Identify TB patients and refer them to providers who can give their employees respiratory protection, or provide adequate respirator protection for employees with a program that includes staff education, annual training, and testing and fitting of respirators.

— Determine your agency’s risk level based on its region and population groups.3

OSHA recommends health care employees use an approved respirator in one of these three circumstances:

— upon entering a room of patients who are suspected or confirmed to be infected with TB;

— when performing an aerosolized medication treatment, bronchoscopy, sputum induction, endotracheal intubation, and suctioning procedures on a person who has a suspected or confirmed case of TB;

— while transporting, in a closed vehicle, a patient who is suspected or confirmed to have TB.

VRE: There has been a rise of VRE infection in hospitals and long-term care facilities in recent years. The CDC reported that VRE has increased from 0.3% to 7.9% between 1989 and 1993.4

The virus is difficult to treat, and it involves bacteria that cause illness in the elderly and in people who have weakened immune systems. Healthy people can be carriers without coming down with the disease.

Subacute and nursing home staff who are treating a patient with VRE should take the following precautions recommended by experts:

• Staff should wear disposable gowns.

• Staff should clean hands with antimicrobial hand soap and wear clean, nonsterile gloves.

• Staff should not carry a clinical bag into the patient’s home, and all equipment carried from the home should be thoroughly cleaned and disinfected.

MRSA: MRSA is the nation’s leading cause of wound infections after surgery, and it’s spreading to subacute care.

The bacteria are resistant to beta-lactose drugs that are usually used to treat the organism.

The CDC has issued the following guidelines for standard precautions health care professionals should take when treating a patient infected with MRSA:

• Wear gloves when touching the patient or the patient’s body fluids, excretions, contaminated items, and blood.

• Wash gloved hands after touching blood, body fluids, excretions, and contaminated items.

• Wear a mask and eye protection to protect mucous membranes of the eyes, nose, and mouth during procedures that cause splashing.

• Wear a gown when treating patient.

• Handle the patient’s equipment in a way that prevents skin exposure and contamination of clothing.


1. Centers for Disease Control and Prevention. Summary of notifiable diseases, United States, 1995. MMWR 1996; 55:66.

2. Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR 1997; 46 (No. RR-10):40-41.

3. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care facilities, 1994. MMWR 1994; 43:1-133.

4. Centers for Disease Control and Prevention. Assessment of testing for and completeness of reporting of vancomycin-resistant enterococci — Connecticut, 1994. MMWR 1996; 45:289-291.