1. Sullivan, Cynthia RN, CCRN, MSN(c)

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A: In January 2008, Cayuga Medical Center in Ithaca, N.Y., implemented methicillin-resistant Staphylococcus aureus (MRSA) infection screening for all patients admitted to the ICU. Our goal is to identify new MRSA carriers on admission and prevent further spread of the pathogen by protecting everyone who comes in contact with identified MRSA carriers.

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Working with our ICU director, ICU staff members, the infection control department, and the lab, we implemented four key interventions that have been proven to reduce hospital MRSA rates:


* active surveillance culture (ASC) testing via nasal swabbing


* the use of proper hand hygiene, including frequent surveillance of staff compliance


* environment and equipment decontamination


* the use of contact isolation precautions for MRSA-positive patients, including the use of isolation carts for each patient.



The early identification of MRSA through ASC testing is one method to identify and isolate an infected or colonized patient. The asymptomatic patient can be identified easily and inexpensively by obtaining a nasal swab culture. All patients admitted to our ICU are cultured for MRSA unless otherwise known to be MRSA-positive. Currently, it takes 48 to 72 hours to obtain final results of MRSA screening swabs. This delay has prompted our lab to look at the quick AST testing method, with results within 5 hours. All positive results are immediately reported by telephone to the patient's primary nurse. The patient's primary healthcare provider and any outside healthcare facility with which the patient was associated are also notified. These steps are verified by the infection control nurse, and the infection control nurse director receives a weekly report.


Proper hand hygiene is always of utmost importance. When caring for any new patient, hand washing is especially important until multiple resistant organisms such as MRSA can be excluded. After MRSA has been confirmed in any patient, contact isolation is implemented. And any open skin wound that's potentially MRSA-positive triggers contact isolation until MRSA is excluded.


The terminal cleaning of patient rooms is critical to preventing the spread of MRSA. In our unit, we've designated a housekeeper who's responsible for this job and acts as an advocate for proper cleaning of all nondisposable equipment in isolation rooms. We've also implemented a new policy requiring that all isolation patient meal trays are passed by nursing staff.


The highest priority in controlling the spread of MRSA is to gain the cooperation of everyone involved. In our hospital, multiple departments were involved in the implementation of the MRSA screening program. Within the first week of ASC testing, we had 3 out of 18 MRSA-positive cultures. Since then, we've noted a sustained positive culture rate of 10%. The majority of these are found in nursing home patients, dialysis patients, or patients who've been in a hospital setting for an extended period of time.


As caregivers, we have a responsibility to aggressively prevent the transmission of MRSA. That's why we've made it our goal to decrease the number of MRSA infections in our hospital.


Learn more about it


Centers for Disease Control and Prevention. Healthcare- associated methicillin resistant Staphylococcus aureus (HA-MRSA).


Diekema DJ, Climo M. Preventing MRSA infections: Finding it is not enough. JAMA. 2008;299(10):1190-1192.


Robicsek A, Beaumont JL, Paule SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med. 2008;148(6):409-418.


Simons H, Alcabes P. A model for surveillance of methicillin-resistant Staphylococcus aureus.Public Health Rep. 2008;123(1):21-29.