Tulare District Hospital



Tulare Regional Medical Center

Educational Services

RN Staff

Revised

MRSA Nasal Culture Module

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MRSA Nasal Culture Module

#021

Introduction:

Welcome to our module on MRSA Nasal Culture. The module is mandatory for RN employees. The intent of this module is to assure that all RN’s understand the requirements associated with collecting a nasal culture for the purpose of MRSA Active Surveillance Testing (AST). All employees that perform nasal swab cultures are required to follow the general guidelines regarding the procedure.

Description:

This module consists of the TRMC Policy #20-8031 related to MRSA Active Surveillance Testing (AST) and a copy of the guide Swab Steps at a Glance. A post-test will follow. Also, a Competency Assessment Tool (CAT) will be completed with hands on competency training/testing with microbiologist or a trained RN (optional).

Objective:

By completion of this module, the employee will:

1. Adhere to the district policy as it relates to MRSA nasal culture swabs.

Target Group:

All RN Employees

Prepared by:

Carol Bradford, RN, BSN, Staff Educator

Josh Warren, RN, Infection Preventionist

Course Sequence:

A. Read Policy #20-8031 MRSA Active Surveillance Testing (AST).

B. Read “Swab Steps at a Glance” Guideline.

C. Read Niles Law (SB 1058) Poster.

D. Take the Post-test.

E. Complete Competency Training and the MRSA Swab Culture CAT (optional).

F. Return the completed test and completed CAT to the Education Department.

TULARE LOCAL HEALTHY CARE DISTRICT

dba TULARE REGIONAL MEDICAL CENTER

POLICY / GUIDELINE

TO: All Departments

FROM: Administration

SUBJECT: MRSA Active Surveillance Testing (AST) Policy

I. PURPOSE

Identify the patient populations eligible for active surveillance testing (AST) for

Methicillin-Resistant Staphylococcus aureus (MRSA) in compliance with the California Health and Safety Code; and to outline the process for specimen collection, patient education and notification of test results

II. POLICY

A. Tulare Regional Medical Center shall comply with the requirements for MRSA AST according to California Health and Safety Code Sections 1255.8 and 1288.55.

B. All patients meeting the following criteria will undergo MRSA AST within 24 hours of admission:

1. Patients undergoing surgery with increased risk of infection: Hip Arthroplasty and Knee Arthroplasty.

2. Admitted patients who have been documented as discharged from an acute care facility within the last 30 days.

3. Patients who will be admitted to the ICU, including transfers from another unit.

4. Admitted patients receiving inpatient dialysis treatment. Patients who have received dialysis during their admission will also have a MRSA screening done at discharge. This is done in accordance with senate bill 1058

5. Admitted patients transferred from a skilled nursing facility.

C. Once converted from an observation/outpatient status to an inpatient; the patient must be tested within 24hours if any of the above criteria are met.

D. All ICU patients who have never tested positive for MRSA and have been inpatients greater than 7 days will undergo MRSA testing prior to transfer or discharge.

III. PROCEDURE

A. Patient identification:

1. Screening to identify patients meeting testing criteria will occur upon admission to the hospital and upon transfer to the ICU.

2. Patients meeting testing criteria identified through the admission process on the nursing units. Daily monitoring will be done.

3. Standard MRSA Screening Orders will accompany every admission order. (See Attachment D):

a. The nurse will screen patient’s status against the criteria for MRSA active surveillance testing (AST).

b. If the patient does meet the criteria for AST the nurse shall indicate the criteria that applies to the patient’s status eligible for AST. The nurse shall sign, date and time the entry. The physician attending to the patient shall sign, date, and time the order within 24 hours of its implementation.

4. Patients who have documented positive results will not be tested subsequently.

.

5. Patients will be surveillance tested no more than once per admission

6. Selected patients will be informed by the nurse the reasons behind nasal testing and expected procedure.

7. Patients refusing testing will be documented in the patient’s record.

B. Patient testing:

1. Nursing will obtain a nasal swab specimen for testing and submit to laboratory as follows:

a. Physician will order the MRSA nasal culture.

b. Nurse will collect the culture (must be obtained within 24 hours of admission).

i. Use a routine culture swab.

ii. Insert sterile, dry swab 1-2cm into the right nostril and gently rotate swab against the inside of the nostril for 3 seconds (enough pressure should be used when swabbing the nares, that it is a tickling sensation and not painful).

iii. Using the same swab, repeat step 2 in the left nostril.

iv. Place swab back into the transport media tube and label MRSA NARES along with Patient Label.

v. Order MRSA in computer ordering system.

vi. Send one culture per patient, DO NOT send multiple cultures.

vii. Send specimen and requisition to the lab.

viii. Results will follow in 24 hours.

2. Nile’s Law (SB 1058):

a. See Nile’s Law (SB 1058) Poster - Attachment A.

C. Patient notification:

1. The Physician will inform the patient or the patient’s representative about the results as soon as possible.

D. Quality Control:

1. Infection Prevention will receive both positive and negative results, and will log and analyze these results on a continual basis.

E. Although not part of MRSA AST, patients with MRSA positive results will be provided with oral and written instruction on aftercare and prevention of MRSA transmission.

1. See Attachment B & C MRSA Patient Education Information (English & Spanish).

IV. DEFINITIONS

A. "MRSA" means Methicillin-Resistant Staphylococcus aureus.

B. “AST” means active surveillance testing

V. REFERENCES

APIC (2007). Guide to Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital Settings

CDC (2006). Management of Multi-Drug Resistant organisms in Healthcare Settings

Retrieved 1/30/2009:

SB 1058 Bill: 20080925chaptered.pdf

Local San Joaquin Association of Professional in Infection Control Chapter consensus on 11/19/10 re: New legislation for MRSA screening prior to discharge for patients at greater risk for invasive MRSA infection.

Questions concerning any aspect of this policy/guideline should be referred to Administration.

This policy/guideline replaces and supersedes all previous policies/guidelines concerning this matter and is effective immediately.

ADDITIONAL INFORMATION from Isolation Policy:

Ten to 35 % of health adults are permanently colonized with S.aures (primarily in the nose) and the others are at least intermittently colonized. Therefore, S.aureus may be recovered from numerous body sites in both patients and medical personnel.

The 2007 CDC Isolation Precaution Guidelines recommend Contact Precautions for patients with colonized MRSA results and facilities where decolonization is not practiced (TRMC) suggests the patients remain in Contact Precautions throughout their admission stay. The guideline further suggests that Contact Precautions may reasonably be discontinued after antimicrobial therapy has ended, the infection has resolved, the patient has not been hospitalized for at least 3 months, and at least three or more surveillance cultures are negative over a 6-12 month period. (TRMC does not currently practice decolonization.)

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This ordering information is in the computer system (Cerner)

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