APIC Weighs in with 2nd Edition MRSA Treatment Guidelines

A few weeks back I wrote about the new (first) IDSA guidelines on MRSA treatment in hospitals. Not to be outdone, the Association for Professionals in Infection Control (APIC) has now released its second edition guidelines for MRSA treatment. APIC first put out guidelines on MRSA back in 2007, and with the recent explosion of MRSA-related research it was high time to take another look at new evidence and best practices in the field.

The new guidelines, assembled with contributions from eight Infection Control Specialists from across the U.S., addressed a broad range of topics encompassing epidemiology, surveillance, prevention, transmission, and education. Most of these sections have been updated and expanded based on new knowledge since 2007. Some of the major points of the report are summarized below:

–          MRSA epidemiology must be tracked carefully in each hospital through risk assessment procedures, and this is a necessary step before development of specific MRSA control interventions.

–          MRSA surveillance is of primary importance, and continuing surveillance measures should be the driver for updated annual hospital risk assessments.

–          Clinical sample cultures do not identify the majority of MRSA carrying patients. Active surveillance testing is also required to generate accurate surveillance results for the purpose of developing interventions.

–          Hand hygiene in the hospital is an extremely important part of MRSA control and prevention. All healthcare facilities should be implementing a comprehensive hand hygiene program.

–          Evidence now exists that MRSA transmission occurs not just through human to human contact, but also through contaminated equipment, supplies, and surfaces in the hospital. Effective cleaning and disinfection procedures for these objects will reduce MRSA transmission.

–          Education and cultural transformation are key parts of the fight against MRSA. Everyone working in the hospital must understand and buy into infection control procedures in order to achieve the greatest benefits.

–          Antimicrobial resistance is a major and growing issue in infection control, and antimicrobial stewardship programs are necessary in order to slow this process and maintain the utility of antibiotics for as long as possible.

Interestingly, the new APIC guidelines also, for the first time, addressed the concept of MRSA decolonization. While the authors did not recommend universal decolonization of MRSA carriers in hospitals, they did acknowledge growing clinical evidence for decolonization of specific high-risk populations. According to the report these populations include surgical patients at risk for surgical-site infections, patients undergoing dialysis, intensive care patients, and patients who have a history of recurring MRSA infections. Judging by the comments I’ve received to past posts on this site, there are many individuals who fall into the latter category and are wondering what they can do to break the cycle.

For more information on the APIC organization, visit: http://www.apic.org//AM/Template.cfm?Section=Home1.

To download and read the full APIC 2nd Edition Guidelines on Elimination of MRSA Transmission in Hospital Settings, visit: http://www.apic.org/AM/Template.cfm?Section=APIC_Elimination_Guides&Template=/CM/HTMLDisplay.cfm&ContentID=14743

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