[Dysphagia] Infection control

[eripley at yahoo.com (Irene Campbell-Taylor)]

I have found with many health care personnel that awareness of the ease of spreading infection is lacking and asepsis is often not adequately taught. How many of you scrupulously wash your hands both before and after seeing a patient? Even if you wear gloves? Even if you don't touch the patient? How many know of the multiple environmental sources of contamination? Please consider the following re MRSA:

MRSA has become a commonly encountered pathogen in the clinical setting. It causes severe morbidity and mortality worldwide, with death rates in patients with MRSA infection ranging from 20% to 50% Spreading easily from patient to patient, MRSA infection also poses a problem for nursing homes. MRSA has been isolated most often from urinary catheters and gastrostomy tube sites in nursing home patients (Mulhausen, Harrell, Weinberger, Kochersberger, & Feussner, 1996). Patients transferred from long-term care facilities to the hospital often act as nosocomial reservoirs of MRSA. However, the low incidence of MRSA infection in nursing homes indicates that many nursing home residents may be colonized with MRSA and act as carriers. Alarmingly, increasing numbers of community-acquired MRSA infections have been identified for the first time. This is particularly worrisome because infection has occurred in persons with no known predisposing factors (Herold et al., 1998). The increasing spread
 of MRSA in community settings could pose a public health threat in the near future.

Risk factors:

   Debilitated patient in intensive care unit. 
   Recent exposure to broad-spectrum antibiotic therapy. 
   Presence of a surgical wound or decubitus ulcer. 
   Presence of invasive dwelling devices: intravenous catheter, urinary catheter, endotracheal/tracheostomy tube, gastrostomy tube. 
   Physical proximity to a patient colonized or infected with MRSA.

Infected or colonized patients are the major reservoir of MRSA in institutions. Colonized patients carry the MRSA organism in epithelial and mucosal regions without suffering MRSA infection, and patients carry MRSA with no obvious signs of colonization. The carrier state is clinically significant because any surgical intervention or exudative skin condition will predispose the MRSA carrier to MRSA infection. Also, health care personnel unknowingly have contact with carriers of MRSA and transmit the organism to vulnerable patients.

General consensus identifies health care providers as the major mechanism for patient-to-patient transmission of MRSA (Boyce, 2001; Pittet, 2001; Simor, 2001). Physicians, nurses, and visitors misperceive superficial contacts with infected patients as "low risk" for contamination. However, hand contamination with MRSA commonly occurs even during brief or noninvasive patient contact (Afif, Huor, Brassard, & Loo, 2002). The hands of nurses and physicians frequently become transiently colonized with MRSA after examining an infected or colonized patient. Health care providers often transmit the MRSA organism from patient to patient due to inadequate handwashing.

Studies show that under routine hospital practices, health care provider compliance with handwashing protocol between patients is less than 50%. The handwashing technique and duration is also often inadequate Isolates of MRSA have also been found on environmental surfaces, particularly computer keyboards and sink faucets in ICUs. This suggests that sources of environmental contamination are not limited to the patient's belongings or patient's room. 

 



Dr I Campbell-Taylor
Clinical Neuroscientist
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