YIKES YIKES AND MORE DOUBLE YIKES!!!!

One in Every 20 Healthcare Workers Is MRSA Carrier

By Michael Smith, North American Correspondent, MedPage Today

Published: April 15, 2008

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
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Action Points:

* Explain to interested patients that methicillin-resistant Staphylococcus aureus (MRSA) is a dangerous strain of bacteria responsible for outbreaks of disease both in the hospital and in the community.
* Note that this study suggests that healthcare workers sometimes play a role in the transmission of MRSA and suggests ways of reducing that role.

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One in every 20 healthcare workers carries methicillin-resistant Staphylococcus aureus (MRSA), researchers said.

But the vast majority is without symptoms and only 5.1% have full-blown clinical infections, according to Stephan Harbarth, M.D., of the University Hospitals of Geneva, and Werner Albrich, M.D., of University Hospital Bern.

One implication is that screening efforts aimed at symptomatic infections are likely to miss a large proportion of colonized healthcare workers who might transmit the bacteria, they wrote in a literature review in the May issue of Lancet Infectious Diseases.

Instead, they said, "aggressive screening and eradication policies" should be used in an outbreak and in situations where MRSA has not reached highly endemic levels.

The researchers looked at 127 studies published from January 1980 through March 2006, to see how likely healthcare workers are to be infected or colonized by MRSA and to assess their role in MRSA transmission.

On the basis of the published evidence, they said, healthcare workers are usually vectors, rather than the main sources of MRSA transmission, implying that "good hand hygiene practices remain essential to control the spread of MRSA."

Among 33,318 workers screened in the studies, 4.6% on average were carrying MRSA, the researchers found -- usually in the nose, although other sites were found. Most (94.9%) had no symptoms.

Risk factors included chronic skin diseases, poor hygiene practices, and having worked in countries with endemic MRSA.

Poor infection control practices were linked to both acquisition and transmission of MRSA, the researchers said, but even good adherence to infection control and hand hygiene did not entirely prevent transmission to patients.

In fact, several studies were unable to identify any risk factors for MRSA colonization, the researchers said.

Of the 127 studies that screened healthcare workers, 106 looked at transmission to patients, Drs. Harbarth and Albrich said. Of those, 27 reported clear molecular and epidemiological evidence of transmission, and another 52 found that transmission was likely.

But the transmission was not dependent on a symptomatic infection in a healthcare worker, they said. In one reported case, a healthy worker was carrying MRSA in the nose-infected patients in a newborn nursery, leading to patient-to-patient transmission.

"Our search revealed 18 studies with proven and 26 studies with likely transmission to patients from healthcare workers who were not clinically infected with MRSA, the researchers said.

That finding suggested that a recent recommendation that screening efforts focus on healthcare workers with symptomatic infection is likely to miss the boat, they said.

"Staphylococcal dispersal is mainly dependent on whether the person is a nasal carrier," they said, so that "screening of infected healthcare workers only will likely miss a large number of asymptomatic personnel capable of transmitting MRSA to patients.
Instead, they suggest that institutions should screen workers as part of a pre-employment exam "irrespective of the presence of risk factors or purulent infections."

They might even periodically -- and without making an announcement -- conduct such screening before a work shift, Drs. Harbarth and Albrich said.

But they added that MRSA screening -- and treatment to eradicate colonies -- "should always be part of a comprehensive infection control policy including staff education and emphasizing high compliance with hand hygiene and contact precautions."

It's also important to avoid "feelings of guilt or stigmatization" among those found to be colonized, they said. "In analogy to needle-stick injuries, MRSA carriage or infection in a healthcare worker should be considered an occupational hazard," they said.

The researchers did not report any outside source of financing. Dr. Harbarth reported consulting fees from 3M, BioMerieux, and Roche Diagnostics. Dr. Albrich reported no potential conflicts.

Primary source: Lancet Infectious Diseases

Source reference: Albrich WC, Harbarth S "Health-care workers: Source, vector, or victim of MRSA?" Lancet Infect Dis 2008; 8: 289-301. [Lancet Infectious Diseases abstract]

© 2004-2008 MedPage Today, LLC. All Rights Reserved.

[Additional resource link provided by Epocrates: CDC Healthcare Infection Control Practices Advisory Committee: Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006]

What's up - Patient(s) have your wrist tied up

OK, I admit again that I was all so slow in getting the blog going, but it is here now and only two homies have posted. I'm sure all of us have a wide variety of nursing/medical articles we enjoy reading - post em like a fly on flypaper and let others in on your generousness! Otherwise I may show up on your door buzzing.

beeman

Living Wills & Advance directives:Tools for medical wishes

When I am admitting someone or a patient/family member asks me questions about living wills or advance directives, I have that moment of !!!!!!!!!. The article "Living wills and advance directives: Tools for medical wishes," below gives you a great tool to either handout or to teach from, either way you have a great tool at hand and it will enhance your teaching abilities. This is an abbreaveated version, for a print copy go to the website listed directly below.

Beeman
Original Article:http://www.mayoclinic.com/health/living-wills/HA00014

The issues surrounding serious illness and death aren't easy to discuss. But it's far easier on everyone if you have a living will and other advance directives in place before you're faced with a serious accident or illness. If you don't, you may find yourself in a situation in which you're unable to communicate your wishes regarding the extent of treatment efforts, such as resuscitation and life-support machines.

Living wills and other advance directives aren't just for the elderly. Unexpected end-of-life situations can happen at any age, so it's important for all adults to have advance directives.

Living wills are just one part of advance directives — forms that tell your doctor what kind of care you'd like to have if you become unable to make medical decisions. Learn more about living wills and other advance directives, how to create them, and how valuable advance directives can be to both you and your family.
Advance directives: More than just living wills

Advance directives are written instructions regarding your medical care preferences. Your family and medical professionals will consult these instructions if you're unable to make your own health care decisions. Anyone age 18 or older may prepare an advance directive.

Advance directives can include:

* Living will. This written, legal document spells out the types of medical treatments and life-sustaining measures you do and don't want, such as mechanical breathing (respiration and ventilation), tube feeding, resuscitation. In some states the living will may be known by a different name, such as health care declaration or health care directive.
* Medical power of attorney (POA). This is also called a durable power of attorney for health care or a health care agent or proxy. The medical POA form is a legal document that designates an individual to make medical decisions on your behalf in the event you're unable to do so. These forms allow your health care agent or proxy to use a living will as a guide, but interpret your wishes when unexpected developments aren't specifically addressed by your living will. The medical POA document is different from the power of attorney form that authorizes someone to make financial transactions for you. If you don't appoint a medical POA, the decisions about your care default to your spouse. If you aren't legally married, decisions fall to your adult children or your parents.
* Do not resuscitate order (DNR). This is a request to not have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. A DNR order can be put in your medical chart by your doctor.

Living wills and medical power of attorney each have limitations. For instance, you can't possibly plan ahead for every situation, so what you include in your living will might not apply in certain instances. Your medical POA isn't given a set of instructions on what to do in every situation, so you have to trust that this person will make decisions based on what's best for you.

The ideal approach to clarify your wishes is to combine the advance directives with a conversation with your loved ones. Talk about what's in your living will and explain how your values shaped your decisions. This gives your loved ones greater insight into what you'd want in medical situations.