Wound Management and Care for MRSA

Wound Management and Care for MRSA

METHICILLIN RESISTANT Staphylococcus Aureus

• MRSA can colonize skin mucous membranes and skin lesions in patients and HCWS. • It causes infection in susceptible patients. • MRSA infection in susceptible patients. • MRSA infections are difficult and costly to treat.

Transmission of MRSA

Contact spread

1. Hands – Transient hand carriage by HCW Most likely route of spread from patient to pt. 2. Skin conditions – Eczemas, dermatitis, psoriasis or cut and wounds on HCW can harbor and transmit 3. Equipment – Can spread when incorrectly decontaminated equipment is used between pts. Transmission may less frequently occur through

4. Dispersed skin scales 5. Droplets (during coughing or respiratory procedures)

Prevention and control of MRSA transmission • Contact Precautions should be taken to prevent MRSA transmission a) Patient placement - Isolate patients with known or suspected MRSA colonization or infection in single room. Explain the reason for isolation to the patient. (it can decide by psychiatry team) - The door of the room should be kept closed, especially during procedures like physiotherapy, wound dressing and bed making. - When single patent room are not available, patient harboring MRSA could be cohorted in a corner of the ward. - Other patient in the ward must not have invasive devices in-situ. - A toilet and bathroom should be dedicated for infected patients. - Any lesion from which MRSA is isolated should be covered with a clean dressing. - The door should be kept closed unless it is likely to compromise patient care. b) Barrier nursing - One nurses should be allocated for the patient or the cohort. - Strict hand washing practices should be adhered to before and after attending to patient. - Do not enter room unnecessarily. - Clean gloves and gown should be worn by the staff attending to the patient. - Discard used gloves and gowns into a bin within the isolation area. - masks are not indicated. (except for the procedures producing aerosols such as chest physiotherapy, suctioning, wound dressing or when attending to patients with infected sputum) - do not lean on to/touch bed, furniture etc. - while handling MRSA patient, HCW should avoid direct contact with other patients. c) Hand Hygiene

- Adequate hand washing facilities and alcohol hand rub should be available for staff and visitors. - After touching patient’s area should be wash hands immediately. - Hand hygiene should be performed using soap and water or alcohol hand rub on WHO 05 moments for hand hygiene. d) Visitors - Strict visitors - Patient should be informed that there is no risk to healthy relatives and friends. - Visitors do not need protective clothing if they do not involve in patient care. - Sitting on the patient’s bed should be strictly prohibited. - Visitors should wash their hands before leaving the patients’ room. - Bystanders assisting the patient should wash hands with soap and water, and ideally wear gloves and gowns. - Designated bystanders should not attend to other patients and should restrict their movements.

e) Equipment - should be kept in the room or isolation area. - clean appropriately after use.

f) Linen g) Environmental cleaning and disinfection - Isolation room / area should be cleaned daily, including bed, bedside cupboard, table and floor. - Mop/wipe with 0.1% hypochlorite. - Disinfect the metal surfaces with 70% alcohol.

h) Movement - As far as possible minimize patient visits to other units/departments. - If visiting another unit, inform before to take necessary precautions, such as hand hygiene, wearing gloves and aprons. i) Transfers - MRSA patient should not be transferred to other wards or hospitals without informing. - MRSA should be clearly indicating the transfer form / bed head ticket. - patient colonized with MRSA but no longer required to be hospitalized can be discharged.

j) Staff screening - This is confined to MRSA outbreaks.

Patient management

Patient infected with MRSA should be treated with relevant antibiotics guided by an antibiotic sensitivity test.

Screening.

Patients should be screened for colonization as follows.

1. Nose – both nostrils swabbed with one swab 2. Perineum/groin – both sides swabbed with one swab 3. Axilla – both axillae swabbed with one swab 4. Throat swab 5. Swabs from any wounds or open lesions 6. Any line sites 7. Urine from patients with indwelling urinary catheters. Swabs are moistened with sterile saline before obtaining specimen.

Decolonization

The microbiologist should be consulted before instituting decolonization protocol

Colonized patient should undergo a 5 days MRSA decolonization protocol

o Daily bath with 4% chlorhexidine in detergent solution is recommended. (alternatively, 7.5% povidone- iodine, 0.1%octenidine or bleach baths can be used) o Wash hair with 4% chlorhexidine (at least one days 1,3,5) o Apply 2% mupirocin nasal ointment to anterior nares three times a day. o Apply 2% mupirocin on colonized or infected skin lesions. o Change personal clothing and bed linen daily. o After 5 days, stop decolonization procedure. o Repeat screening 48 hours after completing decolonization protocol.

MRSA outbreak

02 or more MRSA patient found in one ward we can identify it is an outbreak.

To be screen all patients. (Cannula site, catheter site, trachy site, wounds, nose, axilla, perineum/groin, throat swab)

Positive patient should be isolate in a suitable room.

If there one patient found in a ward (as a psychiatry hospital), should be screen acute site for identification.