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Transcript
Methicillin-ResistantStaphylococcusAureus(MRSA) Methicillin-resistantStaphylococcusaureus(MRSA)isatypeofstaphbacteriathatisresistanttocertain antibioticscalledbeta-lactams.Theseantibioticsincludemethicillinandothermorecommonantibiotics suchasoxacillin,penicillin,andamoxicillin.Inthecommunity,mostMRSAinfectionsareskininfections. Bacteriology Methicillin-resistantStaphylococcusaureus(MRSA)referstoStaphylococcusaureusisolatesthatare resistanttoallcurrentlyavailableβ-lactamantibiotics(penicillins,cephalosporinsandcarbapenems). Methicillin-resistantStaphylococcusaureus(MRSA)isanon-sporeforming,grampositivecoccithatis non-motileandusuallyfoundinclusters.ManyMRSAstrainsproduceexotoxinsincludingstaphylococcal enterotoxinsA,B,C,D,E,toxicshocksyndrometoxin(TSST-1)andexfoliativetoxinsA,andB.OnceMRSA becomesendemicwithinahospital,itisrarelyeliminatedandmayeventuallyaccountfor5–50%ofall nosocomialStaphinfections. ClinicalManifestations MRSAinhealthcaresettingsusuallycausesmoresevereandpotentiallylife-threateninginfections, suchasbloodstreaminfections,surgicalsiteinfections,orpneumonia.Thesignsandsymptomswillvary bythetypeandstageoftheinfection.Inthecommunity,mostMRSAinfectionsareskininfectionsthat mayappearaspustulesorboilswhichoftenarered,swollen,painful,orhavepusorotherdrainage. Theyoftenfirstlooklikespiderbitesorbumpsthatarered,swollen,andpainful.Theseskininfections commonlyoccuratsitesofvisibleskintrauma,suchascutsandabrasions,andareasofthebody coveredbyhair(e.g.,backofneck,groin,buttock,armpit,beardareaofmen). EpidemiologyofTransmission Atanygiventime,between20and30percentofthegeneralpopulationcarryStaphbacteriaand /orMRSAontheirhandsorintheirnoses,butarenotill.Transmissionisgenerallybycontactwith nasalcarriers(30-40%ofpopulation);fromcontactwithdraininglesionsorpurulentdischarges,spread person-to-personorbyingestionoffoodcontainingstaphylococcalenterotoxin(foodmaybe contaminatedbyfoodhandlers’hands).Theincubationperiodishighlyvariableandcanbeindefinite duetocolonization.Mostcommonlytheincubationperiodis4-10days;however,diseasemaynotoccur untilseveralmonthsaftercolonization.Therelatedincubationintervalbetweeneatingfoodandonset ofsymptomsisusually2-4hoursbutcanbeasshortas30minupto8hours. BasicPrevention TheimportanceofhandhygieneintheeliminationofMRSAtransmissioncannotbeoverstated.Alcoholbasedhandsanitizers(≥70%ethanol)maybehelpfulasanadjunctmethodofhandhygiene, butshouldnotreplacewashingwithsoapandwater. Anywoundsthataredrainingorhavepusmustbekeptcoveredwithclean,drybandages.Pusor otherdrainagefromthewoundcancontainMRSA,somakesurethatthebandagesandtapeusedto coverthewoundareproperlydiscarded. Avoidsharingpersonalitems.Bacteriacanbetransferredtoanotherpersonthroughcontact withitemssuchastowels,razorsorwashclothssotrytoavoidsharingtheseitems.Makesureany soiledclothingiswashed;waterandregularlaundrydetergentissufficient. PreventionMeasures InadditiontoRoutine/StandardPrecautions,ContactPrecautionsshouldbeimplementedwith patientswhoaresuspectedorconfirmedtohaveMRSA. • PatientswithsuspectedorconfirmedMRSAmaybeplacedinprivateroomsorcohortwith otherpatientswiththesameinfection. • Followhand-hygieneguidelinesbyeithercarefullywashinghandswithsoapandwaterorusing Alcohol-BasedHandSanitizers(ABHS)aftercontactwithpatientswithinfluenzainfection • Usegownsandgloveswhenincontactwith,orcaringforpatientswhoaresymptomaticwith MRSAforallinteractionsthatmayinvolvecontactwiththepatientorpotentiallycontaminated areasinthepatientsenvironment • AsymptomaticMRSA-colonizedHCWsrarelytransmitMRSAtopatients.Currentguidelinesdo notrecommendrestrictingworkactivitiesunlesscolonizedHCWsarefoundtobethesourceof MRSAtransmission. EnvironmentalControlMeasures MRSAhasbeenfoundtosurviveintheenvironmentfrom1to56daysoncommonhospitalmaterials andonskinfrom30minto38days.PeoplecolonizedwithMRSAcontinuouslyshedintothe environment. Hospital-gradecleaninganddisinfectingagentsaresufficientforenvironmentalcleaninginthecontext ofMRSA.Allhorizontalandfrequentlytouchedsurfacesshouldbecleaneddailyandwhensoiled.The healthcareorganization’sterminalcleaningprotocolforcleaningofthepatient’sroomfollowing discharge,transferordiscontinuationofContactPrecautionsshouldbefollowed.Allpatientcare equipment(e.g.,thermometers,bloodpressurecuff,pulseoximeter,etc.)shouldbededicatedtothe useofonepatient.AllpatientcareequipmentshouldbecleanedanddisinfectedasperRoutine/ StandardPracticesbeforereusewithanotherpatientorasingleusedeviceshouldbeusedand discardedinawastereceptacleafteruse.Toys,electronicgamesorpersonaleffectsshouldnotbe sharedbypatients. References: 1.PublicHealthAgencyofCanada(PHAC),MaterialSafetyDataSheet–InfectiousSubstances: Enterococcusfaecalis. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/enterococcus-eng.php 2.GuidelinesforEnvironmentalInfectionControlinHealthcareFacilities,CDC.MMWRJune2003, Vol52,NoRR-10 3.BestPracticesforCleaning,DisinfectionandSterilizationinAllHealthCareSettings,Provincial InfectiousDiseasesAdvisoryCommittee(PIDAC),February2010 4.GuidelineforIsolationPrecautions:PreventingTransmissionofInfectiousAgentsinHealthcare Settings,HICPAC,2007 5.GuidetotheEliminationofMethicillin-ResistantStaphylococcusaureus(MRSA)Transmissionin HospitalSettings,2ndEd.APIC2010.