MRSA Risk Assessment and Monitoring - Centers for …

1 1 MRSA Risk Assessment and MonitoringPresenterDavid P. Calfee, MD, MSProfessor of Medicine and Health Policy & ResearchWeill Cornell MedicineContributions byVineetChopra, MD, MScUniversity of Michigan Russ Olmsted, MPH, CICT rinity Health, Livonia MIKyle Popovich, MDRush University Medical Center2 Learning Objectives Discuss the importance of conducting a MRSA risk Assessment to prioritize MRSA prevention strategies Identify data that can be used to conduct a MRSA risk Assessment Describe a strategy to use data from hospital-onset MRSA bloodstream infections (MRSA BSI) to identify opportunities for future risk reduction3 Definition of MRSA BSID efinition: MRSA isolated from a blood culture collected more than three days after admission to the facility, with no previous blood cultures prior to day four positive for MRSA, is considered a facility-onsetMRSA BSI.

2 MRSA isolated from a blood culture collected within the first three days of admission is considered a community-onsetMRSA BSI. Note: Reporting definitions are based solely on date(s) of admission and date(s) of blood culture collection Clinical data ( , signs and symptoms) not considered Cause of bloodstream infection ( , CLABSI, SSI, pneumonia, etc.) not assessed/identified4(MDRO and CDI Module, CDC, 2016)MRSA BSI Represents Only Part of a Hospital s MRSA Burden5 All HAIMRSA HAIMRSA BSIHAI, healthcare-associated infectionMRSA BSI Can Result From a Variety of Infections and Processes6(SimorAE, Infect Control HospEpidemiol, 2016; Austin ED, Open Forum Infect Dis, 2016)In one study, 7% of all MRSA BSI were attributed to peripheral intravenous catheters.

3 MRSA Data May Provide Insight Into HAI Prevention OpportunitiesMRSA HAIs may reflect deficiencies in our infection prevention practices MRSA risk Assessment may include: Assessment of adherence with existing infection prevention policies and protocols Estimates of a facility s MRSA burden , rates of transmission and infection Case review of individual MRSA HAIs 7 Assess adherence with HAI Prevention Protocols and PoliciesFoundational Practices Hand hygiene* Contact Precautions** Environmental cleaning** Prevention bundles Special practices Daily chlorhexidine bathing Active surveillance testing8 For more information, refer to the *Hand Hygiene.

4 **Personal Protective Equipment and **Environmental Cleaning modulesAssess MRSA Infection Burden andTransmission RisksEstimates of a facility s MRSA burden can be made using existing data Antibiogram Proportion of S. aureus isolates that are methicillin-resistant Incidence and/or prevalence of MRSA Line list of patients with MRSA MRSA infection burden BSI, CLABSI, SSI Clinical culture data Estimates of MRSA transmission Results of active surveillance testing (if being performed)9(Calfee DP, Infect Control HospEpidemiol, 2014; Cohen AL, Infect Control HospEpidemiol, 2008)Review of MRSA BSI Cases May Help to Prioritize Prevention InterventionsIdentify the primary source of the bloodstream infection Existing NHSN surveillance data (CLABSI, SSI, etc.)

5 Medical record review (NHSN definitions or clinical diagnosis)Look for epidemiologic trends and risk factors Facility location Invasive procedures Adherence to HAI prevention policies and protocols Known history of MRSA colonization Location prior to admission ( , nursing home )10(Borg MA, J HospInfect, 2014)Root cause analysis has been associated with a lower prevalence of MRSA among S. aureusblood culture isolatesPatient Scenario: Mr. Green57 year-old man admitted from home with chest pain and shortness of breathDiagnosed with acute myocardial infarction (MI) Treated with angioplasty and stent placement Course notable for prolonged Cardiac Intensive Care Unit stay due to congestive heart failure (CHF)On hospital day 12, he had a new feverBlood cultures were obtained and MRSA was subsequently isolatedHe was not intubated, had no central lines and had not undergone any surgical proceduresHe had an indwelling urinary catheter11 Disclaimer: All case studies are hypothetical and not based on any actual patient information.

6 Any similarity between a case study and actual patient experience is purely Scenario: Mr. Green (Continued)Nursing notes on the day prior to fever onset describe redness, pain and swelling at right antecubital fossa peripheral IV siteEarlier in the day of the fever, the physician had documented redness, pain and scant purulent discharge from the peripheral IV siteIV catheter was removed the same dayNo other localizing signs or symptoms of infection were documentedYou determine that this case of MRSA BSI was due to a peripheral IV catheter-associated infection 12 Disclaimer: All case studies are hypothetical and not based on any actual patient information.

7 Any similarity between a case study and actual patient experience is purely Scenario: Looking Beyond Mr. Green 13 The Most Common Causes of MRSA BSI Can Vary Among Hospitals14 CLABSI preventionPeripheral IV infection preventionSSI preventionImplement Interventions to Address Key Opportunities for PreventionBasic infection prevention strategies Hand hygiene Environment and equipment cleaning and disinfection Contact precautionsStrategies that target specific types of infection Central line-associated bloodstream infections Peripheral IV site infections SSIs Ventilator-associated pneumonia15Ta ke- home Points While MRSA represents only part of a hospital s overall HAI burden.

8 It may mark a larger hospital HAI problem MRSA BSI are not a homogeneous group of infections, but rather complications that can be the result of a variety of underlying infections and deficiencies in our care practices Conducting a MRSA risk Assessment and mini root cause analysis of MRSA BSIs can identify opportunities for improvement and help to prioritize infection prevention interventions16 ReferencesAustin ED, Sullivan SB, Whittier S, et al. Peripheral intravenous catheter placement is an under recognized source of Staphylococcus aureus bloodstream infection. Open Forum Infect Dis. 2016; 3 , MA, HulscherM, SciclunaEA, et al.

9 Prevention of methicillin-resistant Staphylococcus aureus bloodstream infections in European hospitals: moving beyond policies. J HospInfect. 2014; 87 DP, Salgado CD, MilstoneAM, et al. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control HospEpidemiol. 2014; 35: for Disease Control and Prevention. Multidrug-resistant organism & Clostridium difficile infection (MDRO/CDI) module. 2016. AL, Calfee DP, FridkinSK, et al. Recommendations for metrics for multidrug-resistant organisms in healthcare settings: SHEA/HICPAC position paper.

10 Infect Control ; 29 , PeludeL, Golding G, et al. Determinants of outcome in hospitalized patients with methicillin-resistant Staphylococcus aureus bloodstream infection: results from national surveillance in Canada, 2008-2012. Infect Control ; 37:390-7. 171 Speaker Notes18 Speaker Notes: Slide 1 Welcome to the second module of the methicillin-resistant Staphylococcus aureus, or MRSA, Tier 1 course titled MRSA Risk Assessment and Monitoring . This module will discuss the importance of developing a MRSA risk Assessment and Monitoring program within a health care facility. 19 Speaker Notes: Slide 2 This module was developed by national infection prevention experts devoted to improving patient safety and infection prevention Notes: Slide 3 After completing this course you will be able to: Discuss the importance of conducting a MRSA risk Assessment to prioritize MRSA prevention strategies; Identify data that can be used to conduct a MRSA risk Assessment .