In this assignment I will be explaining how an outbreak of MRSA in a health and social care setting will be managed. The setting I have chosen is a hospital.
MRSA, short for Methicillin-resistant Staphylococcus aureus is a bacterial infection that is resistant to various types of anti-biotic, meaning this is a lot harder to treat compared to other common types of bacteria. It is carried on the skin, inside the nostrils and the throat and spread through skin-to-skin contact with an individual who is infected or colonised by the bacteria. It is very common for someone to develop MRSA when they are in hospital due to people who are staying in hospital are commonly wounded, burnt, using a catheter or intravenous tube which means they are at a higher risk of bacteria entering the body. MRSA can also cause infections in people outside hospital; however it is far less common than in hospitalised people. This is known as community-acquired MRSA and is usually found in nursing and residential homes. MRSA colonisation occurs when MRSA grows in or on your body with no signs or symptoms of an infection. Many people carry MRSA without it causing any symptoms whatsoever. The most common place for colonisation is your armpits, nostrils, skin (especially if you have eczema), throat and urine. This colonisation can act as a reservoir which means that MRSA infections can later either develop in your body or spread to other people.
The number of MRSA infections in hospital can be kept to a minimum if all hospital staff maintains good hygiene measures. The most important measure being to wash hands before and after contact with each patient and before doing any procedure; this is a simple measure that reduces the chance of passing on germs (bacteria) from individual to individual. In hospitals, other measures are used to reduce the spread of infection, such as cleaning of bedding, regular cleaning of wards, etc. Patients with an MRSA infection may be kept away from other patients, perhaps in a single bed room or in an isolation unit until the infection has cleared.
Every hospital needs to establish its “normal” (or baseline) incidence of hospital-acquired infection so that it can identify abnormal levels or outbreaks when they occur. An outbreak may be defined as an increase in the occurrence of a disease by reference to a recorded baseline rate – although, in practice, timely notification of a possible outbreak often relies on the past experience of clinical and laboratory staff, and on them being alert to the condition of individual patients. An outbreak may also be identified by cases of infection that are clearly associated (in time and place). Hospitals need to have plans to deal with outbreaks of hospital-acquired infection. The infection control committee should be closely involved in drawing up and endorsing these plans. The infection control team must have access to managers and medical and nursing staff who have the authority to take the actions necessary to contain the outbreak.
An outbreak first needs to be recognised. Information related to the event then needs to be gathered and an action plan put in place. All but one hospital service reported that they had documented infection outbreak response arrangements or plans that had been endorsed by the infection control committee. Outbreak plans should: define what is meant by an outbreak, assign responsibility for notifying and investigating a suspected outbreak, specify what information should be gathered, set out how a team or committee will be formed to control the outbreak, the membership of the team or committee, and the team’s mandate and tasks, specify required communications with external agencies; and set out requirements for reporting and follow-up.
Communication is a vital part of outbreak management. Most importantly, staff should remain informed and kept aware of any special precautions that may need to be taken. Keeping patients informed is also an important aspect of a hospital’s communications strategy, and their co-operation can help contain a threatened or actual outbreak. Patients isolated for infectious conditions must be aware of what their infection is and how it is going to be treated, how it might affect them, and how to stop it spreading. Some hospitals had published helpful brochures for this purpose. The implementation of multiple, simultaneous, evidence-based management strategies are effective for controlling nosocomial infections. Outbreak management strategies will benefit highly from improving the communication between the institutional and scientific leadership and the ground-level staff. These measures can help to identify individualized solutions and addressing specific unit needs.
In the case of an outbreak, the reinforcement of hand-hygiene, staff training, active surveillance, aggressive implementation of contact isolation, decolonization and antibiotic stewardship. Individuals who have contacted MRSA will be put in the same place in a ward as those who have contacted it, whereas those who haven’t will remain grouped. Hand hygiene measures will need to be taken out after touching individual with MRSA, before and after eating and serving food to a patient, visitors will need to use hand hygiene measures before entering and when leaving, as well as after touching an infected patient.
Sinks and alcohol hand antiseptics are to be available at the entrance of each unit and room, as well as hand hygiene education for all new staff and family visitors health care workers) and self-assessment of risk is to be promoted via leaflets and posters in the all units. Nurses and physicians are to change and wash their uniforms daily; each visitor is to wear a clean gown, some may have long-sleeves. Infection control nurses from the hospital hygiene division are to perform sustained hand hygiene information and education session on the importance of scrupulous hand-hygiene, highlighting a special emphasis on the use of hydro alcoholic solution before and after contact with every patient. Videos may be put on a screen outside every unit that demonstrates how you should be using the hand-hygiene products to ensure you are properly getting rid of any possible harmful bacteria. Surface samples are to be obtained from rooms, incubators, soft toys, monitors and medical devices as well as all staff being screened for nasal colonization, without identifying any MRSA reservoir or carriage. Moreover, soft toys and all items not strictly linked to nursing procedures are to be banned from NICU cots and the reinforced contact isolation for infected patients is to be implemented.
After the breakout has been managed monthly staff meetings of the operational team is to be organized, in order to point out the strategic priorities and to present data on hygiene compliance, rate of MRSA infections and MRSA colonization.