APIC MRSA Elimination Guideline

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Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital SettingsHospital-approved disinfectants must be readily available to all staff with cleaning responsibility at allpoints of use.Monitoring Environmental CleaningA monitor to assess cleaning performance of environmental staff will ensure consistency in cleaning anddisinfection procedures. Monitoring should include an assessment of the cleaning of surfaces in closeproximity to the patient, including bedrails, carts, doorknobs, bedside commodes, bedside tables and faucethandles. Also, the use of an environmental cleaning checklist may increase efficacy of cleaning and maybe helpful when monitors show that cleaning is inadequate. There is generally no need for environmentalcultures unless there is epidemiologic evidence that an environmental source is associated with ongoingtransmission of MRSA. Consider closing a unit for deep cleaning and disinfection if there is evidence ofunchecked transmission.Example of Cleaning ChecklistThe Institute for Healthcare Improvement’s (IHI) 5 Million Lives Campaign “How-to-Guide: ReduceMRSA Infection” includes a comprehensive review of decontamination of the environment andequipment. In Appendix A of this package, there is an environmental services checklist audit for dailycleaning and discharge cleaning.Cited ReferencesNeely AN, Maley MP. Survival of enterococci and staphylococci on hospital fabrics and plastic. J Clin Microbiol.2000;38:724-726.Huang R, Mehta S, Weed D, Price CS, MD Methicillin-resistant Staphylococcus aureus survival on hospital fomites. InfectControl Hosp Epidemiol 2006;27:1267-1269.Bhalla A, Pultz NJ, Gries DM, et al. Acquisition of nosocomial pathogens on hands after contact with environmentalsurfaces near hospitalized patients. Infect Control Hosp Epidemiol. 2004;25:164-167.Carling PC, Briggs J, et al. An evaluation of patient area cleaning in 3 hospitals using a novel targeting methodology. Am JInfect Control. 2006;34:513-519.Hardy KJ, Oppenheim BA, Gossain S, Gao F, Hawkey PM. A study of the relationship between environmentalcontamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients’ acquisition of MRSA. InfectControl Hosp Epidemiol. 2006;27:127-132.Boyce JM, Potter-Bynoe G, Chenevert C, King T. Environmental contamination due to methicillin-resistant Staphylococcusaureus: possible infection control implications. Infect Control Hosp Epidemiol. 1997;18:622-627.Muto CA, Jernigan JA, Ostrowsky BE, et al. SHEA guideline for preventing nosocomial transmission of multidrugresistantstrains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003;24:362-386.30ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL AND EPIDEMIOLOGY
Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital SettingsSurveillance CulturesKey Concepts• Surveillance MRSA cultures are useful in epidemiologic studies of the prevalence, incidence and/ortransmission of MRSA.• Surveillance MRSA cultures may be done for the purpose of discontinuation of contact precautions.• Clinical cultures will not identify the majority of MRSA-positive patients, especially in settings withhigh endemic MRSA rates.• In contrast to the “passive” acquisition of MRSA information from clinical culture, surveillanceMRSA cultures can be part of active data collection for MRSA risk assessments, and for enhancedcontrol efforts.Active Surveillance Cultures (ASC)The 2006 MDRO guideline recommends a two-tiered approach to the management of MDRO inhealthcare settings. The first tier includes routine surveillance activities that can identify evolving MRSAproblems (e.g., increased MRSA transmission) and safeguards for managing unidentified MRSA carriers.The second tier of enhanced control efforts is used when incidence or prevalence is not decreasing despiteimplementation of and correct adherence to the routine infection control measures.One useful MRSA management intervention is active surveillance cultures (ASC). Most hospitals will useACS as part of second tier of interventions when enhanced control efforts are needed.V.B.1.a. Indications for intensified MDRO control efforts should result in selection and implementation of oneor more of the interventions described in VII.B.2 to VII.B.8 below. Individualize the selection of control measuresaccording to local considerations. Category IBV.B.5.b. Develop and implement protocols to obtain active surveillance cultures (ASC) for targeted MDROs frompatients in populations at risk (e.g., patients in intensive care, burn, bone marrow/stem cell transplant and oncologyunits; patients transferred from facilities known to have high MDRO prevalence rates; roommates of colonized orinfected persons; and patients known to have been previously infected or colonized with an MDRO). Category IBV.B.5.b.i. Obtain ASC from areas of skin breakdown and draining wounds. In addition, include the following sitesaccording to target MDROs:V.B.5.b.i.1. For MRSA: Sampling the anterior nares is usually sufficient; throat, endotracheal tube aspirate,percutaneous gastrostomy sites and perirectal or perineal cultures may be added to increase the yield. Swabs fromseveral sites may be placed in the same selective broth tube prior to transport. Category IBASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL AND EPIDEMIOLOGY 31
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APIC MRSA Elimination Guideline

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