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MRSA and More: An Infectious Disease Update for Nurses on the Go


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By Jennifer Larson, contributor

Health care-associated infections (HAIs) are a costly--and often deadly--problem for hospitals and health care systems, made more difficult by the fact that infectious disease information for nurses and other providers is constantly changing. Travel nurses need to be aware of each facility’s protocols and guidelines, as well as the latest findings from infection control experts.

Taking infection control from the national to the personal level

Many efforts and initiatives have been launched to combat HAIs, including national infection reduction goals that were established a few years ago. The U.S. Department of Health and Human Services set up the Federal Steering Committee for the Prevention of Health Care-Associated Infections, which in turn developed the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan).

But how does a national plan translate to individual practice? How can nurses prevent HAIs in their daily work?

Infection prevention experts have found some basic answers to these questions and they continue to learn more. One fact is certain: nurses can and do play a major role in keeping their patients safe.

“It’s an ongoing challenge but it’s a worthwhile challenge to engage in,” said Ann Marie Pettis, RN, BSN, CIC, director of infection prevention for the University of Rochester Medical Center, in Rochester, N.Y., and a member of the Association for Professionals in Infection Control and Epidemiology (APIC).

So here is the latest infectious disease information for nurses, highlighting one HAI and two other diseases making the new in recent months:

MRSA

First, some good news: the numbers of life-threatening infections caused by Methicillin-resistant Staphylococcus aureus, or MRSA, have been declining in recent years.

The Centers for Disease Control and Prevention (CDC) noted that invasive infections that developed in hospitals decreased by 54 percent (or 30,800 cases) between 2005 and 2011. Additionally, the number of deaths due to those MRSA infections fell by 9,000 over the same period.

Yet MRSA still represents a major threat to hospitalized patients’ lives or well-being.

New guidelines have just been released to combat the spread of MRSA. They are part of the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates, a revision of a 2008 publication, and the result of collaboration by The Society for Healthcare Epidemiology (SHEA), The Joint Commission, the Infectious Diseases Society of America (IDSA), the American Hospital Association and APIC.

Other HAIs such as Clostridium difficile or C diff--a very dangerous type of bacterial infection that is often related to exposure to health care settings--have also been addressed in their own updated sections of the Compendium, which is slated to be completed by the end of the year.

Many of the MRSA strategies will sound familiar, Pettis said, because experts have been recommending them for a while.  She stressed that now it’s time for everyone to fully embrace them.

“A lot of this is ‘Business as usual,’ and ‘Oh, by the way, we really mean it,’” she explained. “You really do have to pay attention to those basic things that will help prevent transmission across the board.”

For example, most nurses know that following strict hand hygiene protocols is imperative for infection prevention. Hand hygiene stations are everywhere, it seems, yet the American Journal of Infection Control recently noted that approximately 20 percent of U.S. hospitals don’t have alcohol-based hand sanitizer at some points of care.  Even where the hand hygiene stations exist, some organizations find that it is still an uphill battle to get everyone to use them consistently.

So one guideline calls for ensuring compliance with the CDC or World Health Organization’s hand hygiene recommendations.

Another guideline suggests that organizations conduct a MRSA risk assessment and focus on opportunities for transmission and estimates of facility-specific MRSA burden and rates of transmission and infection, and another calls for ensuring compliance with contact precautions for MRSA-colonized and infected patients.

The report also includes special recommendations to supplement the more traditional ones. One that’s worth noting is a recommendation for daily bathing with chlorhexidine gluconate (CHG), which would kill the germs that contribute to a number of healthcare-associated infections, not just MRSA.

“I think that’s an up-and-coming one that gaining ground,” said Pettis, who presented information on the SHEA/IDSA Compendium of Strategies at APIC’s recent annual conference in Anaheim.

Influenza

The 2013-2014 flu season packed a wallop, with nearly 10,000 people in the United States hospitalized due to H1N1 infection. Unlike most flu seasons, the majority of those affected this year (57 percent) were between the ages of 18 and 64, according to CDC officials.

The CDC also noted that nearly 90 percent of those hospitalized had the same strain of H1N1 that caused the 2009 flu pandemic. That strain has caused almost 200,000 deaths worldwide since that pandemic, according to a report published in the journal PLOS.

Experts continue to recommend that nurses and other health care professionals get a seasonal flu vaccine each year to reduce their chances of contracting the flu themselves or transmitting it to their patients.

Chinkungunya virus

The West Nile Virus isn’t the only mosquito-borne virus making the news; a new one that originated in Africa has hit the Americas.

More than two dozen cases of the Chinkungunya virus have been confirmed in Florida, with new cases now officially confirmed by health officials in North Carolina, Nebraska and Indiana. Two cases have been confirmed in Tennessee, but county health officials noted that the infected people had recently traveled to the Caribbean. Other suspected cases are under investigation.

Fever, joint pain and headaches are the most common symptoms of this virus, which is not deemed a fatal virus. The only way to prevent the Chinkungunya virus is to avoid getting bitten by a mosquito carrying it, so people are encouraged to wear long sleeves and pants, to avoid standing water outside and to use insect repellant.

Related articles and resources:

Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Update - APIC
Hand Hygiene in Healthcare Settings - CDC
Preventing Infections in Cancer Patients: What Nurses Can Do
Nurse Staffing and Burnout Linked to Hospital Infections

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