Sunday, December 2, 2007

MRSA Explained: Best nursing practice on educating patients, in the outpatient setting, about community acquired MRSA and decreasing the spread of th

Community acquired MRSA, methicillin resistant staphylococcus aureus, is bacterial infection that is resistant to many antibiotics and is spreading at an alarming rate. Reduction in the spread of MRSA can be accomplished by educating patients about the bacteria and antibiotic misuse, how to decrease the spread during an active outbreak, and improved hygiene practices for everyday living.
In an outpatient setting where time is limited, an important key strategy when educating patients about MRSA is a short, simple explanation of the bacteria. According to Wingard (2005), ‘the keys to successful patient-focused education are to keep it simple and make it understandable” (p. 2). The following is a brief description of MRSA and it’s relation to antibiotic misuse that can be relayed to patients in an outpatient setting. “Some germs that commonly live on the skin and in the nose are called staphylococcus or “staph” bacteria.” (Group Health Cooperative, Pierce County Health Department & Washington State Department of Health, 2006, p. 2). “Staph” bacteria are harmless, unless they find their way into a break in the skin, like through cut. When the bacteria enter the skin, it can cause an infection. MRSA is a form of a “staph” bacteria except more harmful because it is harder to treat effectively with antibiotics. MRSA is the direct result of misuse and over prescribing of antibiotics. Misuse occurs, according to Plonczynski and Plonczynski (2005), when “a patient is given unnecessary or inappropriate antibiotics, or if antibiotics are discontinued prior to complete eradication of the bacteria”(p. 2-3). This inadequate treatment of bacterial illnesses allows time for the bacteria to mutate and become resistant to the antibiotic(s) given. These behaviors render the antibiotic to become less effective against future infections.
There are two types of MRSA: hospital acquired (infected while hospitalized) and community acquired (infected while out in the general public). This paper will focus on community acquired MRSA in an outpatient setting “because community acquired MRSA infections are more virulent” (Doughton, 2003, p. 2). When an individual is infected with MRSA, they frequently report that it started out as a pimple or blemish that they popped. In one to two days, they will have complaints of a red, hard area that is warm to the touch with a lot of pain, swelling and a rapid increase in size. Pus-like drainage may be noted too. These infections resemble a boil, an abscess or a spider bite. MRSA skin infections are commonly found on the buttocks, groin, legs, abdomen and the back. MRSA can also infect wounds, lungs, kidneys or even blood. An individual should seek medical treatment if they have any of the symptoms listed above. If an individual prolongs seeking medical care, the infection can cause a fever, nausea or tissue death to occur and even spread throughout the body causing death.
Another key strategy, of utmost importance, is to stress to the patients how MRSA is spread. As nurses, we need to emphasize that MRSA is transmitted via person to person contact and at a frightening rate. Dragon (2006) feels “one of the reasons infections may be spreading in the community, is that people have become more mobile…There are a lot more people working and leaving children in daycare. Housekeeping today is not what it used to be years ago; more people are at work” (p. 5). There are two ways to get the bacteria via person to person contact. One way is through contact with an individual that has an active MRSA infection with open sores, wounds or drainage. The other is through contact with an individual that is a carrier. A carrier is a person that harbors the bacteria, usually in their nose, but does not exhibit signs and symptoms of an infection. One may also contract the bacteria from infected objects, for example, using the same towel as an individual that has an active MRSA infection. Again, misuse of antibiotics by an individual may also lead to a MRSA infection.
Relating to patients the methods of preventing the transmission of the MRSA bacteria is an essential strategy in decreasing the rate at which it spreads. Prevention of a MRSA infection can be achieved through improved hygiene practices. The most crucial is increasing the frequency of hand washing. “Hand washing is the single most important infection control practice. Hand washing is essential because personal contact is the primary mode of MRSA transmission. Several research studies have shown that “hand hygiene is an effective method of controlling MRSA infection” (Ott, Shen, & Sherwood, 2005, p. 3). Improvement of regular grooming habits, such as cleaning dirty nails, use of alcohol based gels, no sharing of personal items, bathing on a daily basis, regular use of lotions to keep skin from drying or simply covering one’s mouth when coughing or sneezing, also decrease the spread of MRSA. Improvement of current lifestyle habits by taking nutritional supplements, eating healthier and exercising help to improve one’s own natural defenses against infection. Proper wound care and dressing changes are critical in reducing the spread of MRSA too. In a household affected by MRSA, laundry needs to be washed with hot soapy water with bleach, if possible, and dried at a high temperature to kill any MRSA bacteria. When cleaning household surfaces, any cleaner that states it is a disinfectant is sufficient. A mixture of one tablespoon of bleach to one quart of water is an adequate disinfectant as well. It is important to disinfect surfaces on a regular basis since MRSA bacteria can live on surfaces for days or even weeks. Some practices to use while out in the community to safeguard oneself and others are: Frequent washing of hands, carry alcohol based hand gel when one is not able to wash their hands, keep wounds covered with bandages and appropriate clothing, avoid individuals with compromised immune systems, do not participate in contact sports and clean gym equipment before and after use if gym provides disinfectant.
The points to emphasize when explaining MRSA to patients are the risks related to misuse of antibiotics and increasing the frequency of hand washing. If your facility has any pamphlets or other resources at hand for patient education, pass it along to the patient. In addition, give the patient an opportunity to ask any questions prior to ending the discussion.
We, as nurses, are aware of how critical patient education is and understand the need to decrease the spread of MRSA. Unfortunately, there are several disadvantages we nurses will encounter in regards to each strategy previously mentioned.
The first key strategy discussed was giving the patient a brief, simple explanation of the history of MRSA and preventing its spread. A disadvantage of this strategy is assuming that all of our patients readily understand the information given to them verbally or written. “Most adults read at an eighth-grade level and twenty percent of the population reads at or below a fifth-grade level, most health care materials are written at a tenth-grade level” (Keenan & Safeer, 2005, p. 1). Other factors that are barriers when educating patients include a person’s age, any preexisting, uncorrected sensory deficits (i.e. bad vision, hearing loss), educational background, and patients who know English as a second language. In addition, “when giving information verbally, talking too quickly reduces the chance the patients will understand what is being said” (Keenan & Safeer, 2005, p. 5). This is another disadvantage that is frequently experienced in a clinical setting where interaction between medical staff and patients is limited. When any of the above factors are combined, the end result will ultimately be poor patient education.
Enlightening patients about the misuse of antibiotics was also discussed as a strategy to inhibit the proliferation of MRSA. These efforts are undermined because “physicians routinely prescribe antibiotics for clinical syndromes in which antimicrobials are known to have no effect.” (Low, D & McGeer, A, 1997, p. 3). The reasons for routinely prescribing antibiotics range from patient demand to ease of giving a prescription due to lack of time to discuss why an antibiotic is not needed. This action conveys the wrong message to patients about what illnesses warrant the use of antibiotics. Furthermore, this behavior leads to increased noncompliance for antibiotic use and escalates the spread of MRSA in the community. Low and McGeer (1997) feel that “there is an urgent need both to improve prescribing practices and to provide the tools for physicians to diagnose more accurately those conditions for which an antibiotic is indicated” (p. 3) In relation to antibiotic misuse, is the reality of medical staff lacking education about MRSA. Many medical providers are not aware of the signs and symptoms of an active infection. Countless medical staff is ignorant of proper collection and testing techniques. Numerous physicians still misdiagnose this skin infection as a “spider bite.” “Therapy for infections due to community-acquired MRSA presents additional challenges for the clinician. The first challenge is to recognize these organisms.” (Moellering, 2006, p. 3). Unawareness about MRSA slows proper diagnosing, treatment and indirectly promotes its spread. According to Moellering (2006), “Our knowledge of community-acquired MRSA epidemiology is incomplete, which adds to the challenge of controlling infection by community-acquired MRSA” (p. 2).
In conclusion, community acquired MRSA is on the rise around the world. It is the cause of prolonged hospitalization of patients and increased costs in medical care due to frequent medical visits with several rounds of antibiotic therapy. The first step in controlling the spread of MRSA is to increase awareness of its existence by educating communities about the bacteria and its effects. As nurses, it is our job to stress the importance of this epidemic to our patients and have any information regarding MRSA readily available.


