MRSA: How to stop the spread
Why EMS should embrace its role as the front line in stopping the pathogen’s journey
Sponsored by Medline
By Laura Neitzel for EMS1 BrandFocus
One in three patients who die in a hospital have sepsis. While hospital workers are on the alert for the signs and symptoms of infections that can lead to sepsis, it’s not top of mind for many emergency medical service (EMS) providers – but it should be. According to the Centers for Diseases Control and Prevention (CDC), sepsis begins outside of the hospital for nearly 80% of patients.
Multidrug resistant organisms (MDROs) like methicillin-resistant Staphylococcus aureus (MRSA) are one of the most common sources of infection that can lead to sepsis. And because these bacteria can live for days to months on hard surfaces, effectively stopping the spread of MRSA through person to person contact and shared equipment or supplies can be a challenge.
A recent study to determine if EMS oxygen equipment could be a fomite for transmission of MRSA found that nine out of nine oxygen cylinders and regulators located in ambulances at an EMS station in North Alabama showed MRSA colonization. Further study of oxygen cylinders in an offsite oxygen cylinder storage area showed that 96% of the oxygen cylinders (67 out of 70) tested positive for MRSA colonization.
Cody Vaughn Gibson, the study’s researcher, quoted in Reuter’s, interviewed EMS personnel at the site “and found the staff was not aware of when the oxygen cylinders were last disinfected, while other surfaces that patients contacted were regularly decontaminated with disinfectants.”
While this revelation is disturbing, Rosie D. Lyles, MD, MHA, MSc, Director of Clinical Affairs at Medline, does not think this was an isolated incident affecting a single EMS station. “Since 30% of the population is colonized with staphylococcus aureus in their noses, most Americans are unaware because they have no signs or symptoms. While EMS providers are working in their normal routine; they’re moving oxygen tanks in and out and unconsciously wiping/touching their nose” said Lyles. This natural human behavior combined with the longevity of the pathogen helps spread this “incredibly smart MDRO.” To combat it, Lyles says, “you have to disrupt the cycle of cross-contamination.”
The MRSA study concludes that the development of universal disinfection protocols for oxygen equipment could help reduce the risk of patient infection due to cross-contamination.
While EMS medics are rightly focused on saving the patient’s life in the moment, they should be aware of the prevalence of pathogens like S. aureus in the ambulance setting and their role in preventing the spread of potentially deadly MRSA from one transport to the next.
Disrupt the pathogen’s journey
S. aureus bacteria are commonly found in the nose or on the skin of even healthy individuals and most people who carry it will not develop an infection. The infections that do result in sepsis are often of the intact skin, wounds, lungs, or urinary tract. Often the signs are not visible or are so common they could apply to many conditions.
When a patient is transported and dropped off at a hospital, EMS providers have little, if any, knowledge about whether the person they just transported was colonized with MRSA or any other MDROs or would develop sepsis in the hospital. Should a patient develop sepsis, it’s difficult to pinpoint the source of the original infection or the points of transmission.
Because an EMS provider doesn’t know what kind of situation they may be walking in to, Lyles says to practice infection control strategies in each and every case. “You want to break the chain of transmission of deadly pathogens, so you have to figure out how to do that in a way that fits the agency workflow and helps protect not only the patients, but EMS providers themselves.”
Three ways to disrupt the cycle
1. Implement/Follow infection control guidelines. While there are no universal protocols for disinfecting or decontaminating an ambulance, medical equipment and supplies, agencies should strive to develop one. Although there is pressure to move from one call to the next, there are relatively simple and common-sense infection control guidelines that EMS personnel can follow to reduce the risk of transmission of MRSA or other pathogens in the ambulance. These include:
- Maintaining optimal hand hygiene.
- Wearing personal protective equipment like gloves, gowns, masks, respirators and eye protection while decontaminating.
- Changing cot linens after every patient.
- Using CDC-recommended decontamination supplies daily.
2. Be aware of exposure points. “Knowing that MRSA and other pathogens can survive on unclean inanimate surfaces and a large percentage of the general population is colonized with MRSA; awareness is key to prevent cross-contamination to protect both the patients and EMS providers.” Said Lyles.
3. Use disposables. “Most EMS do not have the personnel, the time, or the capabilities of sterilization and cleaning. Hence, that's why disposables are very effective and needed,” said Lyles. Using proper protection like Critical Response Gloves, and Micro-Kill + can help avoid and clean contamination.
Understand the EMS role in disrupting the cycle
“When we're looking to break the chain of transmission of infectious pathogens, we need all hands on deck to combat this issue because it’s a public health concern across the spectrum of care. From EMS providers, to a hospital or a physician’s office; to disrupt the MRSA lifecycle, it takes collaboration among all medical providers to create that disruption.” Said Lyles.
We have to be really cognitive about having effective tools, making it easy for people to use them, making it part of their routine actions that then start to change this conversation and the equation.