Page 190 - policy and procedure infection control

Policies and Procedures on Infection Control

• Because of its resistance to antibiotics, management of MRSA infections requires
more toxic and expensive treatment.
• MRSA colonization and infections have a significant impact on individual patients
and institutions.
• Many patients with MRSA remain colonized indefinitely, and the majority of hospital and
nursing homes that have endemic MRSA never eradicates MRSA from the institution.

13.2.4Clinical Manifestation
• Infections caused by MRSA are wound infections, bacteremia, ventilator-associated
pneumonia and less commonly endocarditis and osteomyelitis
• It also produces toxins which can cause necrotising entero-colitis among newborns.

13.2.5Laboratory Diagnosis
• Screening for MRSA colonization can be detected by culture of the nares or wound swabs
• Clinical infection caused by MRSA can be identified by cultures of blood, broncho-
alveolar lavage, sputum, urine or surgically obtained specimens.
• Oxacillin susceptibility testing by the Kirby Bauer technique is the preferred method
of identifying MRSA. Resistance to oxacillin also defines resistance to all penicillins,
cephalosporins, cephamycins and other classes of antibiotics including
aminoglycosides, macrolides and quinolones.
• Methicillin resistance in MRSA is conferred by the mecA gene, which encodes an
altered penicillin binding protein (PBP2a).

13.2.6 Treatment

Treatment of MRSA falls into two areas, one is the antimicrobial treatment of clinical invasive
infection and the other is topical to eradicate skin and nasopharyngeal colonization.

Eradication of colonized patients is recommended as these patients provide a reservoir for
subsequent spread of MRSA.
1. Hygiene
• Bath daily and wash hair twice weekly with an antiseptic body wash such as 4%
chlorhexidine gluconate scrub or 2% triclosan .
• Use a disinfectant dusting powder (hexachlorophene 0.33%) after bathing and
drying. Apply to axilla, groin and any skin folds.
2. Nasal carrier
The usual treatment for nasal carriage is mupirocin, which is an effective topical agent
• Apply mupirocin nasal ointment three times per day for a period of five days. A
‘match head’ size of ointment should be applied to the inner side of the nostril.

• After the five-day treatment course, cease eradication therapy for two days and
repeat the swabs.

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