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Protecting your work force from MDRO infections

In recent years, MDROs have come under increased scrutiny, particularly in hospitals. As more infections become progressively resistant to antibiotics, the need to prevent and control these infections in other ways increases.

Because of The Joint Commission's National Patient Safety Goals (NPSG), specifically NPSG.07.03.01, which focuses on MDRO prevention, hospitals are well aware of the dangers these resistant organisms pose to susceptible patients.

Studies have shown that MRSA bacteria can survive on dry inanimate objects anywhere from seven days to seven months. VRE can live on a surface for five days to four months and C.diff spores can live for five months.

A recent study published in the July The Pediatric Infectious Disease Journal found that the rate of MRSA infections in infants in U.S. neonatal ICUs tripled from 1995 to 2004. Using data from the National Nosocomial Infections Surveillance system, researchers focused on late-onset infections that developed more than three days after birth. They discovered that the rate went from less than one infection for every 10,000 hospital days to roughly three, with the greatest increase occurring after 2002. Late-onset infections are typically transmitted by parents, healthcare personnel, and other contacts.

Although much of the focus on MDROs revolves around patient safety, workers put themselves at risk for easily transmittable infections such as MRSA on a daily basis. Without the proper use of personal protective equipment (PPE) and hand hygiene, healthcare workers put their patients and themselves at risk for infection. If an employee contracts such an infection, it could be considered a workplace illness and lead to OSHA involvement.

Prevention and control
Using standard precautions is easily the most important way to protect yourself from infection, says Peggy Prinz Luebbert, MS, MT(ASCP), CIC, CHSP, owner and consultant at Healthcare Interventions, Inc., in Omaha, NE. Fortunately for those working in a hospital, part of NPSG.07.03.01 requires hospitals to have an MDRO alert system in place by January 1, 2010, which will help IPs further protect staff members and patients from transmitting these infections Still, whenever a healthcare worker walks into a room, they should weigh possible risks and take the proper precautions, says Luebbert.

"If there is any time in the history of healthcare where it's more important to use standard precautions, it's now," Luebbert says.

These standard precautions include rigorous hand washing, PPE use, effective cleaning procedures, and respiratory etiquette compliance from staff members and patients. Have respiratory etiquette signs in high-traffic areas or at the front desk and offer alcohol-based hand sanitizer, tissues, and masks. If a patient coughs or sneezes in the waiting area or at the front desk, wipe the area with an appropriate disinfectant.

Luebbert says she often receives questions from receptionists who come in contact with as many sick patients as the healthcare workers. "They say, 'The patient comes and they stand in front of me, and they are coughing in front of me,' " Luebbert says. "My recommendation is, if the patient is coughing in your face, back away, and if need be, put on some facial protection, and then wipe down the area with disinfectant after that patient leaves."

Specific cleaning procedures are also important in prevention efforts, Luebbert says. Each facility should have a detailed plan in which high-touch areas and places such as the waiting room are cleaned on a routine basis.

"Between patients, they should be wiping down with any cloth-type product, wiping down high-touch areas between patients, and of course, cleaning up any bodily fluids," Luebbert says.

Worker protection
For the employer, PPE and training are crucial to protecting workers from common healthcare-associated infections, such as MRSA.

Employers are required to perform a hazard assessment and implement any feasible measures to protect employees from MRSA, an OSHA spokesperson said in an e-mail interview.

Kathy Rooker, safety officer and owner of Columbus Healthcare & Safety Consultants in Canal Winchester, OH, says that it is still the employer's responsibility to ensure that employee's wear the equipment provided.

Instruct staff members to put on and remove PPE correctly, including gloves, masks, face shields, and gowns, and make them aware of the dangers from common infections, Rooker says. Remind staff members to wash their hands regularly, especially before putting on gloves and after removing them. If employees are not complying with proper protocols, the employer needs to enforce disciplinary action.

"Infection control is a part of what I try to teach with hand washing and PPE playing a major role," Rooker says. "Those are the most important ways to keep [infections] from spreading. There is no way that we can control what comes in a doctor's office, or how the person got the initial infection, but we can control how we keep it from spreading."

Determining a workplace injury
Even with training and strict adherence to standard precautions, the risk of transmission still exists for MDROs such as MRSA. Although infections such as VRE and C.diff are relatively harmless to a healthy person, MRSA can infect even those without immunodeficiency, Luebbert says.

If the risk of infection in the workplace is present, it brings into question whether it is covered by OSHA under the workplace injury laws. For example, when an employee suffers a needlestick injury, the employer is obligated to pay for follow-up testing and treatment according to OSHA's Bloodborne Pathogens standard (1910.1030(f)(1)(ii)(C)).
The problem with a workplace MRSA infection is tracing the source of the infection. When a worker suffers a needlestick injury there is a direct, verifiable link. With a MRSA infection, there are few ways to be certain where and when the infection was contracted.

"There is so much MRSA in the community now, it would be very difficult [to trace it] and [employee health] wouldhave to do some tests to say you got it from this patient or that patient," Luebbert says. "I know they have donegenome tracingwith HIV after needlestick exposures in an office setting, but it would be unusual to be able to do that extensive of studies for MRSA in an office setting. There is too much in the community right now to say you got it one place or another."

However, employers would be obligated to determine where and when the exposure occurred, using methods similar to those used in evaluating other infectious disease exposures, according to an OSHA spokesperson.

Determining that moment of infection is extremely difficult to prove, Luebbert says.

"Typically, any time it is a workers' comp issue, you have to have a noted event associated with it," Luebbert says. "If someone has a cut on their hand and they end up with an MRSA infection in that cut and they are at work and they aren't wearing their gloves properly, then there is a potential risk of them developing an infection that was associated with work, but to be able to track it to that would be difficult."

In the end, if an employer conducts a proper risk assessment for the facility and provides adequate PPE and training for hand washing and standard precautions, you are taking all the correct precautions, Luebbert says.

Source: Adapted from Briefings on Infection Control, October 1, 2009