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Title Decolonization Therapy in patients with Methicillin-Resistant Staphylococcus Aureus (MRSA) in outpatient Haemodialysis Centres in Singapore: An Evidence-Based Quality Improvement Project |
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Type Oral Presentation |
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Theme 18th Asian Colloquium in Nephrology (18th ACN 2019) |
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Topic Dialysis: Haemodialysis |
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Main Author Kai Jun Cindy Chan1 |
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Presenting Author Kai Jun Cindy Chan1 |
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Co-Author Luisa Beba Malones 1 Yin Wai Lwin1 An Rui Andrea Sng1 Arnie Julie Binti Paulus1 Mary Tan Sabrina Haroon-Wong2 |
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Department / Institution / Country Department of Nursing / National University Hospital / Singapore1 Division of Nephrology / National University Hospital / Singapore2 |
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Abstract Content: Introduction, Method, Result, Conclusion Introduction Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging public health concern. Once colonized, patients on Haemodialysis (HD) had a 100-fold increase in risk of getting MRSA bacteraemia. Intranasal mupirocin ointment was previously recommended for use in MRSA decolonization with 64% success rate. However, with a rise in mupirocin resistance, octenisan intranasal gel is a new non-antibiotic alternative. This project aims to determine if Octenisan intranasal gel and chlorhexidine shower gel could be used to decolonize patients with MRSA in Singapore on HD.
Method All patients on outpatient HD at Fresenius Medical Centre (FMC) and National University Hospital (NUH), who are MRSA positive at nasal, axilla and groin are recuited. Based on the JBI best recommended practices, an audit tool, patient education material and workflow were developed to facilitate the teaching of patients on the decolonization process in a 30-minutes teaching session. On day three and day five of the treatment, a nurse will call them to render any necessary support. Subsequently, patients will go for MRSA swab cultures on three different days on the following week.
A total of 18 patients were recruited. Three patients (16.6%) did not turn up for teaching and the remaining 15 adhered to treatment. Out of which, 11 patients (73.3%) were MRSA free and four patients (26.7%) remain MRSA positive. Nurses also achieved a 100% compliancy in using the teaching material and workflow during the decolonization process.
The use of Octenisan and chlorhexidine body wash was found to demonstrate slightly better decolonization over what is reported in the literature. Octenisan nasal gel and chlorhexidine body wash when used properly can be used to decolonize patients with MRSA in the local population. A systematic workflow incorporating patient education further helps to improve patients’ adherence. |