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CME: An Update for Preventing MRSA

CME: An Update for Preventing MRSA
Author Information (click to view)

David P. Calfee, MD, MS

Associate Professor of Medicine & Healthcare Policy and Research
Weill Cornell Medical College

David P. Calfee, MD, MS, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

  1. Review key recommendations made in the Society for Healthcare Epidemiology of America and Infectious Diseases Society of America/American Hospital Association/Association for Professionals in Infection Control and Epidemiology/Joint Commission Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals that focused on methicillin-resistant Staphylococcus aureus.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwjuly4.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Christopher Cole, Senior Editor
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
David P. Calfee, MD, MS
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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David P. Calfee, MD, MS (click to view)

David P. Calfee, MD, MS

Associate Professor of Medicine & Healthcare Policy and Research
Weill Cornell Medical College

David P. Calfee, MD, MS, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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Several expert groups have released new guidelines to help reduce the prevalence of MRSA and improve patient safety in hospitals. This guidance can serve as a roadmap for prioritizing and implementing MRSA prevention strategies.
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In 2008, the Society for Healthcare Epidemiology of America and Infectious Diseases Society of America—partnering with the American Hospital Association, Association for Professionals in Infection Control and Epidemiology, and the Joint Commission—published the “Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals,” a collection of recommendations focused on common hospital-acquired infections. With new research emerging and the need for up-to-date information, the organizations recently released an update to the compendium. As part of the compendium, updated recommendations were made on the prevention of MRSA infection and transmission.

Getting to the Basics

Published in Infection Control and Hospital Epidemi-ology, the recently updated compendium recommendations provide a roadmap for prioritizing and implementing strategies to help prevent MRSA infection and transmission. These strategies are broken down into basic practices (Table 1) and special practices. “Based on evidence, expert opinion, and experience, the basic practices are recommended for all hospitals, regardless of the burden of MRSA,” explains lead author David P. Calfee, MD, MS. “These are good, basic infection control practices. Many would be useful in preventing a wide variety of healthcare-associated infections (HAIs) and preventing transmission of various pathogens, including MRSA.”

Update-Preventing-MRSA-Callout

When considering MRSA control practices, conducting a risk assessment is important. This should include an analysis of infection rates, the basic practices that have and have not been implemented already, and whether implemented practices are adhered to consistently, according to Dr. Calfee. “Writing a policy and making sure it’s actually being followed are two different things,” he adds. “A good understanding of the epidemiology of MRSA within your facility is really the first step.” He notes that all providers should be cognizant of their accountability to prevent HAIs like MRSA (Table 2).

Considering Special Practices

Special practices should be considered if the basic practices have been implemented with good adherence to each intervention but there is still evidence of MRSA transmission, infection, or both, according to Dr. Calfee. “Special practices are additional strategies to implement if MRSA hasn’t been adequately controlled with basic practices,” he says. The basic practices remain virtually unchanged from the 2008 version of the compendium recommendations, but the special practices section has been expanded to include interventions based on recent study findings that largely relate to universal decolonization.

“Studies show that performing daily chlorhexidine bathing to all ICU patients, regardless of their MRSA status, may reduce MRSA transmission and infection,” Dr. Calfee says. “Special practices also include various ways to use classic MRSA decolonization therapy—usually a combination of chlorhexidine plus intranasal mupirocin. Historically, MRSA decolonization therapy has been used only when patients are known to have MRSA. However, a recent, large study showed that a universal approach to using this therapy may be useful.” The recommendations discuss these and other approaches to help providers make informed decisions that are best for their institution.

Implementing Practices

The compendium recommendations encourage the “4E” approach—engage, educate, execute, and evaluate—to implementation. The guideline includes specific recommendations on how to implement the 4E approach and provides references to other tools, education materials, checklists, and more. “Take active surveillance testing for MRSA, for example,” says Dr. Calfee. “There’s a lot of information on the various types of testing, how to respond to different results, and what to do when waiting for results. This document walks providers through the steps that should be considered if they’re thinking about implementing one of these approaches. The guidelines also give the pros and cons of each.”

Existing Needs

More research is needed on the potential risk of developing resistance to agents used in universal MRSA decolonization. With more widespread use, this may impact future opportunities to prevent HAIs. “We need to clarify the long-term effects of some of the antiseptic- and antibiotic-related approaches to MRSA,” Dr. Calfee says. “Also, many believe that antimicrobial stewardship could be effective in helping control the spread of multi-resistant organisms in general. However, we lack data on exactly how effective antimicrobial stewardship is on MRSA infection and transmission.”

Until new data emerge, Dr. Calfee encourages providers to use the updated compendium recommendations to structure their approach to assessing and addressing MRSA infection and transmission within their institution. He stresses the importance of making an individual institutional risk assessment because issues are often different from hospital to hospital and because the resources that hospitals have to battle MRSA are not unlimited.

Readings & Resources (click to view)

Calfee DP, Salgado CD, Milstone AM, et al. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:772-796. Available at: http://www.jstor.org/stable/10.1086/676534.

Calfee DP, Salgado CD, Classen D, et al. Strategies to prevent transmission of methicillin-resistant Staphylococcus aureus in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(suppl):S62-S80.

Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol. 2013;34:1-14.

Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008;29:996-1011.

Dantes R, Mu Y, Belflower R, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med. 2013;173:1970-1978.

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