CDC answers questions related to MRSA

Awareness and identification of risks important

Although the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) is not as high in hospice care as it is in hospitals, the Centers for Disease Control and Prevention addresses the risk and identification of the infection as well as precautions to take to prevent spread of any antibiotic-resistant infection in non-hospital settings on its web site.1

• What are "nonhospital health care settings"?

They refer to residential settings (e.g., long-term care and skilled nursing homes), home care, hemodialysis centers, and physicians' offices.

What are multidrug-resistant organisms?

They are bacteria and other microorganisms that have developed resistance to antimicrobial drugs. Common examples of these organisms include:

— MRSA. Methicillin/oxacillin-resistant Staphylococcus aureus;

— VRE. Vancomycin-resistant enterococci;

— ESBLs. Extended-spectrum beta-lactamases (which are resistant to cephalosporins and monobactams);

— PRSP. Penicillin-resistant Streptococcus pneumoniae.

• Which multidrug-resistant organisms are most commonly seen in nonhospital settings?

MRSA and VRE are the most commonly encountered multidrug-resistant organisms in patients residing in nonhospital health care facilities, such as nursing homes and other long-term care facilities. PRSP is more common in patients seeking care in outpatient settings such as physicians' offices and clinics, especially in pediatric settings.

• What conditions increase the risk of acquiring these organisms?

There are several risk factors for both colonization and infection:

— severity of illness;

— previous exposure to antimicrobial agents;

— underlying diseases or conditions, particularly:

— chronic renal disease;

— insulin-dependent diabetes mellitus;

— peripheral vascular disease;

— dermatitis or skin lesions;

— invasive procedures, such as: dialysis, presence of invasive devices, urinary catheterization, repeated contact with the health care system, previous colonization of by a multidrug-resistant organism, and advanced age.

• Should patients colonized or infected with these organisms be admitted to non-hospital health care facilities?

Nonhospital health care facilities can safely care for and manage these patients by following appropriate infection control practices. In addition, nonhospital health care facilities should be aware that persons with MRSA, VRE, and other infections may be protected by the Americans with Disabilities Act or other applicable state or local laws or regulations.

• What can be done to prevent or control transmission of these pathogens in my facility?

The CDC's recommendations for preventing transmission of MRSA/VRE in hospitals consist of standard precautions, which should be used for all patient care. In addition, the CDC recommends contact precautions when the facility (based on national or local regulations) deems the multidrug-resistant microorganism to be of special clinical and epidemiologic significance.

The components of contact precautions may be adapted for use in non-hospital health care facilities, especially if the patient has draining wounds or difficulty controlling body fluids.

In addition to standard and contact precautions, the following procedures also may be considered for nonhospital health care facilities:

Patient placement. Place the patient in a private room, if possible. When a private room is not available, place the patient in a room with a patient who is colonized or infected with the same organism, but does not have any other infection (cohorting). Another option is to place an infected patient with a patient who does not have risk factors for infection.

Group activities. It is extremely important to maintain patients' ability to socialize and have access to rehabilitation opportunities. Infected or colonized patients should be permitted to participate in group meals and activities if draining wounds are covered, bodily fluids are contained, and the patients observe good hygienic practices.

The following are recommended for prevention of MRSA/VRE in hospitals and may be adapted for use in nonhospital health care facilities:

Obtain stool cultures or rectal swab cultures of roommates of patients newly found to be infected or colonized with VRE, and nasal swabs for MRSA.

— Adopt a policy for deciding when patients can be removed from isolation (e.g., VRE-negative results on at least three consecutive occasions, one or more weeks apart).

• How should clusters or outbreaks of infections be handled?

Consult with state or local health departments or an experienced infection control professional for reporting requirements and management of MRSA or VRE outbreaks.

Reference

1. Centers for Disease Control and Prevention. Multidrug-Resistant Organisms (MDROs) in Non-Hospital Healthcare Settings. Web: www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.html.