The Nose Knows: Act 52 regulations for Methicillin Resistant Staphylococcus Aureus (MRSA) screening. Impact on an Inpatient Behavioral Health Facility

Background: Act 52 was signed into law on July 20, 2007, as part of the “Prescription for PA” healthcare reform plan. The Act made amendments to the Medical Care Availability and Reduction of Error Act to reduce and prevent health care-associated infections (HAI’s).  A key component of the Act was identification of patients colonized/infected with MRSA or other Multi-Drug Resistant Organisms by requiring screenings for all long-term care (LTC) and other high-risk patients admitted to the hospital.  This involved developing a process for these patients to be flagged so that a nasal swab could be obtained during their H&P. Western Psychiatric Institute and Clinic (WPIC) is part of the University of Pittsburgh Medical Center and includes services provided at the 289 bed inpatient Behavioral Health Facility (BHF)as well as outpatient locations throughout western PA.

Objective: To describe the impact of Act 52 MRSA screening in a BHF.

Methods: Patients transferred from acute or LTC to WPIC are required to be screened on admission. The admissions team flags these patients and alerts the Diagnostic Emergency Center or clinical unit to prompt nasal screening for MRSA.  If positive, an Infection Control (IC) Report is sent from the Micro lab to IC and clinical unit via printer. This includes  patient name, MR #, culture date, site, precautions needed and website for staff to obtain educational materials. This data is entered into the registration system (Medipac) and the IC surveillance program (Theradoc) by IC, facilitating appropriate precautions on this and subsequent admissions.  

Results: Of the 36,219 admissions between 1/07 and 11/09, 2,028 (5.6%) patients were admitted from acute or LTC. As per state law, these patients are MRSA screened. Droplet/Contact Precautions (DCP) are used at UPMC for patients with MRSA. Unlike acute medical centers where equipment is stored in the patient room, DCP poses a peculiar problem for patients in BHF.  BP cuffs, thermometers and gloves are considered contraband as they could be used to injure self or others and are stored in a locked cart outside of the patient room. Unlike acute care, the patient must leave their room to enter the therapeutic milieu. Modifications allow attending group if compliant with DCP. If the patient cannot comply with mask, placement of the patient ≥ 3 ft. from others is used. The patient room is located adjacent to a BR reserved for that patient. When staff enter the patient’s room, they must wear a mask and gloves; gown if the task indicates such. Prior to Act 52, few patients were identified as MRSA colonized/infected. Since then, an average 6% are in isolation for MRSA. 
Conclusions: .        Most patients are compliant with DCP, but some are unable to wear a mask as on the Geriatric unit.
·         When masks cannot be worn, the patient is placed ≥ 3 feet away from other patients.
·         Implementing DCP in a BHF can be challenging but not impossible.