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Incidence and Prevalence of MRSA in Australia

Discuss about the Methicillin Resistant Staphylococcus Aureus.

Methicillin-Resistant Staphylococcus Aureus (MRSA) is an infection caused by a human bacterial microorganism called Staphylococcus aureus (S.aureus). According to Bogestam et al (2018), S.aureus is responsible for various infections in humans such as bullous impetigo, folliculitis, boils, cellulitis, septic arthritis, osteomyelitis, post-surgical wound infection as well as intravascular line infections. The author further adds that S.aureus can also lead to deadly infections such as meningitis, septicemia and endocarditis. The main aim of this essay is to analyze MRSA by identifying its risk factors and evaluating its prevalence in Australia. With specific reference to Mrs. Jenkins, a patient admitted with MRSA, the paper will first identify the incidence and prevalence of MRSA in Australia. Secondly, there will be an examination of Mrs. Jenkins’ diagnosis and the relationship between her infection and other factors such as hand hygiene, transmitted-based precautions, and standard precautions. Lastly, the paper will examine the role of both community registered nurse and occupational therapist in relation to Mrs. Jenkins’ case.

The identification of incidence and prevalence of  MRSA in Australia has largely been the responsibility of the Australian Group on Antimicrobial Resistance (AGAR), an organization that has been monitoring the prevalence of MRSA in Australia since 1985 (Wang et al 2018). According to the author, there exist two main types of MRSA namely the hospital-acquired MRSA and the community-acquired MRSA. Community-based MRSA (CA-MRSA) are MRSA infections acquired by individuals who have not had a recent hospital and may not have undergone any clinical procedure such as catheter, dialysis or surgery. CA-MRSA is mostly manifested in the form of boils, pimples and skin infections that may otherwise occur in healthy individuals (Askura et al 2018). On the other hand, according to Hongo et al (2018), hospital-acquired MRSA (HA-MRSA) occur among individuals who might have been in the hospital in the recent past for clinical procedures such as surgery, catheter or dialysis. They mainly occur where patients undergo invasive medical procedures or where patients have low immune systems and are mainly transmitted when a physician touches an HA-MRSA carrier and fails to wash their hands (Heckel et al 2017). Research has it that the hospital-acquired MRSA in Australia (Aus-2/3) is associated with most MRSA infections and originated from Australia after becoming established in most Melbourne Teaching hospitals in the 1970’s. According to Kuonza et al (2017), the first survey done by AGAR in 1985 revealed that Aus-2/3 was responsible for 25% of all S.aureus infection in most big hospitals in Sidney, Canberra, Eastern Seaboard, and Melbourne. These revelations called for intensive efforts by the Australian Department of Health to reduce the prevalence and address the possible risk factors.

Mrs. Jenkins' Case

A recent study by AGRA indicate that the Aus-2/3 may be existing in two types of clones, a phenomenon suspected to have been the cause of an increase in the prevalence of MRSA in the period of 2001 and 2005 especially within New South Wales, Queensland, and Victoria (Becker et al 2018). However, studies by Guimaraes et al (2017) indicate a decline in Aus-2/3 prevalence in the year 2009 and the decline is estimated to have continued at a rapid rate since then. Nonetheless, Sorensen et al (2017), Naidu et al (2017) and Herrera et al (2016) acknowledge that Aus-2/3 has largely contributed to various community-onset infections especially among patients with a history of admission into facilities characterized by its prevalence.

As illustrated by Sato et al (2017) in figure1 below, the decline in the prevalence of Aus-2/3 has largely been attributed to an improvement in infection control within Australian hospitals, an introduction of The National Hygiene Program in 2008, and the implementation of policies that demand public reporting of MRSA infection trends in Australia. Sato et al (2017) also note that the decline in the prevalence of Aus-2/3 has largely been boosted by the implementation of National Safety and Quality Health Service (NSQHS) Standards which mainly advocates for preventing and controlling infections associated with healthcare.

