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By: Caitlin Bourke, Jennifer Schemerhorn, Kathleen Brock Nursing 217 Teaching Project

MRSA
Methicillin-resistant staphylococcus aureus
Gram + bacterium Developed resistance to beta-lactam antibiotics Spread through contact with the bacteria S/S depend of location/type of infection Most commonly are skin infections; can lead to sepsis, cellulitis, endocarditis, pneumonia, osteomylitis, or TSS

C. Diff
Clostridium Difficile

Gram + bacterium Most prevalent hospitalacquired infection Strains with reduced susceptibility to both metronidazole & vancomycin are common Mild-mod. diarrhea, pseudomembranous colitis, toxic dilatation of colon, sepsis, and death

VRE
Vancomycin-Resistant Enterococci

Gram + bacteria Have become resistant to Vancomycin Are hardier than MRSA Can remain viable on environmental surfaces for weeks Similar to MRSA - S/S depend on type and location of infection

HANDWASHING!!!

ACH Policy & Procedure


CONTACT PRECAUTIONS: This is the most common form of disease transmission. It can occur from direct skin-to-skin contact, or indirect contact with a contaminated objects HANDWASHING!! Gown and gloves upon entering; face shield PRN Type of isolation indicated in pt kardex, noted on computer record, on pt chart, and outside pt room. Green sticker for contact precautions. Specify date of start, and initials of individual who started precautions

Contact Precautions
Gloves Gown Face mask/Shield PRN

Isolation
Essential!! Decreases transmission to other individuals Private bathroom is key with C. Diff Avoid transporting pt. Assess for adverse affects

Barrier Precautions
Dedicate equipment to the room or disinfect prior to exiting Disposable equipment when possible Dont bring anything into room that you dont have to! Change linens PRN

Antiseptics
Lysol, CaviWipes, Clorox for cleaning equipment Chlorhexidine for VRE Alcohol-based hand sanitizers are ineffective for C. Diff

Evidence Based Study


A before and after quasi-experimental design, by Mangini et al, examined the effects of contact precautions on the incidence of MRSA in a community hospital burn unit for 27 months, after an outbreak of MRSA infection. The combined rate in the burn ICU was 10.0 MRSA infections per 1000 pt days at baseline and 2.5 MRSA infections per 1000 pt days after implementation of contact precautions.

Pop Quiz!
1. Precautions used for C.Diff, MRSA, and VRE include: (Select all that apply) A. Direct contact B. Indirect contact C. Airborne D. Droplet

Pop Quiz!
Ques. 1 Answer: - A & B. Direct and Indirect Contact precautions

Pop Quiz!
2. Which of the following is used to clean equipment used with a pt with MRSA infection? A. Clorox and CaviWipes B. Chlorahexidine C. Alcohol-based products

Pop Quiz!
Ques. 2 Answer: -A. Clorox and CaviWipes

Pop Quiz!
3. According to ACH P&P, what is the most stressed action R/T contact precautions? A. Green sticker outside door B. Hand washing C. Gown and gloves worn

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Ques. 3 Answer: -B. Hand washing

Pop Quiz!
4. Case Study: 33y/o male pt admitted with active C. Diff. Has had multiple foul-smelling, watery stools. Upon emptying the bedpan the RN should don.. (Select all that apply) A. Gloves B. Gown C. Face shield D. Hair net

Pop Quiz!
Ques. 4 Answer: -A, B, & C. Gloves, Gown, and Face shield

Pop Quiz!
5. Are alcohol-based hand sanitizers effective against C. Diff? True ___ False ___

Pop Quiz!
Ques. 5 Answer: -False. Alcohol-based hand sanitizers are ineffective against C. Diff.

References
Larson, E.L., Cohen, B., Ross, B., & Behta, M. (2010). Isolation Precautions for Methicillian-Resistant Staphylococcus Aureus: Electronics Surveillance to Monitor Adherence. American Journal of Critical Care, 19(1), 16-26. Retrieved from http://ebscohost.com/ Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L., & Camera, I.M. (2011). Medical-Surgical Nursing. Assessment and Management of Clinical Problems: Elsevier Mosby Shenold, Carol. (2011). 9461: Clostridium Difficile: Superbug. Retrieved from http://www.netce.com/coursecontent.php? courseid=769 Siegal, J.D., Rhinehart, E., Jackson, M., et al. The Healthcare Infection Control Practices Advisory Committee (HIPAC). (2006). Management of Multi-Drug Resistant Organisms in Healthcare Settings. Retrieved from http://m.cdc.gov/