National Nurses United

CE:8 page 2/8/08 2:25 PM Page 25 The patient simply presents him or herself at the retail clinic with an ailment that needs to be ruled out or made definitive (diagnosed). If the ailment is contagious, many of the clinic visitors will be exposed while in a waiting room or standing in an aisle, pending being seen. Retail store shoppers are also subject to exposure, partic- Wearing gowns and eye protection as appropriate for procedures that are likely to generate splashes or sprays of body fluids. Using contact precautions for patients with abscesses or draining wounds in which wound drainage cannot be contained. Dispose carefully of dressings and other materials that come into contact with pus, nasal discharge, blood, and urine. Clean examination room surfaces and patient rooms with an EPA-registered hospital detergent/disinfectant, in accordance with label instructions, or a 1:100 solution of diluted bleach (one tablespoon bleach in 1 quart of water). Use contact precautions for patients in acute-care inpatient settings known or suspected to be infected or colonized with MRSA. This includes: Greater spatial separation of patients (through placing infected patients in private rooms or cohorting patients with similar infection status), Use gown and gloves for all contact with the patient or their environment, and Use dedicated noncritical patient-care equipment. Precautions may be modified as appropriate for ambulatory care and other nonacute-care inpatient settings based on risk factors for transmission. Household and Community Setting. Patient education is a critical component of SSTI case management. To prevent spread of MRSA to others in the community, patients with MRSA, family members, household members, and close contacts should be counseled about the following control recommendations. Patients with suspected or confirmed MRSA infections should: Not pick, scratch, or squeeze pimples or boils. Keep wounds covered, particularly those skin infections that produce pus. Carefully dispose of soiled dressings/bandages. Heavily soiled bandages or dressings should be placed in a plastic bag before discarding into the trash. If not heavily soiled, they may be placed directly into the trash. Refrain from sports or other activities that involve close contact if the patient cannot maintain adequate hygiene and keep wounds covered with clean, dry bandages during activity. Wash clothes, towels, sheets, uniforms, etc. and any other soiled items using hot water, laundry detergent, and dry on the hottest cycle after each use. Pre-wash or rinse any item that has been contaminated with body fluids. Patients and their family, household members, and close contacts should: Perform frequent handwashing with warm water and soap (preferably not bar soap), especially before and after touching or changing the dressing/bandage. Alcohol-based hand sanitizers JANUARY | FEBRUARY 2008 ularly individuals who are immunosuppressed, medically fragile, or debilitated. What started as "providing another healthcare option for common ailments" has now caused the opening of a Pandora's box to deadly or debilitating infectious diseases. may be used instead of soap and water, if hands are not visibly soiled. Whenever possible, dry hands with a paper towel and discard paper towel after use. If using clean, disposable gloves to change a dressing/bandage, make sure that hands are washed before putting on and after taking off gloves. Maintain a clean environment. Make sure to clean and disinfect surfaces and objects in the immediate environment and shared common areas that may have become contaminated with wound drainage or infected body fluids. Wipe surfaces with a commercial disinfectant or a 1:100 solution of diluted bleach (1 tablespoon bleach in 1 quart water), and allow to air dry. Practice good personal hygiene, including showering thoroughly each day and as soon as possible after physical activity, direct contact sports, or working out. Make sure to use a clean, dry towel. Not share personal care items (i.e., razors, towels, bar soap, and water bottles). Not share any topical preparations (i.e., ointments, balm, lotions, deodorants, antibiotic creams). Not shave body skin for cosmetic or wound care reasons, as shaving can create micro-abrasions that can permit entry of bacteria. i "Methicillin-resistant" is a misnomer given that the infection is not necessarily solely resistant to methicillin but to many drugs. ii Moran, G. et. al. Methicillin-resistant s. aureus infections among patients in the emergency department. N. Engl. J. Med. 2006; 355(7): 666-674. iii It is difficult to get an accurate measurement of the percentage of staphylococcus cases that are MRSA and consequently the actual causes of deaths of patients because in the United States, health care facilities are not required by law to report or track MRSA cases. Thus, the official cause of death often may not be attributed to MRSA if there were other factors present. See "Drug Resistant Staph Killed More Americans than AIDS in 2005." Environment News Service (Online), October, 19, 2007, http://www.ens-newswire.com/ens/oct2007/2007-10-19-01.asp. iv This statistic means 1% of all reported staphylococcus infections are MRSA infections. See for example,, Simor, A. and Barry, C. MRSA in Canada – Progress, Priorities, Plans. (Seminar Transcript – Maunco Sanitation and Safety Supplies) Aug. 22, 2001, www.maunco.com/seminars/transcripts/mrsa.htm and Enright, M. MRSA Epidemiology & Evolution. Proceddings of the BRLSI (University of Bath), volume 9, 2005. v Kleven, Morrison, et. al. Invasive MRSA Infections in the United States. JAMA, October 17, 2007, Vol. 298, No. 15, 1763-1771. vi Simor and Barry, supra note 4. vii 2% represents the number of actual infections, while all MRSA colonizations are at 10% according to the Public Health Agency of Canada. Surveillance for Methicillin-Resistant Staphylococcus aureus in Canadian Hospitals – A Report Update from the Canadian Nosocomial Infection Surveillance Program. Volume 31-03, 1 February 2005, http://www.phacaspc.gc.ca/publicat/ccdr-rmtc/05vol31/dr3103ea.html. W W W. C A L N U R S E S . O R G REGISTERED NURSE 25

• Cover