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Beyond patients, MRSA is a big employee concern, too

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March 1, 2008

Mandated protection from Methicillin-resistant Staphylococcus aureus (MRSA, pronounced MER-sah) isn’t just for patients any more.

Some states have crafted bills that include healthcare worker safeguards to avoid the nasty staph infection.

The Health Professionals and Allied Employees (HPAE) union threw the spotlight on the issue by endorsing New Jersey S2580, a bill mandating patient screening for MRSA and hospital infection control reporting to state health authorities to check up on how they’re controlling the super bug.

New Jersey enacted the law in fall 2007, joining Illinois and Pennsylvania in mandating MRSA screening. Other states such as Washington and New York have similar bills proposed.
 
Watch for worker-to-patient infections

MRSA is and always was an employee safety matter—in addition to being a headline-grabbing patient safety issue—says Iris Udasin, MD, associate professor at the University of Medicine & Dentistry of New Jersey.

Improperly applied infection control measures not only can spread MRSA from patient-to-patient via employees, but workers can also take the illness home to their families.

“Screening people is important, but infection control practices [are also essential], whether it’s to protect the patient from the worker or the worker from the patient,” says Udasin, who also consults for hazardous waste and pharmaceutical companies.

In 2005, about 18,650 people died during hospital stays related to serious MRSA infections, according to the Centers for Disease Control and Prevention (CDC).
The CDC indicates that the main mode of transmission of MRSA is via the hands—especially healthcare workers’ hands—which are contaminated by contact with:
  • Infected patients
  • Infected body sites of the workers themselves
  • Devices, items, or environmental surfaces contaminated with body fluids containing MRSA
Tag team with infection control

It’s possible that all staff members at your hospitals aren’t on the same page regarding MRSA knowledge.

Corey Robertson, MD, MPH, medical director for the New Jersey Department of Health and Senior Services, and Udasin recommend that safety managers test employee competence on donning and doffing personal protective equipment. Hospitals should also provide solid, baseline knowledge about how MRSA and other common hospital infections spread.

Shoring up that knowledge begins with a hospital safety officer working together with infection control staff members to design educational materials and schedule in-service meetings led by a clinical authority (e.g., an epidemiologist).

Further, don’t hesitate to ask infection control professionals at your hospital to visit units more often to ensure that workers take proper infection control measures, Udasin says.

A hospital’s safety officer serves as the conscience for the facility, she says. Udasin encourages safety professionals to never settle for the “not enough money” excuse from administration to not carry out sound safety practices—especially when there’s evidence-based research proving a need.

“I feel really strongly about that,” Udasin says. “I think the doctors and nurses really want to do the correct thing, but it’s not always obvious what to do. You’ve seen a patient, you need a piece of equipment, [now] how do you get it clean?” Such deliberations branch the infection control and facility safety realms.
 
Look at policies with a safety eye
Include at least the following practical matters in your hospital’s MRSA safety policy, as noted by Udasin and Robertson:
  • Properly donning, using, and removing personal protective equipment
  • Ensuring that gear (e.g., stethoscopes) have undergone proper cleaning and aren’t transmitting MRSA from patient-to-patient
  • Dealing with patients who have active MRSA infections, including who should treat them
  • Educating all employees who might come in contact with a MRSA patient—down to ancillary staff such as dietary services and housekeeping—about how to protect themselves
  • Reminding folks about proper hand hygiene
Clean hands are a big protection against MRSA transmission. “Hand hygiene is a simple measure, but for whatever reason, it doesn’t come into routine practice,” Robertson says.
“For safety managers I think educating their workforce in respect to what MRSA is and how they can protect themselves would go a long way toward controlling the spread of MRSA in their particular facilities,” he adds.
 
Review the evidence yourself

Studies in Pittsburgh and Denmark have proven that hospitals can control MRSA through screening coupled with aggressive infection control practices.

The U.S. Department of Veterans Affairs’ Pittsburgh Health System has been active in MRSA screening and educating other hospitals on what works in battling the illness. The Consumer’s Union (of Consumer Reports fame) also strongly promotes the idea as a patient-safety measure. Meanwhile, some states require hospitals to publicly report infection rates, which might inspire healthcare facilities to try MRSA screening.

Added together, these discrete campaigns are putting a lot of attention on MRSA and forcing hospitals to tackle the problem, Robertson says.

Udasin says she’s in favor of whatever measures work, because it’s neither fair nor right that patients and employees can enter hospitals MRSA-free and leave with an infection. The employees are the reservoir for the disease, and the employees’ actions are a key to stopping MRSA’s spread.

“The good thing about the screening debate is that people are actually thinking about [MRSA],” Udasin says. Protection measures against MRSA will hopefully soon find equal ground with those for HIV and tuberculosis, she adds.



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