Re: Documentation of MRSA ‘clearance’ and swabs collected etc

[Lindy Ryan]

Dear john,

response as requested

a) yes for MRSa – do not yet clear VRE – waiting for further advice

b) we currently have an MRSA clearance checklist review form we
utilise here at Nepean that exactly follows the guidelines as
outlined
in ORIGINAL NATIONAL REC ON CLEARANCE AND SCREENING FOR MRO
the only addtional information/ modifications we include in the
clearnace process is an agreement not to clear until we have
support/sign off by our Mcirobiologist/ ID team here to ensure that
they
have been included in the consultation process once we get to that
point.(given a clinical perceptive from Micro/ID is part of the
overall
clinical review & as we some of the patients we are revieiwng for
deflagginfg have been pts of our Micro/ID team and their input is
always
of value ast this time given their specific expertise and knoweldge
of
patients thay may be directly involved in with treatment)

c) Nose and groin. Not specfic perianal – however the lab uses plates
with enhanced agar for detection of MRSA & VRE – all swabs from the
one
pt are plated together for screening.

d) we have developed a nurse intiated standing order for e- orders
that
included the process for collection. i have treid to attached this keep
getting rejected so will send direct to your email if interested?

cheers

Lindy

Lindy Ryan
Infection Control Clinical Nurse Consultant (CNC)

Nepean Hospital,
Western Cluster
Sydney West Area Health Service

email: ryanl@wahs.nsw.gov.au

“Infection Control is Everybody’s Business”

>>> John.Ferguson@HNEHEALTH.NSW.GOV.AU 4/06/2010 10:41 am >>>
Dear All

Could I ask:

a) whether people follow the practices recommended in this document for
documenting clearance to the letter?
http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/F22384CCE74A9F01CA257483000D845E/$File/mroscreenjun05.pdf
(excerpt below).

b) If not what modifications do you include? Please justify/reference
if possible.

c) What sites you screen for MRSA clearance swabs? Specifically, do you
include a perianal swab in clearance screens?

d) If you perform perianal, groin or perineal swabs, how do you
instruct for the sample to be taken? I’ve never seen a clear
instruction! Please share yours!

Thanks
John

A variety of resources and discussion is at
http://www.asid.net.au/hicsigwiki/index.php?title=Screening_and_Clearance_Process-MRSA

EXCERPTS FROM ORIGINAL NATIONAL REC ON CLEARANCE AND SCREENING FOR
MROs
The document recommended screening of the following sites for MRSA-
Nose swab
Wound(s) tissue/swab
Clinical specimens (wounds, catheter urine, respiratory, other as
clinically indicated)
During an identified hospital outbreak, the addition of a perineal or
groin swab is recommended.

GUIDELINES FOR MRO CLEARANCE
All the following criteria should be satisfied prior to certifying that
a patient has cleared a particular MRO:
More than 3 months elapsed time from the last positive specimen;
All wounds healed, no indwelling medical devices present;
No exposure to any antibiotic or antiseptic body wash for at least 2
weeks prior to screening;
In the case of MRSA, no exposure to specific anti-MRSA antibiotic
therapy in the past 3 months; and
Consecutive negative screens from above screening sites on two
separate occasions OR evaluation of
a single set of screening swabs with a broth amplification technique.

Dr John Ferguson
Director, Infection Prevention and Control Unit
Microbiologist and Infectious Diseases Physician
HUNTER NEW ENGLAND HEALTH
Locked Bag 1, Newcastle, NSW 2310, Australia
tel 61 2 49214422, fax 61 2 49214440

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