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Incidence and Prevalence of MRSA Infections

Discuss about the Incidence and Prevalence of MRSA.

Methillin resistant staphylococcus Aureus or the MRSA is one of the types of bacterium that are responsible for causing infections in different parts of the body. This organism is very difficult to treat as they are resistant to a large number of antibiotics. These organisms are mainly seen to cause various types of problems as it ranges from skin infections and sepsis to that of bloodstream infections and pneumonia (Haysom et al. 2018). Therefore, nursing professionals who provide wound care treatment to different patients need to be very careful regarding their hygiene maintenance so that the patients do not get vulnerable to such disorders (Zingg et al. 2015). The assignments will mainly show the incidence and prevalence of the infectious organisms, differences between the two types of infections, care habits that professionals need to uptake and multi-disciplinary team support that would provide care to the patients.

Staphylococcus Aureaus is considered to be one of the major bacterial pathogen that remains intricately associated with the considerable mortality and morbidity of not only patents in the healthcare centres but also in the communities that have the infections of the organism. Manifestations of this form of pathogen are seen to take place in the form of occurrence of infections that may range from mild to that of moderate skin (Banach et al. 2015). In many cases, studies have also shown that such pathogens may also cause soft tissue infections such as impetigo and furunculosis and may result in invasive as well as life threatening infections like osteomyletis. Necrotitis pneumonia and infective cardititis are also seen to occur. Other disorder that may also take pace is called the bacteraemia. In the present generation, not only in the nation of Australia but also in the rest of the world, antimicrobial resistance in the pathogen can be described as the major impediment for effective treatment. Researchers have stated that most of the hospital strains are not only resistant to methicillin but also to other multiple antimicrobials. From the studies conducted in the year 2014, it is known that about 27 institutions around the nation of Australia had participated in the Australian Staphylococcal Sepsis Outcome Programme (ASSOP) (Huang et al. 2016). It was found that 18.8% of the 2206 Staphylococcus aureus bacteraemia (SAB) isolates were found to be methicillin resistant. This was significantly higher than the other European countries. They had also found that the 30day all cause mortality associated with MRSA infection was 23.4% and this is significantly higher than the 14.4% mortality associated with the methicillin sensitive strains.

Types of MRSA Infections and their Symptoms

People who are receiving medical care in the healthcare centres can get serious infections from these pathogens which is called the healthcare associated infections or the HAIS. This has the capability to cause death in individuals besides tremendous suffering. Different hospitals are seen to report various kinds of infections like the infections caused by C. difficile, infections that follow surgery and even infections that may occur following the placement of a tube in the bladder or a large vein. Researchers are of the opinion that HAIs are mainly caused by antibiotic resistant bacteria that may lead to sepsis or death and MRSA is one of the such deadly strains that result in increasing the sufferings of patients mainly affecting wound management and many others (Ji 2016). On the other hand it is seen that when people in the community settings acquire such pathogens they are called the community acquired MRSA. However, the level of incidence in the community is much smaller than that of the healthcare settings. However, researchers are of the opinion that people are more prone to get community-acquired MRSA when they have skin trauma, skin tattoos or body piercing, previous infection with MRSA, sharing equipments or supplies that are not cleaned or laundered and many others. People living in the communities like those in prisons, people in military or people in athletic teams are also prone to development of such disorders (Lee et al. 2015).

Many risk factors expose individuals to development of infections by MRSA. Researchers are of the opinion that mainly three types of risk factors result in the infection of MRSA among different individuals. The first one risk factor is being hospitalised. It is seen that those individuals who have been hospitalised become more vulnerable to the occurrence of this infection. Studies conducted over the years have shown that older adults, children and those who have weakened immune systems are more vulnerable to the disorders. Another risk factor is witnessed when patients are provided with invasive medical device (Salge et al. 2017). Researchers conducted over the years have shown that medical tubing like in cases of the intravenous lines as well as urinary catheters also act as a pathway for MRSA for travelling in the body. Another risk factor is that individuals who live for long-term facility in healthcare centres are also highly vulnerable to acquire the infection. They may be also carrier where they might not be affected themselves but they may make others sick. In the case study provided, it was seen that Mrs. Jenkins had also been exposed to the environment of the healthcare when she had faced a fall. She had been admitted to emergency centre for her treatment of the wounds and this might have been the situation when she had acquired the infection (Vaidya et al. 2015). The healthcare environments or the nursing professionals may not have maintained proper hygiene for which she might have been exposed to the infection (Ventola et al. 2015). Moreover, as she is old she is also vulnerable to the disorder, as researchers have mentioned that old patients are more vulnerable to this infection.

