MRSA Prevention and DetectionDebby BoyleNicole CoryLinda HansenAnne Hendricks

What is MRSA?Methicillin-resistant Staphylococcus

aureus ( MRSA) is one of the major

nosocomial pathogens responsible for

increased morbidity, mortality, and

prolonged hospitalization (Kucina et al.,

2008). MRSA was first reported in the

United Kingdom in 1961, when it was found

that Staph aureus infections were becoming

resistant to beta-lactum inhibitors such as

methicillin (Romero, Treston, & O’Sullivan,

2006). Staphylococcus aureus bacteremia

(SAB) is a potentially lethal and increasingly

common infection in hospitalized patients

(Lahey, Shah, Gittzus, Schwartzman &

Kirkland, 2009).

Methicillin-Resistant StaphylococcusAureus

MRSA in the Healthcare Setting• MRSA ranks “among the most prevalent pathogens in hospitals worldwide” (Diekema & Climo

2008, p.1192).

• Infections caused by multidrug-resistant gram-positive bacteria represent a major public health

burden in terms of morbidity and mortality, increased expense in patient management, and

implementation of infection control measures (Woodford & Livermore, 2009).

• The "superbug", MRSA, regularly attracts media interest and there is political pressure to reduce

MRSA infection rates (Woodford & Livermore, 2009).

• Each year126,000 patients hospitalized develop MRSA and 5,000 of

those patients die (Klevins et al., 2007).

• Today’s numbers state that 46 out of 1,000 patients have MRSA

(Klevins et al, 2007).

• Healthcare Acquired-MRSA patients have an increased

length of stay up to nine and one-tenth days and incur

costs of roughly $30,000 per episode (Richmond et al, 2007).

Several factors are listed as contributory to the increased and persistent nature of MRSA in the healthcare setting (Barnes & Jinks, 2008).

• Inappropriate prescribing practice (compounded by the

use of antimicrobial agents in veterinary and agricultural

practices)

• Poor and inconsistent infection control measures such as

hand washing

• Lack of adequate surveillance together with inadequate

isolation resources for colonized or infected individuals

• Nurses’ lack of knowledge and understanding of

epidemiology, microbiology, pharmacology and infection

control have also been singled out

Some patients are at higher risk for contracting

MRSA including:

• Patients with known previous MRSA infection

• Patients who have been hospitalized three or more times

in one year

• Residents of long-term care facilities

• Patients with chronic wounds (Kucina et al., 2008).

Hand-Washing •In two different studies, hand washing was shown

to be a key factor in reducing the spread of

microorganisms (Laustsen et al., 2009; Thomas et

al., 2005).

•According to the CDC, “The main mode of

transmission (of MRSA) to other patients is

through human hands, especially healthcare

workers' hands” (Siegel et al, 2007).

•In one study hand-hygiene compliance was

deemed to be 20%, after interventions such as

posting posters, it was increased to 37% (McKinley

et al., 2005).

• Hand hygiene is shown to be the single most

effective way to prevent the spread of healthcare

related infections (Yammamoto et al.,2007).

Environmental Services• MRSA can live on surfaces for long periods of time

(Hardy et al., 2006).

• In one study, “Environmental strains were more

often identical to those colonizing another patient

elsewhere in the ward, possibly indicating the

spread of bacteria” (Hardy et al., 2006, p. 130).

• One study showed that the highest area (81 of 216

sites) of MRSA contamination was obtained in the

samples from under the beds which led researchers

to speculate as to possible reasons for this finding

(Hardy et al., 2006).

• Even if the bed space was not occupied with a

patient colonized with MRSA, the space still tested

positive for MRSA 20.2% of the time (Hardy et al.,

2006).

• Unrecognized carriers render infection control programs futile, therefore

evaluation of the benefit of screening both the nares and throat was

examined in four study populations (Mertz et al., 2007).

• Clinical trials were 100% correct in identifying MRSA and

98% positive of identifying the less dangerous strain.

• This rapid screening test requires a maximum of three hours

and forty minutes to complete (Kucina et al, 2008).

• Combining swabs of the throat, skin, and nares is important s and throat

was examined (Mertz et al., 2007).

• A because selective colonization of the throat may be more common than

presently acknowledged (Mertz et al., 2007).

Early Detection

Integration of the Evidence• Most healthcare workers have encountered more than one

undiagnosed MRSA infection in their practice. A rapid test

with results obtained in a 3 to 4 hour period could prevent

this unseemly event.

• The rapid testing is performed utilizing swabs, which is a fairly non-invasive and

inexpensive procedure (Kucina et al., 2008). Patients may prefer to have this

testing done to avoid being placed in tentative isolation, or to avoid potentially

exposing other patients.

• Patients have expressed anger and resentment at contracting the infections and

express dismay at missing work, costs of travel and time/duration of the

treatment. Patients are now understandably fearful of the possible

consequences of healthcare interventions or a stay in the hospital (Barnes &

Jinks, 2008).

Recommendations to Utilize the EvidenceRecommendations include a plan to implement the rapid MRSA assay as a screening

tool in order to recognize patients who have been

colonized with MRSA before they are transferred to another

nursing unit.

Hand washing is essential in the prevention of the

transmission of MRSA between patients and healthcare

personnel.

Utilization of the Evidence

Assess for risk factors: presence of a chronic wound, has been hospitalized

three or more times in the last year, or is a resident of a long-

term care facility.

If found to be at high risk, the swabs

should be obtained and sent for analysis

to the lab.

Maintain isolation until culture results

are obtained. As always, with every patient, standard

precautions should be maintained .

If positive for MRSA the patient will

require a private room. Contact

isolation precautions should be utilized

• Wash hands after contact with patient s, bodily fluids, and contaminated items, and after gloves are removed between patient contact

• Use gloves (clean, non-sterile are adequate) when contacting patient or patient items.

• Use clean gloves when touching mucous membranes and non-intact skin.

Hand Hygiene

• Always wear gloves; wear masks and eye protection during procedures that are likely to generate splashes

• Ensure that reusable equipment is not used in the care of another patient until it has been appropriately decontaminated.

• Isolate patient in a private room or in room with other patients on MRSA precautions.

• If possible, divide patient assignments so that health care personnel are not required to care for both (Capriotti, 2003).

Isolation Precautions

• Assure that patient environment is cleaned daily with antiseptic solution.

• Use single-use disposable equipment; discard in biohazard waste container.

• Ensure that reusable equipment is not used in the care of another patient until it has been appropriately decontaminated.

Surfaces

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