MRSA Prevention in American Hospitals: A Review of the Literature Jenny Niemann AP Language and Composition Mrs. Cook November 4, 2010 Abstract Methicillin-resistant Staphylococcus aureus (MRSA) is a harmful and virulent antibiotic resistant bacterium that is a major concern in most American hospitals. Modern scientists are aiming to discover effective prevention methods for MRSA in hospitals, so productive prevention guidelines can be created. Clinical microbiologists such as K. Nguyen, J. Cepeda, and M. Struelens all conducted clinical trials in separate American hospitals.
They employed different MRSA inhibition techniques, such as hand hygiene, isolation, and MRSA screenings, which were tested on a wide range of patients. The analyzed results revealed that despite controversies, methods exist that could be successful in preventing and controlling MRSA infections. Final Outline I. Introduction A. Methicillin-resistant Staphylococcus aureus (MRSA) is the most commonly identified and perhaps the most lethal antimicrobial-resistant pathogen in the world and the rates of this infection are steadily increasing globally B. (Bryce, 2009, 627). C.
Current studies present numerous safety measures that could provide an effective regiment for preventing MRSA infections in hospitals. II. Body A. Kim Nguyen’s clinical study has perhaps gained the most media attention for its promise to show how simple, inexpensive measures, like hand hygiene, can reduce MRSA infection rates. 1. Study of hang hygiene program 2. Results of study 3. Evaluation of hand hygiene in prevention B. In the clinical trial conducted by Jorge Cepeda (2005), infective disease control professor at the University College London Hospitals, another preventative technique was investigated. . Description of isolation trials 2. Results of trials 3. Analysis of possible uses C. The evidence provided from another article indicates that screening for MRSA can also protect patients and reduce infection rates. 1. Clinical trials of screening 2. Results of trials 3. Potential flaws described III. Conclusion A. In attempt to protect the safety of people in hospitals and in the community, there are numerous prevention methods that could be implemented to create a successful MRSA prevention regiment. B.
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All in all, MRSA is and extremely deadly and virulent bacterium, but with the use of newfound prevention methods, everyone can be protected. MRSA Prevention in American Hospitals: A Review of the Literature Methicillin-resistant Staphylococcus aureus (MRSA) is the most commonly identified and perhaps the most lethal antimicrobial-resistant pathogen in the world and the rates of this infection are steadily increasing globally (Bryce, 2009, p. 627). According to an article by clinical microbiologist, Jason Surg (2008) concurred, “Recently, in American hospitals, the rate of MRSA infections was 31. per 100,000 persons admitted per year” (p. 642). It is recorded that there are more than 100,000 cases related to MRSA per annum in the United States alone, adding up to an estimated health-care bill of over 5 billion dollars (Bryce, 2009, p. 627). Today many scientists believe because of MRSA’s ability to quickly evolve into separate strains that there is no way to halt the spread of the bacterium (Bryce, 2009, p. 628). However, microbiology teams across the world have seen enormous success in reventing MRSA transmissions in hospitals with simple measures. For example Kim Nguyen (2009), Jorge Cepeda (2005), and M. Strulens (2010), all conducted clinical trials, performing different successful prevention tactics. Current studies present numerous safety measures that in combination could provide an effective regiment for preventing MRSA infections in hospitals. Kim Nguyen’s clinical study has perhaps gained the most media attention for its promise to show how simple, inexpensive measures, like hand hygiene, can reduce MRSA infection rates.
During the study conducted by Nguyen and her team in the Urology ward at the Texas Medical Center in Houston, Texas, more than 2377 patients were admitted and assessed throughout the two section study (20008, p. 1298). The first section served as the indicator for baseline occurrences of MRSA in the ward, while during the second section the hand hygiene program was initiated. Nguyen (2008) explains the hand hygiene program by stating: The hand hygiene program consisted of a 1h training program to all staff on the Urology ward and daily intervention to train relatives and reinforce hand hygiene in all staff.
Posters demonstrating hand hygiene were put up throughout the ward and bottles of SoftaMan hand hygiene lotion were mounted at patients’ bed ends. (p. 1299) The number of MRSA infections was then recorded for both sections of the study, and the data was analyzed. The ratio of infected patients compared to the number of admitted patients during each section resulted in a 13. 1% infection rate in the baseline study, and a 2. 1% infection rate after the hand hygiene program was implemented (Nguyen, 2008, p. 298). Nguyen also recorded the estimated personal costs of the experiment, calculating that the SoftaMan antibacterial lotion cost about $0. 60 per patient, translating into a significantly lower cost than MRSA infection treatment (Nguyen, 2008, p. 1298). Contrary to popular belief that simple and inexpensive antiseptic hand hygiene programs do not significantly reduce infections in hospitals, the infection percent rates in this study were decreased by 84% (Nguyen, 2008, p. 1298).
