|Title:||The Management of MRSA Clones in Western Australia that are of Public Health Significance|
|Document ID:||Operational Directive OD 0089/07|
|Date of issue:||Thursday, 13 December 2007|
|Status:||NO LONGER APPLICABLE|
|Description:||The focus of this Operational Directive is imported clones of Methicillin-Resistant Staphylococcus Aureus that are considered to be of public health significance. Control measures are being taken by the WA Dept. of Health to minimise transmission of these clones in the community, residential care facilities and acute healthcare settings in an effort to prevent their establishment as endemic pathogens in WA .|
|Applicable to:||Health professionals working in community public health, acute healthcare settings and residential care facilities.|
|Period of effect:||from 13 December 2007|
|Authorised by:||Dr Neale Fong, DIRECTOR GENERAL, DEPARTMENT OF HEALTH, 13-Dec-2007|
|Print version:||View print version|
The Management of MRSA Clones in Western Australia that are of Public Health Significance
The emergence of infections that arise in the community due to clones (strains) of methicillin-resistant Staphylococcus aureus (MRSA) in healthy children and adults is now a global public health concern. Epidemics have been reported in Canada, United States and Europe. These community-associated clones of MRSA frequently possess a unique combination of pathogenic factors and consistently produce Panton-Valentine leukocidin (PVL), a toxin that is associated with white cell destruction and tissue necrosis. Although a majority of infected individuals have presented with skin or soft tissue infections, some develop complications such as necrotising pneumonia, bacteraemia, endocarditis, or osteomyelitis. Several fatal infections have occurred in otherwise healthy individuals.
Some clones of MRSA are known as “epidemic MRSA” or “EMRSA” due to their demonstrated ability to spread efficiently within and between healthcare settings causing significant infections. EMRSA are differentiated from other MRSA which do not necessarily cause epidemic problems. Early detection and intervention of novel epidemic clones is important to reduce their spread and prevent their establishment as endemic pathogens.
This Operational Directive outlines comprehensive strategies developed by the Communicable Disease Control Directorate to contain the spread of significant imported community-associated MRSA clones and novel epidemic clones with the aim of limiting their impact in Western Australia (WA).
2. Emergence of Significant MRSA Clones in Western Australia
In WA, community-associated MRSA strains were first observed in the early 1990s, initially in indigenous people in remote communities in the Kimberley region, and continue to dominate as the most prevalent MRSA in WA (79.5% of all isolates). Most WA community clones of MRSA tend not to cause serious problems in the community and infrequently carry virulence factors and PVL. However, imported clones that are well documented nationally and internationally to spread and cause serious infections in the community have been increasingly detected in WA in recent years. One of these clones is closely related to the USA MRSA clone (USA300) which has become their predominant strain causing severe progressive, recurrent skin infections and necrotising pneumonia in the community. USA300 has now emerged as a major cause of healthcare-associated bloodstream infections in that country and therefore presents new challenges to infection control programs. There were 12 cases of USA300 detected in WA in 2007 from January until August.
A novel epidemic MRSA clone called New York / Japan MRSA that has become the predominant healthcare associated clone in the USA has been identified in small numbers in WA since 2005. It has the ability to spread and replace existing clones within regions and has caused one outbreak in regional WA.
3. Action by Department of Health, Western Australia
Vigilance and determined control efforts are required in WA to limit the emergence of these significant imported community and novel epidemic MRSA clones in order to prevent them from becoming endemic in the WA community. As MRSA is notifiable in Western Australia and isolates are sent to and typed by the Gram-positive Bacteria Typing and Research Unit (GPTU), WA is in a unique position to identify the majority of these significant clones enabling effective intervention strategies.
Unlike most Australian states, the employment of comprehensive state-wide MRSA control measures in WA healthcare facilities has prevented MRSA from becoming endemic in acute care hospitals. The WA Department of Health has now referred mainly to strategies implemented in Europe in an attempt to decrease carriage rates of the significant emerging clones in regions, hospitals and residential care facilities.
The measures to be undertaken to reduce the impact of significant clones of MRSA include:
These measures are described in the following strategy documents:
(i) “Guidelines for the management of significant clones of MRSA in WA.”
(ii) “General Practitioner Guidelines. The management of infections in the community due to significant clones of MRSA”.
Acute healthcare settings and residential care facilities should use the guidelines in conjunction with DoH Operational Circulars for management of epidemic strains of MRSA (EMRSA) in acute settings and residential care facilities:
4. Actions to be Undertaken
4.1 Area Health Services (AHS) and Area Public Health Units (PHU)
4.2 HCAI Unit – Communicable Disease Control Directorate
4.3 Gram-Positive Bacteria Typing and Research Unit (GPTU)
Compliance with the requirements of this Operational Directive is mandatory.
Dr Neale Fong
This circular last updated: Thursday, 13 December 2007 at 10:38am