National Nurses United

CE:8 page 2/8/08 2:25 PM Page 24 for an office or clinic visit. This is achieved through phone screening (signs, symptoms, cough, fever, diarrhea, and rash). The physician has access to a child's immunization record. This is a critical issue since many parents are not aware of the type of immunization the child has received. In contrast, retail clinics have no prior interaction with the patient; no appointment is made; no assessment or triaging information through phone screening has occurred; no assessment of possible contagious infection or exposure to someone with e.g. chickenpox, significant respiratory illness, febrile respiratory infection has been identified. MRSA or Methicillin-Resistant Staphylococcus Aureus BACKGROUND MRSAi is rapidly becoming one of the most serious health concerns in the United States. It now accounts for the single most frequent cause of skin and soft tissue infections in emergency departments in the United Statesii and is the estimated cause of death of 18,700 people in the United States in 2005, which is more than the number of deaths attributed to AIDS.iii In comparison to other developed nations, the United States has an alarmingly high level of MRSA, second worst only to Japan.While the Netherlands reports less than 1 percent and the Scandinavian countries report MRSA rates approaching 1 percent,iv the United States has a rate that is up to 64 percentv.This is a drastic increase from the 1999 level. As a comparison, the estimated rate was 36 percent.vi This also stands in stark contrast to geographically proximate Canada, whose reported rates are 2 percent.vii Different approaches to prevention and containment have emerged as countries become more aware of the problem of MRSA. Japan's extremely high MRSA rate is attributed to its lack of attention to the problem,and is evidence of the result when MRSA policies are not established and implemented. At the other end of the spectrum is the Netherlands,with its notorious"search and destroy"approach.The Dutch approach relies on active and extensive screening not just of all patients but also of healthcare workers,isolation of infected individuals and mandatory treatment (of patients and healthcare workers). Other approaches, such as that in the United Kingdom and Canada,put emphasis on the education of healthcare workers and standard infection control procedures related to basic hygiene practices such as routine hand-washing and proper laundering of linens and uniforms. STATEMENT OF THE PROBLEM Methicillin-resistant Staphylococcus aureus bacteria (MRSA) were first recognized in the 1960s and the first nosocomial outbreak in the United States occurred in 1968 in Boston, Mass. It soon became identified as a source of infection in hospitals and other healthcare facilities. Traditionally MRSA infections have been associated with hospitalization or other healthcare-associated risk factors, but in recent years healthcare providers have observed MRSA infections in an increasing number of people who lack traditional healthcare-associated risk factors. These people appear to have community-associated (CA) infections. 24 REGISTERED NURSE Beginning in the 1990s, there has been an increase in MRSA infections among persons who have onset in the community and who do not have healthcare facility exposure. This pathogen is referred to as community-associated methicillinresistant Staphylococcus aureus or CA-MRSA. Since there is no nationwide surveillance system for CA-MRSA, the incidence and prevalence in the United States is unknown at this time. Until recently, reports of CA-MRSA outbreaks had been uncommon. However, nationwide outbreaks are being reported with increasing frequency in a variety of community settings, especially where there is close physical contact or close living conditions. Outbreaks have been reported among members of sports teams, children in day care centers, prisoners, injection drug users, men who have sex with men, military personnel living in a dormitory setting, and Native Americans. Frequent skin-to-skin contact between individuals, compromised skin surfaces, sharing of personal items that may become contaminated with wound drainage, contact with contaminated surfaces, and poor personal cleanliness and hygiene are factors that may increase the risk of CA-MRSA transmission. Healthcare providers must be advised about the growing number of CA-MRSA infections in persons of all ages who previously were considered to be at low risk for infection. The information provided in this advisory is principally based on the report "Strategies for Clinical Management of MRSA in the Community: Summary of an Experts'Meeting Convened by the Centers for Disease Control and Prevention. March 2006." PREVENTION AND CONTROL Intact healthy skin is a natural barrier for infection.Therefore, preexisting cuts, abrasions, or other irritated areas can contribute to skin infections, as bacteria find an entry point in the broken skin. Healthcare Setting. Enforce strict compliance with hand hygiene. Use standard infection control precautions for all patients in outpatient and inpatient healthcare settings. This includes: Performing hand hygiene (handwashing or using alcoholbased hand gel) after touching body fluids or contaminated items (whether or not gloves are worn), between patients, and when moving from a contaminated body site to a clean site on the same patients. Wearing gloves when managing wounds. W W W. C A L N U R S E S . O R G JANUARY | FEBRUARY 2008

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