Prevalence of methicillin-resistant and methicillin-sensitive Staphylococcus aureus nasal colonization among patients at time of admission to the hospital.

Bodh R Panhotra

Dept of Infection Control, King Fahad Hospital, Al Hoful, Al Hasa, Saudi Arabia

Abstract: BACKGROUND : Methicillin-resistant Staphylococcus aureus (MRSA) is an important agent of hospital-acquired infection. The mode of entry of MRSA in the hospital might be on admission of patients with MRSA infection or nasal colonization. The present study was undertaken to determine the prevalence of MRSA nasal colonization among patients on admission to hospital. METHODS : Six hundred patients were screened for nasal colonization of MRSA on admission to hospital. Nasal swabs were cultured on salt mannitol agar and blood agar. Age, sex, previous admission to hospital and antibiotic therapy were recorded. RESULTS : S. aureus was isolated from the nasal swabs of 122 patients (20.2%) on admission to hospital. MRSA was isolated from 7 patients (1.1%) and methicillin-sensitive S. aureus (MSSA) from 115 patients (19.1%). Nasal colonization of S. aureus was higher in younger and elderly patients and significantly higher colonization was observed among females. The MRSA strains isolated from nasal swabs had a different antibiotic susceptibility pattern than those isolated from patients having hospital-acquired MRSA infection. Previous admissions to hospital, underlying disease antibiotic therapy were not risk factors for MRSA nasal colonization. CONCLUSION: MRSA nasal colonization of patients on admission to hospital is low in this region. The screening of every new admission would not be cost effective, but patients transferred form other institutions should be screened for MRSA. Standard infection control precautions should be strictly implemented to prevent the spread and control of MRSA infections. Read full text here

Wishing All

Chinese Sisters and Brothers

A

Very Happy and Prosperous 

Chinese New Year

Best Wishes and Waramest Regards

MalaysianKidneySPA

Cleaning and Disinfection in a Hemodialysis Setting 

by John Micheal Weir, BBA, CHESP, REH

http://johnmichaelweir.com/tag/mrsa/

The process of physical cleaning of environmental surfaces using detergent (soap), water, and friction is the critical step required prior to surface disinfection. The combination of the cleaning and disinfection processes is designed to remove and kill vegetative microorganisms on surfaces. Disinfection will not be effective in the presence of dirt, blood, or other bio burden. The  goal of the cleaning step is to remove bio burden and with it, the majority of pathogens. Disinfection is designed to be a synergistic and somewhat redundant step to ensure comprehensive removal/kill of pathogens on surfaces.

The CDC’s Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, states that, “noncritical surfaces (e.g., dialysis bed or chair, countertops, external surfaces of dialysis machines) should be disinfected with an EPA-registered disinfectant unless the item is visibly contaminated with blood. In that case, an EPA registered tuberculocidal agent with specific label claims for HBV and HIV should be used.”1 the commonly used disinfectant for blood contaminated environmental surfaces is a 1:100 dilution of bleach (500–600 parts per million [ppm] free chlorine).

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Revisitng Methicillin-Resistant Staphyloccus Aureas (MRSA) infections Abdelkarim Waness Division of Internal Medicine, King Abdulaziz Medical City, Dept of Medicine, Code #1443 PO Box11465 Saudi Arabia Abstract Within less than 50 years, methicillin-resistant Staphylococcus aureus (MRSA) made a tremendous impact worldwide. It is not limited to medical facilities and healthcare institutions anymore. Indeed since two decades, cases of MRSA infections arising from the community among apparently healthy individuals are increasing. In this paper, I will present a case of community-associated MRSA sepsis followed by a comprehensive review about the history, pathogenesis, epidemiology, clinical presentations, diagnostic modalities, therapeutic options, contributing factors, growing cost and other pertinent elements of this newly evolving epidemic of MRSA infections. MUST READ - full text here

The Challenge of Methicillin-Resistant Staphylococcus aureus 

Prevention in Hemodialysis Therapy.

Parker MG, Doebbeling BN.

Source

Division of Nephrology and Transplantation, Maine Medical Center, Portland, Maine VA HSR&D Center on Implementing Evidence-Based Practice, Indianapolis VAMC, Indianapolis, Indiana Regenstrief Institute and Indiana University Center for Health Services and Outcomes Research, Indianapolis, Indiana Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.

Semin Dial. 2011 Dec 9. doi: 10.1111/j.1525-139X.2011.00999.x. [Epub ahead of print]

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) infections have challenged care process and resource utilization in the acute hospital care setting for nearly 30 years. These infections have become important causes of morbidity, mortality, and a source of concern in the primary and emergency care context over the past decade. 

As individuals receiving recurrent therapy with features of both ambulatory care and acute care, hemodialysis patients are exposed to numerous opportunities for MRSA acquisition. Surprisingly, high prevalence rates for MRSA colonization have been demonstrated for both hemodialysis patients and their care providers. 

The necessity of vascular access and the persistent high prevalence of endovascular catheter use among patients repeatedly exposed to healthcare settings provide the perfect milieu for the troubling rates of MRSA infection, particularly bloodstream infections, in outpatient dialysis care. Dialysis industry shifts, including increased requirements for compliance and reporting in other areas of dialysis care, tax resources for infection prevention processes. 

Multifaceted strategies that include reassessment of vascular access care, attention to the interruption of MRSA transmission dynamics, and emphasis on organizational learning processes are needed to accomplish a meaningful reduction in the morbidity, mortality, and cost associated with MRSA infections in dialysis care.

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ALL MALAYSIAN

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MERRY AND HAPPY

NEW YEAR 2012

Warmest Regards and Best Wishes

MalaysianKidneySPA

The Scribner shunt: 50 years later

Joseph B Lockridge¹ and Sindhu Chandran²

1. ¹Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
2. ²Division of Nephrology, Kidney Transplant Unit, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
3. 
   
4. http://www.nature.com/ki/journal/v81/n1/full/ki2011344a.html

A 49-year-old male with end-stage renal disease returned to the United States 6 months following a repeat renal transplant in the Philippines that had failed 1 month after surgery. He presented with no records of his surgery or hospitalization, and stated that he had been on hemodialysis for 5 months. A Scribner shunt in the left arm (Figure 1) was identified by the nephrology service about 24 h following admission, with the connecting segment visible about 0.5 cm between the shunt lines (Figure 2). The arm was immediately covered with a dressing to minimize the risk of avulsion or interruption of the tubing, arterial clamps were made available at the bedside, and the device was removed 3 days later by a vascular surgeon. The ‘simplified’ or ‘poor-man's’ Scribner shunt (as it was known in the United Kingdom because it was inserted by the renal senior house officer rather than the surgeon) was developed in 1964 and consists of a simple loop of Teflon, which connects indwelling cannulae in the artery and vein. The connecting segment allows the artery and vein extensions to be attached to the dialyzer during dialysis and to be re-connected to each other after the treatment is completed. These shunts were prone to thrombosis, infection, and dislodgement and disappeared from most countries in the late 1970s and early 1980s, as venous catheters became widely adopted for temporary hemodialysis access. Many younger nephrologists in the United States have never seen a Scribner shunt. Prompt visual recognition is essential to avoid inadvertent manipulation or cannulation of the shunt, which can result in catastrophic bleeding.