HHC Health & Home Care Clinical Policy And

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HHC HEALTH & HOME CARE Section: 13-13 Infection Control: Methicillin-Resistant Staph Aureus (MRSA) Vancomycin-Resistant Enterococcus (VRE), Precautions For Care Of Patients With __RN__ HHA PURPOSE: To protect clinical staff and caregivers, and prevent the spread of contamination of MRSA/VRE, while providing care to MRSA/VRE-infected patients. CONSIDERATIONS: 1. Staphylococcus bacteria can be found throughout nature. In particular, these bacteria thrive in moist, warm places, including the human mouth, nose, respiratory and urinary tracts, and open wounds. Studies have implicated the contaminated hands of health care personnel as a major cause of personto- person transmission of MRSA. 2. An increased risk for VRE infection has been associated with previous vancomycin and/or multimicrobial therapy, severe underlying disease or immunosuppression, and intra-abdominal surgery. Because enterococci can be found in the normal gastrointestinal and female genital tracts, most enterococcal infections have been attributed to sources within the patient. However, recent studies have indicated that person-to-person transmission of VRE can occur via the hands of health care personnel or contaminated patient care equipment or environmental surfaces. 3. Universal Precautions with strict hand hygiene guidelines must be followed at all times. (See Hand Hygiene, No. 14.03) Contact Isolation will be instituted. 4. Clinical staff that comes in contact with the patient will wear gowns and gloves. Family members/ caregivers that come in direct contact with the patient and with their bodily fluids must be educated to also wear gowns and gloves at that time. 5. Nursing bag should be left in the car and only necessary items carried into the house in a plastic bag. 6. No disposable equipment, once taken in the home, will be returned to the agency. The equipment will be disposed of in the home upon discharge from home care services. (See Disposal/Handling of Infectious Medical Waste, No. 14.11.) 7. Reusable equipment will be bagged and labeled and sent to the appropriate area for cleaning and disinfection prior to reuse. 8. If possible, MRSA, VRE infected patients should be scheduled to be seen the last visit of that day by clinical staff. EQUIPMENT: Gowns Gloves Stethoscope (if applicable) Blood pressure cuff (if applicable) Thermometer Alcohol preps Bottle of 70% alcohol Antimicrobial and/or non-antimicrobial soap, alcoholbased hand rubs Paper towels Plastic bags Bleach solution, 1:10 PROCEDURE: 1. Adhere to Universal Precautions and Contact Isolation. (See Isolation/Precaution Categories, No. 14.17.) 2. On admission, arrange for needed equipment to be in patient's home, and restock, as needed. All assigned staff will be informed of infection precautions and required Personal Protective Equipment. 3. Dispose of supplies e.g., dressings, gowns, masks, gloves, etc. (See Disposal/Handling of Infectious Medical Waste, No. 14.11.) 4. Care for soiled, patient-care surfaces following Handling of Blood and Body Fluid Spill, No. 14.10. 5. Soiled linens should be sealed in a plastic bag until laundered. (See Disinfection of Linen in the Home, No. 14.09.) 6. "MRSA Instruction Sheet" (see attached) will be provided to the patient/caregiver so that the patient and caregivers will have written instructions for teaching purposes. Teaching will include: a. Disease process. b. Infection control measures. c. Sterile technique. d. Specific medication regime. AFTER CARE: 1. Document in patient's record: a. Procedure and observations. b. Patient's response to procedure. c. Instructions given to patient/caregiver. 2. Leave Instruction Sheet for Caregiver. (See Sample on next page. Instructions are as follows.) Instructions for Caregivers When Giving Direct Care to Persons With Methicillin-Resistant Staph Aureus (MRSA) or Vancomycin - Resistant Enterococcus (VRE) Infections: Staphylococcus (Staph) is a bacteria that can be found throughout nature. Everyone has Staph on their skin and in their mouth, nose, and throat. Enterococcus is an organism that can normally be found in the digestive system and in the female genital tract. Most of the time, these two organisms do not cause infection. However, 292
HHC HEALTH & HOME CARE Section: 13-13 Infection Control: Methicillin-Resistant Staph Aureus (MRSA) Vancomycin-Resistant Enterococcus (VRE), Precautions For Care Of Patients With __RN__ HHA MRSA and VRE are two types of bacteria that are often resistant to many drugs, which limits treatment options. Because MRSA/VRE are easily transmitted, the home care staff will be wearing gowns and gloves when caring for the person with MRSA/VRE. This is to prevent staff from becoming infected and from carrying the germ to other patients. 1. Wash your hands before and after any treatment given to the patient. 2. Wear gloves and a gown (or protective covering over your clothes) when you have direct contact with the patient's wound, mouth, or nose. Examples: changing the bandage, helping the person brush their teeth/dentures, emptying urine drainage bags, handling bedpans, or bedside commodes. 3. Keep your hands away from your mouth and face while working. Wash your hands before eating. 4. Wash linens and clothing soiled with body fluids in a washing machine with hot water and detergent. If bleach can be used, add one cup of bleach. 5. Use plastic bags to dispose of soiled tissues, bandages, bandaids, and gloves. Close and secure the bag tightly, double bag, and discard in a plastic lined trash container with a tight lid. 293
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