References
Doughton, S. (2003). Resistant Staph, Once confined to hospitals, now a threat to public. Seattle Times. P. A-1. Retrieved January 17, 2007, from Proquest database (409046991).
Dragon, N. (2006). Fighting today’s superbugs: infection control at the forefront. Australian Nursing Journal, 14(2), p. 16-19. Retrieved February 18, 2007, from Proquest database (1096108491).
Group Health Cooperative, Pierce County Health Department, & Washington State Department of Health. (2006) Living with MRSA.
Keenan, J. & Safeer, R. (2005). Health Literacy: The Gap Between Physicians and Patients, 72(3), p. 463-468. Retrieved October 26, 2007 from Proquest database.
Low, G. & McGeer, A. (1997). The Microbes Strike Back. Canadian Medical Association Journal, 15(12), p. 1703-1704. Retrieved October, 26, 2007, from Proquest database.
Moellering, R. (2006) The Growing Menace of Community-Acquired Methicillin-Resistant Staphylococcus aureus. Annals of Internal Medicine, 144(5), p. 368-370. Retrieved October 26, 2007, from Proquest database.
Ott, M, Shen, J., & Sherwood, S. (2005). Evidenced-based practice for control of methicillin-resistant Stapylococcus aureus. Association of Operating Room Nurses Journal, 81(2), pp. 361-364, 367, 369-372, 375-378. Retrieved February 18, 2007, from Proquest database (793987051).
Plonczynski, D. & Plonczynski, K. (2005). Antibiotic resistance: the impact on care of hospitalized patients. MedSurg Nursing, 160(7). Retrieved February 18, 2007, from Expanded Academic ASAP database.
Windgard, R. (2005). Patient Education and the Nursing Process: Meeting the Patient’s Needs. Nephrology Nursing Journal, 32(2), pp. 211-215. Retrieved March 6, 2007, from Proquest database (824946611).

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