The Heat Is On: Control of Community-Acquired MRSA in a Burn Center

ISSUE: Over the past decade, Methicillin resistant Staphylococcus aureus has emerged as a cause of skin and soft tissue infections in the community. Most cases of community acquired MRSA (CA-MRSA) take the form of pustules, furuncles or boils. Outbreaks of CA-MRSA infections in correctional institutions and in sports teams have been documented. In 2005, two CA-MRSA outbreaks occurred in the Burn Center at the University of Kansas Hospital. PROJECT: The first outbreak affected six inpatients and one employee, a hydrotherapy technician. PFGE analysis indicated that all isolates were the same strain of CA-MRSA. This outbreak occurred over a 2-month time frame, and ended after strict infection control measures were implemented. Infection control measures include placing all Burn Center patients in Contact Precautions, surveillance cultures for multi-drug resistant organisms (MDROs) on admission to the unit, limiting staff access to the unit, strict hand hygiene compliance, meticulous attention to environmental cleaning, and daily examination of all inpatient and outpatient Burn Center patients for evidence of CA-MRSA lesions. During the outbreak investigation it was noted that pillows used in the hospital were not fluid-proof, and when cut open, many were visibly contaminated with body fluids. Within 2 weeks all pillows were replaced with a fluid-proof style. RESULTS: The second outbreak occurred 5 months after the first, and affected six patients. Infection control measures were again implemented, and the outbreak ended. No new cases have been identified in the past 6 months. LESSONS LEARNED: Burn patients are highly susceptible to infections, including those caused by CA-MRSA. These infections are readily transmitted from one patient to another, and can be spread to healthcare workers. Adherence to basic infection control measures such as hand hygiene and environmental cleaning, as well as less common measures such as placing all patients in Contact Precautions and screening patients on admission for MDROs were effective in controlling two outbreaks of CA-MRSA. image