Page 189 - policy and procedure infection control

Policies and Procedures on Infection Control

13.2 Methicillin Resistant Staphylococcus Aureus

13.2.1 Introduction

MethicillinResistant Staphylococcus Aureus (MRSA) have been a major cause of health
care-associated infections (HCAI) worldwide. Detection of MRSA within hospitals and
long term care facilities has increased dramatically and a great deal has been written
regarding its management and control.

Concern about MRSA is related to the potential for health care and community transmission
and the limited number of antibiotics available to treat infections caused by this organism.

13.2.2 Epidemiology

The current prevalence rate of MRSA in United States hospitals is now believed to exceed
50%. Canada reported a 6% rate, while Japan’s rate exceeded 80%. Most European
countries had a greater than 6% rate of S. aureus strains be MRSA in 1999, but the
Netherlands reported less than 1%.
In Malaysia, the rate of MRSA isolate was 0.5% per 100 admissions in 2005 and 0.3%
2007. The epidemiology of MRSA has changed with the apparent emergence of MRSA in
the community with clinical, epidemiologic and bacteriologic characteristics distinct from
health care-associated MRSA.

13.2.3 Methicillin-Resistant Staphylococcus Aureus
• Staphylococcus aureus is a facultative anaerobe, non-motile, catalase positive, gram-
positive cocci which predominantly arranged in grape-like clusters.

• It is the most important human pathogen among the staphylococci.
• S. aureus that is resistant to the synthetic penicillins (methicillin, oxacillin, nafcillin)
is referred to as MRSA.
• They colonises the skin, particularly the anterior nares, skin folds, hairline, axillae,
perineum and umbilicus. They may also colonise chronic wounds, for example in
eczema, varicose and decubitus ulcer.
• MRSA is transmitted primarily through direct person-to-person contact, commonly
through the hands of health care workers. However, It can also be transmitted through
contact with inanimate objects such as linen, clothing and dust, although these do
not represent significant sources for transmission.
• Nasal carriage of MRSA is very common and due to hand to nose transmission.
• A nasal carrier often contaminates his/her own hands by hand to nose contact, then
transmits the organism in the course of routine activities.
• Since skin to skin contact is the most significant mode of transmission, hand hygiene
is of primary importance in preventing its spread.

178 Ministry of Health Malaysia