Risk Factors for Acquiring MRSA Infections

Hand Hygiene is considered one of the most important primary measures that have the capability of preventing healthcare associated infections. Researchers have found out that hand of healthcare workers are the most common route of transitions for microorganisms like that MRSA during delivering of care and therefore, proper cleanliness of the hands should be ensured before treating patients. Hand hygiene is therefore considered to be one of the most important part of the standard and isolation precautions and are at the core of multi-faceted strategies for prevention of different types of infection like that of surgical site, wound handling, ventilator-associated pneumonia and vascular catheter- and urinary catheter-related infections (Magil et al. 2014). Every healthcare professional should maintain the key principles that are required for maintaining hand hygiene while handling vulnerable patients. It is of high chance that the healthcare professionals who attended Ms. Jenkins had not maintained the key principle of hand hygiene. Hand hygiene should be performed at the appropriate time and along with the correct technique. Moreover, professionals also need to be careful that that whether they are following hand hygiene in five key moments or not that reduce the risk of pathogen transmission. These are before touching the patient, before taking up the aseptic procedures or cleaning procedures, after body fluid exposure, after touching the patient, after touching surroundings (Slayton et al. 2015). All these might to have been properly done when Mrs. Jenkins was treated that might have exposed her to the disorder.

There are ten important standard precautions that every healthcare professionals need to take so that the spread of infection does not take place.  The first one is maintaining of proper hand hygiene and use of gloves in the correct moments and the correct ways. Professionals should do facial protection of eyes, nose and mouth when they visit patients with MRSA (Septimus & Schweizer 2016). It might have happened that professional who treated the patient did not take these precautions on meeting MRSA positive patients before attending her. Therefore, Mrs. Jenkins might have been affected by the disorder. Besides, wearing of proper safety gowns, proper prevention of needle stick and injuries from other sharp instruments should also e handled with care. The professionals should maintain respiratory hygiene and cough etiquettes.  Environmental cleaning should also be ensured. Handling of the linen should be done in ways by which skin and mucous membrane exposure does not take place (Kelly et al. 2016). Waste disposals should be done responsibly and patient care equipment should be sterilised and handles with care so that transmission of the pathogen does not take through them. The healthcare professionals of Mr. Jenkins might have failed to maintain these standard precautions where providing care for the patient and hence her wound was exposed to the pathogens resulting her to suffer.

The Importance of Hand Hygiene in Preventing MRSA Infections

Transmission based precautions are considered to be the second tire of basic infection control and are needed to be followed in addition to that of the standard  precautions. There are mainly three areas of Transmission based precautions. One of them is the contact precaution, droplet precaution as well as airborne precautions. Professionals need to ensure proper patient placement so that they remain free from chances of getting the infection from another patient, properly use personal protective equipments like gloves, limiting patient’s movements and transportations. Proper disposable or dedicated patient care equipments should be ensured and cleaning and disinfection of the rooms should be prioritised. Using of masks, gloves and other protective materials can prevent transmission of the germs (Yao et al. 2015). All these guidelines were not followed by the professionals in case of Mrs. Jenkins and therefore, she might have been exposed to these infection.

The patient who would be discharged home would be highly vulnerable to lead poor quality lives if proper care is not taken. Her wound was affected by MRSA and proper antibiotics have been given to her. If the proper course of medication and wound management is not done, the degree of infection might also develop and this might affect healing of the wound. Therefore, the community registered nurse who would be attending her at home has a large number of responsibilities to care for. Besides conducting proper wound management of the skin tear that had been infected by MRSA and providing her the correct dose of medication of antibiotics at the right time through the proper routes, she also have to conduct many other activities that would help in developing a MRSA-pathogen free environment. She should participate in normal domestic cleaning assuring that the environment is clean (Tilahun et al. 2015). Surfaces and floors should be vacuumed and cleaned regularly. Moreover, she should also take care of the clothing, bedding and many others ensuring that they are washed properly. Rubbish should properly disposed. Moreover, they should also educate the patient and her family members about how to maintain hygiene while handling the patient or while attending her needs. This would ensure prevention of the spread of infection to other members. The occupational therapist should put his focus on the rehabilitation that is related to her skin tear in the lower extremity of her right leg. As the wound is not healing for long time, she might not be able to mobilise properly and would be spending most of her time is supine position. Therefore, occupational therapist would make sure that he evaluates’ the psychosocial as well as the emotional needs of the patient, thereby modify the treatment approach to facilitate her compliance with the rehabilitation program. He would be providing a holistic and client centred approach helping her to develop mobility in gradual ways and keep her empowered throughout her treatment (Kelly et al. 2016).