Naro et al (2018) believe that CA-MRSA had its first onset in Australia in 1980’s and has since increased in prevalence to exceed the prevalence of HA-RMSA in Australia. In fact, according to the author, CA-MRSA is largely believed to have rivaled HA-MRSA as the cause of hospital-onset infection in Australia. Part of the reason for their high prevalence is its high resistance to antibiotics and it is estimated that this resistant is likely to increase over time (Ghaznavi-Rad et al 2018).

Blanco et al (2017) claim that CA-RMSA was first noted in Australia in 1985 and became more prevalent in Kimberley region in 1989. By 2004, a number of CA-RMSA clones are believed to have gained much prevalence in Western Australia. Fast forward to 2014, CA-RMSA is believed to have accounted for 45% of all hospital-onset infections as compared to HA-MRSA which was at 48% (Sato et al 2017). The following figure (figure 2) illustrates AGRA’s survey of CA-MRSA prevalence between 2001 and 2014:


In the case of Mrs. Jenkins, her MRSA infection could be a HA-MRSA because she has a history of sustaining an injury and was admitted in the hospital where her wound was dressed and cleaned before discharge. He has now been readmitted again and the doctor has diagnosed her with MRSA. According to Carfora et al (2016), HA-MRSA usually occurs on patients who have recently had a hospital admission and therefore it is highly likely that Mrs. Jenkins’ earlier admission might have exposed her to HA-MRSA.

Hand Hygiene and HA-MRSA

Because both HA-MRSA and CA-MRSA occur in different settings, Mrs. Jenkins might have been exposed to HA-MRSA as a result of three main factors namely:

  • Being hospitalized
  • Undergoing an invasive medical procedure, and
  • Longer residence in the hospital.

Being hospitalized is a great risk factor for HA-MRSA because a hospitalized patient is highly exposed to carriers of MRSA bacteria (Wang et al 2018). In the case of Jenkins, the physician might have touched his wound during dressing with gloves which may have earlier been used to handle a HA-MRSA carrier patient. Likewise, the hospital might not have been at a good hygienic condition when Jenkins was fist admitted in the hospital. This is because according to Bogestam et al (2018), MRSA bacteria spread rapidly in hospitals that have poor hygiene practices.  Jenkins could have also been exposed to HA-MRSA as a result of getting into contact with invasive medical devices especially if the physician used them during wound dressing. According to Hongo et al (2018), invasive medical materials such as scissors, catheters, and surgical knives provide a pathway for HA-MRSA to invade the patient’s body. The hospital bedding could have also been a risk factor for Jenkins to contact HA-MRSA if at all she lay on some that were not properly washed or sanitized. According to Heckel et al (2017), HA-MRSA bacteria tend to reside on unclean or poorly kept hospital linen such as bed sheets or blankets.

Other risk factors for RMSA include keeping wounds uncovered, using other people’s personal items such as razors, towels, clothing and sheets, keeping unclean hands especially after touching other people’s personal objects, and lack of protective gadgets such as gloves in hospital settings. While some of these risk factors may not relate to Jenkins’ case, being aware of them minimizes the likeliness of getting MRSA (Askura et al 2018).

Nearly a decade ago, Ignaz Semmelweis discovered a relationship between health workers’ hand hygiene and infections to patients. Indeed, several years after his death, a slew of evidence (Kuonza et al 2017; Becker et al 2018; and Bogestam et al 2018) are still emerging to show that there is an association between healthcare-associated infections and health workers’ hand hygiene. As a result, scholars have proposed improved hand hygiene as a major prevention remedy for HA-MRSA. In fact, while there is still no consensus among scholars over the best control mechanism for HA-MRSA, a majority of them (e.g. Heckel et al 2017, Kuonza et al 2017, Becker et al 2018 and Bogestam et al 2018) agree that keeping hand hygiene is a cornerstone remedy. For instance, Pittet et al (2009) launched a quasi-experimental study to investigate the effects of maintained hand hygiene on the infection rates of HA-MRSA. The intervention included an increased access to alcohol hand scrubs and visual hand washing reminders. Feedback from the hospital staff indicated an increase in hand washing compliance by 18% with a reported decrease in HA-MRSA episodes in the hospital by 0.5 incidences per 10000 patient-days. This and other studies (Hongo et al 2018, Heckel et al 2017 and Sorensen et al 2017) reveal that keeping high-level hand hygiene by washing hands with antibiotic soaps after touching body fluids, secretions, excretions, blood or contaminated items reduce the chances of Jenkins contracting HA-MRSA. Kuonza et al (2017) also recommend that when hands (with gloves or not) are visibly soiled with body fluids or blood when handling the same patient, physicians should wash them with clean water and soap to prevent cross-contamination of the patients’ different body parts.

