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

[Wishart, Michael]

Hi John

a) We follow the basic concept for MRSA clearance, but due to difficulty in getting swabs over repeat admission we dont enforce the more than 3 months part. We do ensure wounds are healed and no remaining indwelling devices, but only say more than 7 days since anti-MRSA therapy (not any other antibiotics). We have a rule of three negative sets (nose, axilla/groin and any specific previously positive site (eg urine) at least 24 hours apart before clearance.

b) See above

c) No perianal swabs for MRSA clearance. Only combined axilla/groin swabs (unless previous perineal abscess colonised or infected with MRSA; then we would).

d) Groin swabs are combined axilla/groin swabs. A swab moistened with transport media is used, and wiped along the axilla (both sides) and groin (both sides)

As an aside, we do collect rectal swabs for ESBL/VRE, and the instruction has always been to insert and rotate gently.

As a second aside, despite clearing previous MRSA carriers, we always re-screen them on re-admission, even if we dont use contact precautions for each subsequent admission after being cleared.

No actual references for any of this that I am aware of; it is just what our infection control committee has recommended based on experience and practicality.

Cheers

Michael

Michael Wishart

Infection Control Coordinator
Quality & Safety Unit | Greenslopes Private Hospital
Newdegate St, Greenslopes QLD 4120
tel: 07 3394 7919 | pager 047 | fax 07 3394 7985

e: WishartM@ramsayhealth.com.au

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—–Original Message—–
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?titleScreening_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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