Standard Precautions and Transmission-Based Precautions to Prevent MRSA Transmission

Conclusion:

From the entire discussion, it becomes quite clear that the professionals who were appointed in the emergency department to treat Mrs. Jenkins did not follow the proper measures requiterred to prevent MRSA. It is one of the strains of Staphylococcus aureuas that have become resistant to a number of antibiotics and are therefore called methicillin resistant. Treatment of such infections is important as that may expose the patient to several other disorders like pneumonia and others. Therefore, it is expected of the professionals to undertake proper hand hygiene, standard precautions and transmission based precautions so that they can provide high quality care service. Hospital acquired infections results in suffering of patients that are easily avoidable. Hence, it has become one of the main priorities of every healthcare centres to ensure safe and high quality care. This would prevent hospital readmissions, longer stays of hospitals and unavoidable deaths.

References:

Banach, D.B., Bearman, G.M., Morgan, D.J. & Munoz-Price, L.S., 2015. Infection control precautions for visitors to healthcare facilities.

Haysom, L., Cross, M., Anastasas, R., Moore, E. & Hampton, S., 2018. Prevalence and Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Custodial Populations: A Systematic Review. Journal of Correctional Health Care, 24(2), pp.197-213.

Huang, S.S., Singh, R., Eells, S., Gombosev, A., Park, S., McKinnell, J.A., Gillen, D., Kim, D., Macias-Gil, R., Rashid, S. & Bolaris, M., 2016, October. Project CLEAR (Changing Lives by Eradicating Antibiotic Resistance) Randomized Controlled Trial (RCT): Serial Decolonization of Recently Hospitalized Methicillin-Resistant Staphylococcus aureus (MRSA) Carriers Reduces Risks of MRSA Infections and All-Cause Infections in the 1-Year Post-Hospitalization. In Open Forum Infectious Diseases (Vol. 3, No. suppl_1, p. 1745). Oxford University Press.

Ji, Y., 2016. Methicillin-resistant Staphylococcus aureus (MRSA) protocols. Humana Press.

Kelly, J.W., Blackhurst, D., McAtee, W. & Steed, C., 2016. Electronic hand hygiene monitoring as a tool for reducing health care–associated methicillin-resistant Staphylococcus aureus infection. American journal of infection control, 44(8), pp.956-957.

Lee, Y.J., Chen, J.Z., Lin, H.C., Liu, H.Y., Lin, S.Y., Lin, H.H., Fang, C.T. & Hsueh, P.R., 2015. Impact of active screening for methicillin-resistant Staphylococcus aureus (MRSA) and decolonization on MRSA infections, mortality and medical cost: a quasi-experimental study in surgical intensive care unit. Critical Care, 19(1), p.143.

Magill, S.S., Edwards, J.R., Bamberg, W., Beldavs, Z.G., Dumyati, G., Kainer, M.A., Lynfield, R., Maloney, M., McAllister-Hollod, L., Nadle, J. & Ray, S.M., 2014. Multistate point-prevalence survey of health care–associated infections. New England Journal of Medicine, 370(13), pp.1198-1208.

Salge, T.O., Vera, A., Antons, D. & Cimiotti, J.P., 2017. Fighting MRSA infections in hospital care: how organizational factors matter. Health services research, 52(3), pp.959-983.

Septimus, E.J. & Schweizer, M.L., 2016. Decolonization in prevention of health care-associated infections. Clinical microbiology reviews, 29(2), pp.201-222.

Slayton, R.B., Toth, D., Lee, B.Y., Tanner, W., Bartsch, S.M., Khader, K., Wong, K., Brown, K., McKinnell, J.A., Ray, W. & Miller, L.G., 2015. Vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities—United States. MMWR. Morbidity and mortality weekly report, 64(30), p.826.

Tilahun, B., Faust, A.C., McCorstin, P. & Ortegon, A., 2015. Nasal colonization and lower respiratory tract infections with methicillin-resistant Staphylococcus aureus. American Journal of Critical Care, 24(1), pp.8-12.

Vaidya, P., Pawar, G. & Krishnamurthy, N., 2015. Community acquired MRSA infections—Three recent cases and an overview of CA MRSA infections. Pediatric Infectious Disease, 7(1), pp.8-12.

Ventola, C.L., 2015. The antibiotic resistance crisis: part 1: causes and threats. Pharmacy and Therapeutics, 40(4), p.277.

Ventola, C.L., 2015. The antibiotic resistance crisis: part 1: causes and threats. Pharmacy and Therapeutics, 40(4), p.277.

Yao, Z., Peng, Y., Chen, X., Bi, J., Li, Y., Ye, X. & Shi, J., 2015. Healthcare associated infections of methicillin-resistant Staphylococcus aureus: a case-control-control study. Plos one, 10(10), p.e0140604.

Zingg, W., Holmes, A., Dettenkofer, M., Goetting, T., Secci, F., Clack, L., Allegranzi, B., Magiorakos, A.P. & Pittet, D., 2015. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. The Lancet Infectious Diseases, 15(2), pp.212-224.

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