Methicillin Resistant Staphylococcus aureus

Shannon Rutz
An a opposable thumb, four fingers, and a palm, that some say, ‘carries your future.’ As nurses, we are trained that by our own hand, we can convey compassion, empathy, and trust. Unfortunately, nurses can infect patients, too.
Methicillin Resistant Staphylococcus aureus(MRSA) is one of the most common causes of community and health care associated infection (Graham lll, P. 2006). Hands of health care workers are the most prevalent form of transmission from patient to patient (Public Health 2007). There can be a large dichotomy between what nurses are trying to accomplish and what they may actually be doing. With increasing incidence of cross transmission among patients in clinical care settings and hospitals, education and protocol should take the highest priority in preventative nursing practices.
In 1940, the discovery of penicillin helped to cure bacterial infections around the world. Revered as the answer to all bacterial infections, the medical pioneers were unaware of what was to come. In 1961 the first strain of Methicillin Resistant Staphalococcus aureus was identified (Capriotti, T 2003). A bacterium that developed the ability to destroy penicillin by producing an enzyme called beta-lactamase (Capriottti, T 2003). The impact of this “super bug” resonated among the medical community. In 2002 a study found that approximately 84 million and two million noninstitutionalized
persons in the U.S. population are colonized with MRSA, respectively (Graham lll, P. 2006). It caused severe morbidity and mortality worldwide, with death rates in patients
with MRSA infection ranging from 20% to 50% (Capriotti, T 2003). Clinical manifestations of MRSA include but are not limited to: abscesses, endocarditis, osteomyelitis, postoperative pneumonia, and surgical/skin infections, or death (Ott, Shen, Sherwood. 2005).
As nurses, it is our responsibility to first do no harm. Yet, after receiving education and following strict guidelines, MRSA seems to be increasingly more prevalent in care settings. Where is the breakdown in nursing practices?
In 1860, Florence Nightingale wrote, “the greater part of nursing consists in preserving cleanliness” (Practices 2004). That is a great start to an integral part of nursing practices. With hands being the major transport system for MRSA infections, it seems that the first step to reduction in cross contamination would be to educate nurses about preventing infection. Education that must include teaching proper hand washing techniques, standard precautions, aseptic practices, facility isolations procedure, and maintaining good personal hygiene (Spaulding, L 2006). Studies show that under routine hospital practices, compliance with hand washing protocol between patients is less than 50%. The technique and duration of the hand washing was also inadequate (Capriotti, T 2003). Reasons given for non-compliance ranged from lack of sufficient facilities, lack of time, high patient load, urgency of care for patients, and dermal irritation (Capriotti, T
2003). Artificial nails have also been found to carry greater bacterial counts than natural nails, thus increasing bacterial contamination (Capriotti, T 2003). Hand washing is the single most important infection control practice (Ott, Shen, Sherwwod. 2005).
A recent study compared the effectiveness of three modes of different hand hygiene practice among health care workers:
• hand wash using chlorhexidine gluconate; water-based, antiseptic had washing soap used for one minute
• hand rub using ethanol; waterless, alcohol-based, antiseptic hand rub solution used for 30 seconds
• waterless, alcohol-based antiseptic gel hand rub for 30 seconds
The study showed that repeated hand rubbing for 30 seconds with ethanol was better tolerated than repeated hand washing with antiseptic soap (Capriotti, T 2003). There was greater compliance with the practice of using the ethanol for 30 seconds than with the one-minute of washing with soap (Capriotti, T 2003). Compliance with hand washing is also very hard on health care workers’ hands. The Centers of Disease Control, CDC, recommends use of hand lotions and creams during non-patient contact, such as breaks or before and after work (Capriotti, T 2003).
While hand washing is the first line of defense in prevention of the spread of MRSA, the CDC recommends patients who are colonized or infected should be placed in isolation (Ott, Shen, Sherwood. 2005). Isolation is beneficial because it can help
minimize close contact, which increases risk of contamination, and nurses tend to wash their hands more when caring for patients in separate rooms (Ott, Shen, Sherwood. 2005).
Even with the best nursing practices, if procedures are not followed the benefits of MRSA prevention fails to accomplish its goal. Standard precautions to control the spread of MRSA:
• Wash hands after contact with patient fluids and contaminated items, whether gloves are worn or not
• Wash hands immediately after gloves are removed between patient contacts
• Use gloves when touching pt mucous membranes and non-intact skin
• Wear a gown if splashes or sprays may happen during procedures
• Use single-use disposable equipment
• Clean pt environment with antiseptic solution daily
• Dedicated medical equipment for patients in isolation
The complete list is available through the Centers of Disease Control who have provided a standard guideline (Capriotti, T 2003). Special care should be given to those that are at high risk for MRSA. Those included are: invasive dwelling devices, nursing home pts, critically ill pts, presence of a wound or decubitus ulcer, and proximity to a patient with MRSA (Capriotti, T. 2003). These procedures and guidelines are set forth to protect the
patient along with the nursing community. Many nurses not only have passed MRSA between patients, they have contracted the infection themselves. By protecting ourselves
as nurses, we can perform safely for our patient, giving them the protection that they need to have productive and infection-free hospital or clinic stays.
The incidence of antibiotic-resistant infective agents such as MRSA is increasing among health care settings. Those that are sent to heal sometimes harm without knowledge of what they are doing. The invisible microbe can be a mighty force. The air that we breath, the touch of a friend, the sneeze of a child; all things that we take for granted in our daily lives, but which can potentially bring illness to one another. As nurses it is our ethical duty to provide a safe environment for our patients. The rise of MRSA has put infection control as one of our highest priorities in nursing practices.

