Vol. 16 Issue 22
Subacute and Long-term Care
Control MRSA With Good Hand Hygiene
Rehab patients with infections tend to be more ill, more dependent, and take longer to achieve therapy goals. Among many microorganisms causing infection, Staphylococcus aureas, or "staph," are bacteria that are found on the skin and in the nose of 20 to 40 percent of the general population. The bacteria are harmless until they penetrate the skin or invade other parts of the body, causing an infection.
Facts about MRSA
MRSA is the term for methicillin-resistant S. aureus. MRSA is also called multiple resistant staph because the bacteria rapidly develop resistance to many different antibiotics. MRSA is the most common cause of surgical wound infections and the second most common cause of health care-associated pneumonia and systemic infections of the blood and urine.1
Health care costs for patients with MRSA are double that of patients with methicillin sensitive staph (MSSA). This is because intravenous vancomycin, the antibiotic of choice, is expensive, and because more nursing care is needed. In the past, MRSA has been a problem mainly in hospitals and nursing homes.
Starting in 2000 there have been many reports of MRSA infectionsparticularly skin and soft tissue infections such as boils, abscesses, and cellulitisoccurring among persons in the community without any health care contact. These infections are called community-associated MRSA, or CA-MRSA.
The most common mode of MRSA transmission is through the hands of health care workers. Patient to patient infection is rare. PTs and PTAs can help control the spread of MRSA by practicing hand hygiene before and after every patient contact. Numerous studies in hospitals have reported unacceptable hand hygiene compliance rates of less than 50 percent.2 CDC guidelines recommend:3
• If hands are visibly dirty, wash with antimicrobial soap for at least 15 seconds. Be sure to rub the fingertips and fingernails. Hands should be thoroughly dried with two paper towels.
• If hands are not visibly dirty, use an alcohol-based waterless product. Use enough to completely coat the hands and rub vigorously until dry, at least 20 seconds. Alcohol-based hand rubs take less time to use than traditional hand washing. They reduce the number of microorganisms on the skin by over 99 percent, are fast acting and cause less skin irritation than soap and water.
• The use of gloves does not eliminate the need for hand hygiene. Studies show that you cannot remove gloves without contaminating your hands. Likewise, the use of hand hygiene does not eliminate the need for gloves.
• Health care workers should avoid wearing artificial nails, which harbor microorganisms, and keep natural nails less than one quarter of an inch long.
• Use dedicated equipment for each infected patient, such as a gait belt and walker.
• Encourage visitors to practice hand hygiene. Visitors to long-stay patients often get acquainted with other patients and stop in to see them.
Pat Preston, a national consultant on the control of infectious diseases, has obtained an advance copy of new CDC guidelines for MRSA which will be available to the public in 2006.4 According to these guidelines, if MRSA is contained or colonized, therapists can use standard precautions using gloves and hand hygiene before and after treatment. Gown and masks may be used but are optional.
Colonization refers to the presence of MRSA on the body although the patient has no symptoms of infection. Colonization is a problem because 30 to 60 percent of these patients eventually develop an infection.
If MRSA is not contained, then therapists should observe contact precautions and don gowns, masks, and gloves (in that order) before entering the patient's room. Infections which might be uncontained can come from patients with MRSA in the sputum who are coughing, patients with draining wounds, and incontinent patients with MRSA in the urine.
Although the incidence of MRSA is increasing, it can be controlled. By practicing meticulous hand hygiene, PTs and PTAs not only prevent the spread of infections but also serve as role models for other health care workers.
1. Warden, J. (1997). Germ warfare. Contemporary Long-term Care, 20(8), 62-66.
2. Lankford, M.G. et al. (2003). Influence of role models and hospital design on hand hygiene of health care workers. Emerging Infectious Diseases, 9(2), 217-222.
3. Department of Health and Human Services, Centers for Disease Control (2005). Retrieved from the World Wide Web, www.cdc.gov/handhygiene
4. Preston, P. (2005). Infectious diseases. In-service presentation to Consonus Rehab Directors, Milwaukie, OR.
Emi Storey is clinical lead physical therapist for Consonus Rehab Services, based in Milwaukie, OR. An alumna of Stanford University, she has worked in long-term care for 14 years. Bob Thomas is a geriatric physical therapist and serves as president of Infinity Rehab, based in Wilsonville, OR. He lectures nationally for GREAT Seminars on rehab solutions for the elderly and is an adjunct professor at Pacific University.