With limited MRSA transmissions in the health care field, it could lead to better patient outcomes and safer hospital environments for patients and staff (Nguyen 2008, p. 1299). In the clinical trial conducted by Jorge Cepeda (2005), infective disease control professor at the University College London Hospitals, another MRSA inhibition technique was investigated. Isolating MRSA colonized patients was the technique Cepeda and his team studied. The prospective trial was conducted in two general medical-surgical intensive-care units of two American teaching hospitals for 1 year (Cepeda, 2005, p. 95). All 21,840 entering patients were swabbed and tested for MRSA, and MRSA-positive patients were moved to a single cohort isolation room. While a patient was in the isolation room, policies for hygiene remained constant. 6 months into the study the practice of isolation was abandoned, and the rates of MRSA infection were once again recorded. The crude (unadjusted) Cox proportional-hazards model showed evidence of increased transmission during the latter non-isolation phase in both hospitals (Cepeda, 2005, p. 96). The evidence represented up to a 62. 2% decrease in the proportional-infection transmission rates when isolation was used (Cepeda, 2005, p. 295). Cepeda then concluded, “Moving MRSA-positive patients into single rooms or cohorted bays reduces cross infection” (Cepeda, 2005, p. 297). However, Cepeda also reported possible flaws stating that, “Despite lower transmission severity scores, isolated patients are visited half as often as are non-isolated patients (5·3 vs 10·9 visits per h)” (Cepeda, 2005, p. 296).
Because transfer and isolation of critically ill patients in single rooms carries potential risks, the findings suggest a variant of isolation could be used in intensive-care units where MRSA is endemic. Although isolation was successful in reducing MRSA, it was not a risk free technique, leading to the investigations of other innocuous prevention methods. The evidence provided from another article indicates that screening for MRSA can also protect patients and reduce infection rates. M. Struelens (2009), a member of the U. S. epartment of clinical microbiology, describes in his article that, “Active surveillance (or screening) for MRSA carriers is the systematic use of microbiological tests able to detect mucocutaneous carriage of MRSA by individuals without clinical infection” (2009, p. 113). This strategy is regarded as highly effective because of its direct search-and-destroy nature. Screening is generally accomplished by swabbing areas such as the throat or nose, with recent technology allowing the cultures to be processed in less than 20 hours, with a 95% sensitivity rate (Struelens, 2009, p. 16). By identifying a carrier of the MRSA disease, the transfer of infection can be immediately stopped by treating the source with certain antibiotics. This elimination of MRSA colonies not only prevents the spread of infection in hospitals, but the entire community (Bryce, 2009, p. 627). Struelens does mention MRSA screening flaws in his conclusion reporting that, “There is an urgent need for health care professionals and diagnostic companies to assess the cost-effectiveness of these tools.
In addition, greater harmonization of surveillance and typing schemes is needed to facilitate cooperation in an effort to control the MRSA pandemic” (2009, p. 116). Besides minimal flaws, Struelens expresses hope for the future of MRSA surveillance due to its success and reliability in multiple different trials (2009, p. 117). In attempt to protect the safety of people in hospitals and in the community, there are numerous prevention methods that should be implemented to create a successful MRSA prevention regiment.
The various techniques in MRSA prevention, which include hygiene programs, isolation, and surveillance, have all been clinically tested and proven successful. However, there is further research that can be conducted to determine the cost-effectiveness of these methods, as well as to establish the most successful approach to combining the prevention techniques. All in all, MRSA is and extremely deadly and virulent bacterium, but with the use of newfound prevention methods, everyone can be protected. References Bryce, E. (2009).
Hospital infection control strategies for methicillin-resistant staphylococcus aureus and clostridium difficile. American Medical Association Journel, 180 (6), 628-631. Retrieved from www. ebscohost. com Cepeda, J. , Whitehouse, T. , Cooper, B. , Hails, J. , Jones, K. , Kwaku, F. , et al. (2005). Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet, 365(9456), 295-304. Retrieved from www. ebscohost. com Nguyen, K. (2008). Effectiveness of an alcohol-based hand hygiene programme in educing nosocomial infections in the Urology Ward of Texas Medical Institute, Texas. Tropical Medicine & International Health, 13(10), 1297-1302. doi:10. 1111/j. 1365-3156. 2008. 02141. x Struelens, M. (2009). Laboratory tools and strategies for methicillin-resistant staphylococcus aureus screening, surveillance and typing: state of the art and unmet needs. Clinical Microbiology & Infection, 15(2), 112-119. doi:10. 1111/j. 1469-0691. 2009. 02698. x Surg, J. (2008). Methicillin-resistant staphylococcus aureus in hospitals. Clinical Microbiology and Infection, 13(8), 642-643. doi:10. 1111/j. 1445- 2197. 2008. 04605. x
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