MRSA, considered a modern hospital pathogen, may be resistant to many antibiotics including penicillins, cephalosphorins, and aminoglycosides. Vancomycin, an expensive antibiotic, is often the only effective drug for intravenous treatment of serious infection.
MRSA is so prevalent in many U.S. institutions that the spread is no longer controllable in some areas. Strict isolation and treatment is imperative to prevent this scenario in Canadian hospitals.
Reservoirs:
1. Patients who are colonized or infected. Common sites of colonization are the nose, axilla and groin. Common sites of infection are surgical incisions, central lines and soft tissue wounds.
2. Hospital personnel who are colonized with MRSA in the nose or skin. Chronic skin conditions such as eczema predispose to this.
3. Equipment which has been inadequately disinfected between patients.
Risk Factors:
The major risk factors for carriage of MRSA include previous antibiotic therapy, prolonged hospitalization, and the presence of underlying disease, especially immuno-compromised patients e.g. renal, oncology, transplant, HIV.
Mode of Transmission: Direct transmission via the hands of personnel is the most common form of cross-infection between patients. Droplet spread from a patient or staff who is a nasal carrier, or indirect contact via contaminated equipment may also occur, but is less common.
Infection Control Measures: The Infection Control Nurse should be notified immediately of any patient with known or suspected MRSA. Patients are immediately placed on STOP Isolation. STRICT HANDWASHING must be enforced. Contact tracing of other patients and/or staff will be determined by the Infection Control Team.
Treatment: In the Hospital, colonization of personnel, or colonization and/ or infection in a patient requires treatment. Mupirocin ointment is effective for treatment of nasal carriage and soft tissue wounds without systemic involvement. The usual drug of choice for other sites is vancomycin, but occasionally rifampin may also be used. Patients with MRSA identified at any site should be cultured for MRSA in the nose, and any incision or draining wound they may have. Refer to Policy 60.14, Disease Specific Information, in the Infection Control Manual for methods of culturing and patient care.
References:
1. Bennett, Mary Ellen. "Recommendations from a Minnesota task force for the management of persons with MRSA". AM.J. Infec Control 1992;20;42-48.
2. Wenzel, Richard P. "Methicillin-Resistant Staphylococcus Aureus: Implications for the 1990's and Effective Control Measures". AM.J. Infec Control 1991;91 (Supplement 38), 221-227.
Back to Newsletters Directory