References
Capriotti, T. (2003, December). Preventing Nosocomial Spread of MRSA is in Your
Hands. Dermatology Nursing,15(6),Retrieved July 19,2007,from Academic Search
Premier database.
Graham lll, P., Lin, S., & Larson, E. (2006, March 7). A U.S. Population-Based Survey
Of Staphylococcus aureus Colonization. Annals of Internal Medicine, 144(5),318-
w-58. Retrieved July 19, 2007, from Academic Search Premier database.
MRSA Super course, ( July 22, 2007). Public Health of Pittsburg College.
Http://www.publichealth.pitt.edu
Ott, M,. Shen, J,. Sherwood, S,. (2005). Evidence Based Practice for Control of
Methicillin Resistant Staphlococcus aureus. Association of Operating Room Nurses
AORN Journal, 81(2), 361-364,367,369-378. Retrieved July 12, 2007, from Research
Library database.
Practices of Keeping Clean (2004) The Lancet, 364(94,31)304. Retrieved August 3, 2007,
From Platinum fulltext periodicals.
Spaulding, Linda L. (2006, May) The Changing Role of Infection-control Programs in
Longterm Care Management. Nursing Homes, 55(5), 95-96. Retrieved Aug 3, 2007
From Platnium full text Periodicals.
Annotated Bibliography
Capriotti, T. (2003, December). Preventing Nosocomial Spread of MRSA is in Your
Hands. Dermatology Nursing,15(6),Retrieved July 19,2007,from Academic Search
Premier database.
The reason I used this source was because it was very informative. I had also seen other articles in the database by this author. The article contained lots of information on MRSA and its history. It also contained information on the epididomology and treatment and prevetion of MRSA. Capriotti is a DO, MSN, CRNP and the assistant Clinical Professor at the College of Nursing.
Practices of Keeping Clean (2004) The Lancet, 364(94,31)304. Retrieved August 3, 2007,
From Platinum fulltext periodicals.
I used this article only once in my paper. It was a very small article and no author was listed on the paper. The only reason I used it was I liked a quote from Florence Nightengale. I also went ahead and used the quote because I figured that it could be verified very easily if I had to.
MRSA Super course, ( July 22, 2007). Public Health of Pittsburg College.
Http://www.publichealth.pitt.edu
I found this power point on the web just browsing. I searched for epidimology of MRSA. It had lots of good information and since it was an edu site I figured it was pretty safe to use. I only used tidbits of information that I knew would be easily confirmed.
Spaulding, Linda L. (2006, May) The Changing Role of Infection-control Programs in
Longterm Care Management. Nursing Homes, 55(5), 95-96. Retrieved Aug 3, 2007
From Platnium full text Periodicals
I used this article the second most in my paper. I found it by using Boolean search terms and thought it had a lot of the information I needed to make this paper less dry. I also liked it because it came from a magazine that deals with long term care facilities which is the highest rate of MRSA cross contamination.
Intervention 1: Manditory testing for high risk patients entering a hospital setting or
long term care facilities. There are rapid screening tests available for the medical community that can quickly give results. MRSA cultures can take up to 2-3 days to process and receive results(Stone1998). By instilling a rapid screening process that is mandatory for all high risk patients, it can potentially eliminate many of the cross contamination infections.
Disadvantage: As with many rapid screen tests, the cost of testing is enormous. MRSA rapid screen test is relatively new on the market which makes it rather difficult to make it economically beneficial for patients and health care organizations(Stone 1998). In addition to the cost of the testing, it is expensive to employ the workers qualified to read and perform the testing. It also is rather expensive to educate existing staff to be qualified to read and run the test.
Disadvantage: Because of MRSA’s virulent nature and its high potentiallity for cross contamination, the rapid screening creates an avenue to break patients confidentiality. A patient, upon entering a rehab facility tests positive for MRSA, is then put in isolation and on droplet precautions and is now flagged for having the infection. Any one entering that room whether it is staff or family are now aware of the infections this pt carries.
Intervention 2: Improving handwashing technique and compliance will help to eliminate the cross contamination that happens in health care facilites. It has been documented that the compliance of handwashing and the type of alcohol based cleanser has reduced the incidince of MRSA cross over(Capriotti).
Disadvantage: Increasing compliance can be a relatively hard task to complete. Most healthcare workers state reasons for non compliance are lack of places to wash hands, time between pts, and effects of soap on hands(Capriotti). Many facilites are not up to standards with the number of sinks, disinfectant stations, or ability to don protective equipment. Many nurses are bogged down with numerous pt’s that take away from time to wash between pts. Frequent handwashing also takes a toll on health care workers hands.
Disadvantage: While it is difficult to obtain compliance among healthcare workers it is even harder to gain the general populations compliance with proper handwashing techniques. The general population has a signifigant knowledge deficit at this time in regards to MRSA. With socioeconomic status being a major effector in many countries the knowledge of handwashing and cross contamination is very difficult in communicating to the masses.
Sheldon P Stone, Virka Beric, Anne Quick. (1998). The effect of an enhanced infection-control policy on the incidence of methicillin-resistant staphylococcus aureus conlinization in acute elderly medicare pt. Age and Ageing, 27(5), 561-568. Retrieved 10/28/07 from Platinum Full Text periodicals database.