Apart from hand hygiene, the other standard precaution required to be maintained to prevent HA-MRSA include gloving, eye, mouth and nose protection, gowning and proper laundry handling. According to Hongo et al (2018), wearing non-sterile and clean gloves when a physician is likely to handle blood or other infectious fluids such as non-intact skin (e.g. Jenkins’ wound), mucus, or contaminated intact skin is extremely important. The gloves should also be carefully removed after handling the patient to prevent hand contamination. While handling mucous membrane, the physician should wear protective gear such as masks, face shields, goggles, or a combination of both; on the nose, eyes, mouth, and ears to avoid contact with splashed blood or infectious fluids (Wang et al 2018). According to Bogestam et al (2018), it is also a standard precaution to wear gowns to protect the physician’s skin from contamination and to ensure that the physician’s clothes are not contaminated by body fluids or secretions. After dressing Jenkins’ wound, it was necessary to transport or handle his bedding/linen carefully to avoid contamination of air or the nearby surfaces (Askura et al 2018).

Transmitted-base precautions for HA-MRSA are categorized into droplet, airborne and contact precautions. According to Kuonza et al (2017), contact-based precautions are normally meant to prevent the transmission of HA-MRSA through direct or indirect contact with a carrier and may include placing patients diagnosed with HA-MRSA in private rooms or together with other patients with similar diagnosis. It also involves keeping the patients quarantined in their respective rooms unless they are to be moved for a medical procedure (Wang et al 2018). According to Hongo et al (2018), other contact-based precautions include wearing gloves before handling the diagnosed patient and observing all the other standard precautions related to HA-MRSA.

Droplet precautions are meant to prevent transmission from infectious agents that can drop from the patient through sneezing or coughing. According to Bogestam et al (2018), they include keeping the patient in surgical masks when out of the room, keeping them in private rooms unless they are to be moved for a medical procedure, keeping patient care items such as pressure cuffs dedicated to the patients only, and teaching the patients to cover their nose when sneezing or coughing. Being an old-age patient, these precautions should be implemented with care to ensure that she does not perceive her isolation as a disregard to her health situation or age (Sorensen et al 2017). It is also important to explain to Jenkins the importance of each procedure to gain her best cooperation.

Hongo et al (2018) write that a community registered nurse’s major role is to attend to patients receiving health care services outside the hospital setting. In the case of Jenkins, a community registered nurse would help meet her health needs in respect to her old age situation especially owing to the fact that she is highly prone to forgetting to take her prescribed medication, and maintain the required hygiene for the wound to heal faster. Typically, the nurse would be responsible for cleaning and dress Jenkins’ wound, ensuring Jenkins maintains the oral medication until the end of the dosage, and maintain Jenkins’ general hygiene to ensure that she does not infect other people around her with MRSA. On the other hand, an occupational therapist majorly offers therapy services to patients with chronic musculoskeletal illness. In the case of Jenkins, an occupational therapist would be responsible for helping improve her performance of daily activities such as valued daily roles, social interaction and leisure activities (Wang et al 2018). According to Bogestam et al (2018), an occupational therapist would also assist Jenkins to adapt to life routine disruptions as a result of her wound and maintain her physiological balance as a result of her health and age condition.

References

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