1. MRSA By Danielle Gill PharmD Candidate UC 2011

2. Methicillin-Resistant Staphylococcus aureus Background Discovered in 1961 in a strain of Staph aureus in a hospital in the United Kingdom Resistant to broad spectrum antibiotics (penicillin, methicillin, and cephalosporins) Through plasmids, can infect other strains of regular staph to create resistant strains (more MRSA and VRE) Many healthy individuals harbor MRSA and show no illness (can pass on)

3. MRSA… continued MRSA is a skin soft tissue infection that can infiltrate respiratory tract, open wounds, IV catheters Immunocompromised patients are at highest risk In 2007, CDC said MRSA treatment cases doubled from 1999-2005 MRSA is responsible for 94,360 serious infections and 18,650 hospital stay related deaths in 2005 These results were adjusted to consider the underlying disease of the pt.

4. MRSA Symptoms (moderate to severe) Red Bumps Skin lesions Boils Deep, painful abscesses Impetigo Pneumonia Life threatening infections (bones, surgical wounds, bloodstream, heart, lungs, and joints) Endocarditis Toxic shock syndrome DEATH

5. MRSA Some Examples

6. MRSA… continued Patients with MRSA had both 3X length of hospital stay and cost Patients also experienced 5X risk for in hospital death Cosgrove et. al. concluded that MRSA is associated with increased mortality compared with methicillin susceptible staphylococcus aureus Where is MRSA located in a hospital setting?

7. Research at Plateau Medical Hospital, Oak Hill, WV9/11/08 Testing Sites Drug Cart in Pharmacy Patient Transfer Wheelchair Vending Machine Buttons 1st Floor Medical Room Locks Drug Counter in Medical Preparation room (1st floor) Keyboards on 1st Floor Pyxis Machines Counter in ER lobby Payment Clerk Window Nurses Stethoscope Head Medical Preparation Counter in ICU Nurses Computer Keyboard/Mouse in ICU Nurses Station 1st Floor Stairwell Railings Anesthesia Boxes in Pharmacy Walls and Gloves in Isolator Chamber Room

8. Results MRSA Found ICU Keyboards of Pyxis Machines Medication Preparation Counter in ICU

10. Suggestions Spoke with Nursing, Housekeeping, and Pharmacy for resolutions Immediately Clean the ICU with ONLY ANTI-MRSA agents!!! (Switched from Virex II to Virex TB) Change out the Pyxis plastic Keyboard Covers

11. Re-Test on 10/02/08 Restricted to Plateau Medical ICU Testing Sites Patients Bed Table 2 (just cleaned with anti-MRSA) Medication Preparation Counter Patients Bedside Table 1 (patient occupancy) Medication Preparation Counter in Medication Preparation Room Pyxis Machines (keyboards) Pyxis Machines (screens) Patients Bed rail (patient occupancy) IV drip dispenser

12. Results Patients Bed Table (just cleaned) Staphylococcus* Patients Bedside Table 1 (patient occupancy) Staphylococcus aureus Medication Preparation Counter by Pyxis Staphylococcus aureus

13. What does this mean? Positive Steps toward MRSA control in the hospital : Loop Holes: Medication Counter in the Medication Preparation Room (by Pyxis) is cleaned 1 time/day Housekeeping can’t clean nursing areas Small ICU, easier transmission of infections

14. MRSA = “BAD APPLE” Only 5% of medical harm is caused by incompetent or poorly intended care, meaning 95 % of errors that cause harm involve conscientious, competent individuals trying hard to achieve a desired outcome. Barbie Covelli, RPh CAMC Pharmacy TJC Coordinator

15. Communication Radiology Laboratory Materials Management Administration Nursing Pharmacy Maintenance Doctors Housekeeping Admissions Medical Records Dietary Physical Therapy Surgery Respiratory Therapy Business Office Volunteers Administration

16. Current MRSA control… Listed on patients chart Isolation (if available) Pharmacy knows Rooms are cleaned after every patient leaves Possible problems: Do not know whether pts have MRSA Same nurses/doctors Housekeeping Laboratory workers Dietary

17. Short Term Strategies Hand washing (easiest and cheapest) before and after touching patients (with or without gloves) Switch out plastic keyboard covers (when MRSA patient leaves) Put anti-MRSA wipes by the nurses stations and any medication preparation tables (in store) Alert Infection Control of all MRSA patients

18. Long Term Strategies Periodic MRSA testing Computer keyboard covers on all computers and change regularly Mouse covers in ICU Stethoscope covers (color coded) Autoclave/ disposable mats used in medication preparation Screen all patients coming in for MRSA (standing MRSA order) CA MRSA can’t control Educational seminars (TJC, University speakers, other medical institutions)

19. Some Good Examples Screening has been found to be effective in reducing the number of MRSA at Veterans Affairs Hospital in Pittsburgh, PA, Davis Memorial Hospital, and in hospitals in Denmark, Finland, and Netherlands In 2006 CDC stopped short of recommending screening, but they did want more research

20. Conclusion MRSA is everywhere we need to stop fearing it and take control Small hospital, we should be able to control infection and make a model for other hospitals We can make a difference in the lives of our patients!

21. Follow Up at Plateau Medical Checked up in 3 weeks, found that none of the suggestions were taken into consideration. Decided to switch focus from everyone helping to the infection control nurse taking charge. Spoke with the CEO, Infection Control Nurse, and Housekeeping - will require pts who meet high risk to be screened.

22. Resources CDC.gov [homepage on the Internet]. Atlanta, GA: Centers for Disease Control and Prevention: [updated 2008 October; cited 2008 October 20]. Available from: www.cdc.gov. Covelli, Barbie. Developing a Comprehensive Patient Safety Program. Patient Safety Lecture. University of Charleston School of Pharmacy Spring 2008. Hartel, Paul. The Changing Biology and Epidemiology of Common Pathogens: Methicillin-resistant Staphylococcus aureus and Clostridium difficile. Proceedings of Davis Memorial Hospital Conference on MRSA/C-diff; Fall 2008; Elkins, WV: pg 1-5.