Discuss about the MRSA Infection for Hospital Epidemiology.
The reservoir of Methicillin resistant Staphylococcus aureus (MRSA) infection is colonized or infected individual. MRSA mainly colonize in skin or body of an individual. A person carrying the bacteria without any signs of infection are colonized individual, whereas those with signs of infection are infected patients. Hence, MRSA mainly spreads by direct contact. The three main reservoir of infection is staff, patient and infected objects.
In a 500 bed community hospital, risk of infection is high in the following patient group-
- Patients with weak immune system such as older adults.
- Patients having invasive medical devices such as medical tubing or urinary catheters. These devices create the pathway for transmission of MRSA infection into the body.
- Patients who are staying for longer time in hospitals. This is because of MRSA infection is most prevalent in nursing home and carriers of MRSA may spread the infection. Crowding, skin-to-skin contact and sharing equipments may spread the infection (General Information | MRSA | CDC, 2017).
People living in crowded area are most likely to be admitted to hospital for MRSA infection. This population group mainly involves athletes, student, military personnels, health care staffs. Secondly, people going for treatment in dialysis centers are likely to get infected with MRSA (Huttunen & Syrjänen, 2014). Hence, people with chronic conditions are susceptible to infection.
MRSA is an antibiotic-resistant pathogen causing may serious infections. MRSA is transmitted in individuals mainly by skin-to skin-contact and touching contaminated objects such as infected wound, towels and razors. Discharge of infected individual and soiled area may also lead to transmission of MRSA infection. Poor personal hygiene among people easily transmits the infection. MRSA is transmitted in a person who comes in contact with people with active infection or carrier of infection. Carrier of infection is mostly found in community and hospitals (Most, 2014). On this basis, the infection is classified into hospital acquired infection or community acquired infection. A person becomes a carrier of the MRSA bacteria when they come in contact with contaminated objects. On the other hand, people may develop active infection if the bacteria enter the body parts by means or cuts or wounds on the body. A colonized individual can remain a carrier for few weeks to several years.
About 2, 00, 000 people gets infection while being admitted to hospitals in Canada. Out of them, 80% of the infection were spread by health care worker, patients and visitors coming at hospital. The rate of MRSA infection increased by more than 1000% from the year 1995 to 2009 (Report on the State of Public Health in Canada, 2013). However, currently the rate of MRSA infection and colonization is gradually declining. According to current statistics, the rate infection rate declined by 56% in 2011 compared to the year 2005. Although, it was the major cause of mortality in hospitals, however fewer deaths in hospital is reported now (MRSA Tracking | MRSA | CDC, 2017).
MRSA is a kind of infection most prevalent in hospital and community settings of different country. The widespread prevalence of MRSA strain is seen mainly because of poor hand hygiene practices by health care staffs and visitors. ICU patients are most vulnerable to infection. On the other hand, community associated MRSA infection is seen mostly in children with bloodstream infection. However, currently emergence of MRSA is also seen in patients with no health care contact or risk factors. MRSA Infection is classified into three types such as- health care associated with onset at hospital, healthy care associated with onset at community level and community associated infection. Majority of MRSA infection is hospital associated with community onset, followed by hospital and community onset. The highest rate is found in adults above 65 year and lowest rate is seen in children between 7-10 years (The Epidemiology of MRSA, 2017).
Infection prevention can be done by multiple means such as educating people about transmission modes of infection, reminding health care staffs to clean their hands with disinfectants before coming in contact with patient, making hand hygiene options easily available, monitoring rate of infection and implementing best practice in infection prevention in hospital setting. The followings control mechanism are the most effective in preventing MRSA infection:
Hand hygiene technique: Hand hygiene program consisting of educating health care staffs about the importance of hand hygiene before coming in contact with patient and teaching them regarding proper hand washing technique is effective in reducing the infection. The adherence to infection may be increased by easy acceptability to antimicrobial soap and encouraging patients to accept treatment from staffs only if they perform hand hygiene technique. Even small improvement in hand hygiene has been found to give positive results (Barnes et al., 2014). The research regarding the impact of hand hygiene on controlling MRSA showed that implementation of hand hygiene reduced the number of MRSA positive patients. Alcohol based disinfectant are the most effective for hand washing to prevent infection (Ferguson, 2009).
In a 500 bed community hospital, screening program will look into detection of colonized individual and removing them from the hospital premise. This can be done by random screening as well as on admission screening. However, random screening will be followed because it is the most effective for nosocomial control. By this mean, patients are admitted to hospital unscreened and then routine random screening is conducted (Robotham et al., 2007).
MRSA infection in wound swab can be detected by means of MRSA screening test. In this, wound swab of person is cultured in a special nutrient medium and incubated. The development of characteristics MRSA colonies determine the absence or presence of MRSA in the wound swab (Butler-Laporte et al., 2016).
Both hospital acquired and community acquired infection is reported in Canada. The report for surveillance is defined as the Canadian Antibiotic Resistance Surveillance System Report which gives surveillance data on MRSA infection in Public Health Agency of Canada. It helps in better response to community level action (Canada, 2017).
Barnes, S. L., Morgan, D. J., Harris, A. D., Carling, P. C., & Thom, K. A. (2014). Preventing the transmission of multidrug-resistant organisms: modeling the relative importance of hand hygiene and environmental cleaning interventions. Infection Control & Hospital Epidemiology, 35(09), 1156-1162.
Butler-Laporte, G., Cheng, M. P., Cheng, A. P., McDonald, E. G., & Lee, T. C. (2016). Using MRSA Screening Tests To Predict Methicillin Resistance in Staphylococcus aureus Bacteremia. Antimicrobial Agents and Chemotherapy, 60(12), 7444-7448.
Canada, P. (2017). Canadian Antimicrobial Resistance Surveillance System Report 2016 - Canada.ca. Canada.ca. Retrieved 30 May 2017, from https://www.canada.ca/en/public-health/services/publications/drugs-health-products/canadian-antimicrobial-resistance-surveillance-system-report-2016.html
Ferguson, J. K. (2009). Preventing healthcare?associated infection: Risks, healthcare systems and behaviour. Internal Medicine Journal, 39(9), 574-581. doi:10.1111/j.1445-5994.2009.02004.x
General Information | MRSA | CDC. (2017). Cdc.gov. Retrieved 30 May 2017, from https://www.cdc.gov/mrsa/community/#community
Healthcare-Associated Infections Due Diligence - The Chief Public Health Officer s Report on the State of Public Health in Canada, 2013: Infectious Disease—The Never-ending Threat - Public Health Agency of Canada. (2017). Phac-aspc.gc.ca. Retrieved 30 May 2017, from https://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2013/infections-eng.php
Huttunen, R., & Syrjänen, J. (2014). Healthcare workers as vectors of infectious diseases. European journal of clinical microbiology & infectious diseases, 33(9), 1477-1488.
Most, M. R. S. A. (2014). Methicillin-resistant Staphylococcus aureus.
MRSA Tracking | MRSA | CDC. (2017). Cdc.gov. Retrieved 30 May 2017, from https://www.cdc.gov/mrsa/tracking/
Robotham, J.V., Jenkins, D.R. and Medley, G.F., 2007. Screening strategies in surveillance and control of methicillin-resistant Staphylococcus aureus (MRSA). Epidemiology and infection, 135(02), pp.328-342.
The Epidemiology of MRSA. (2017). Medscape. Retrieved 30 May 2017, from https://www.medscape.com/viewarticle/565516