Download Methicillin-resistant Staphylococcus Aureus (MRSA)

METHICILLIN-RESISTANT
STAPHYLOCOCCUS AUREUS
(MRSA)
MEGAN SHRUM
CONCORDIA UNIVERSITY
WHAT IS MRSA?
• Methicillin-resistant Staphylococcus
Aureus:
• Potentially fatal staph bacterium that commonly
causes skin infections.
• Challenging to treat because of its resistance to
certain antibiotics including methicillin, oxacillin,
penicillin, and amoxicillin. (CDC, NCEZID, DHQP,
2012).
• Occur in both the community and healthcare
setting.
PUBLIC HEALTH DOMAINS
• Epidemiology
• Environmental Factors
• Biostatistics
• Biomedical Factors
• Social & Behavioral Factors
• Health Policies
EPIDEMIOLOGY
• MRSA can affect anyone in any given setting.
• Historically, infections were commonly found in hospitalized
patients
• Now we are seeing more infections occurring within our
communities
• People who are living in crowded living conditions are more
susceptible to MRSA
• Those with weakened immune systems are more susceptible
• Athletes who participate in sports which involve physical
contact are more susceptible
• Patients in healthcare facilities, who undergo procedures and
have weakened immune systems, are at greater risk
(Pastagia, Kleinman, Lacerda de la Cruz, Jenkins, 2012).
EPIDEMIOLOGY CONTINUED…
• Infections occur through
• Indirect and direct contact with the bacteria
• Skin-to-skin contact
• Through Exposed wounds
(Pastagia, Kleinman, Lacerda de la Cruz, Jenkins, 2012).
• Common MRSA infections include surgical wound
infections, urinary tract infections, bloodstream
infections, and pneumonia (CDC, NCEZID, DHQP, 2012).
• MRSA can cause hemorrhagic-necrotizing pneumonia
and possibly death (Aldabagh, Tomecki, K. J, 2010).
SOFT TISSUE MRSA INFECTIONS
• Soft tissue MRSA infections:
• abscesses,
• boils,
• Cellulitis
• folliculitis.
(Aldabagh, Tomecki, K. J, 2010).
EPIDEMIOLOGY: STATISTICS
• Healthcare onset:
• Infections which began in hospitals, declined 28% from 2005
through 2008.
• A 17% drop in invasive MRSA infections that were
contracted outside the hospital within patients who recently
left the hospital
• Bloodstream infections within hospitalized patients has
dropped 50% from 1997 to 2007
• Community Onset:
• Infections within the community are increasing rapidly
throughout the last decade.
(CDC, NCEZID, DHQP, 2012)
CA= community associated
HACO=healthcare-associated community-onset
HO=hospital onset
ENVIRONMENTAL FACTORS
• MRSA infections can occur in any geographic
location, on any part of a person’s body and can
affect anyone (Pastagia, Kleinman, Lacerda de la Cruz, Jenkins, 2012).
• Are seen in both community and healthcare settings
ENVIRONMENTAL FACTORS:
FACILITIES THAT ARE MORE SUSCEPTIBLE TO MRSA CONTAMINATIONS
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Athletic facilities
Dormitories
Military barracks
Correctional facilities
Daycare centers
Prisons
Facilities that experience crowded living
• Athletes may spread MRSA through their locker rooms in
the showers, in whirl pools, through contact with each
other and athletic equipment
(CDC et al., 2012).
BIOSTATISTICS
The CDC is committed to several short- and long-term “surveillance
projects”
Active Bacterial Core surveillance (ABCs)
• Provides CDC and laboratories with demographic information
and bacterial isolates
• Studies risk factors, evaluates vaccine effectiveness, and
monitores the effectiveness of prevention policies.
(NCIRD, DBD, 2012).
Health departments, individual hospitals, and academic
medical centers are working with the CDC to track MRSA
infections (CDC, NCEZID, DHQP, 2011).
BIOSTATISTICS…
• MRSA Case Patient Report Form:
• http://www.cdc.gov/abcs/downloads/MRSA_case_rpt_form_2010.pdf
• Forms are filled out for each MRSA patient at the healthcare
facility and sent to the CDC.
Forms include:
• Description of patient (age, gender, ethnicity, race etc.)
• Where treated
• Was it Healthcare or community associated
• Severity
• Type/location of infection
• Underlying factors,]
• Predisposing factors
• Outcome of the patient.
(NCIRD, DBD, 2012).
BIOMEDICAL FACTORS
• MRSA…
• Caused by the bacteria Staphylococcus Aureus
• Is a human pathogen
• The pathogens contain toxins and virulence mechanisms
• have altered PBP’s that antibiotics cannot attach to
• Produce beta-lactams and lactamase
• causes resistance to certain beta-lactams antibiotics.
• methicillin, amoxicillin, penicillin, and oxacillin.
• Hard to treat because of it’s resistance to antibiotics
(Shopsin, Kreiswirth, 2001) (Wang, Khan, Hines, Mediavilla, Zhang, Chen, Hoet, Bannerman, Pancholi,
Robinson, Kreiswirth, Stevenson, 2012).
BIOMEDICAL FACTORS…
• Community associated (CA) MRSA
• Contain genes that are associated with skin and soft-tissue
infections.
• Panton-Valentine leucocidin (PVL)
• Exfoliative toxin
• Less resistance to methicillin
• Hospital associated (HA) MRSA
• larger resistance to methicillin
• associated with urinary tract, respiratory tract, and skin
infections.
(Giudice, Blanc, Durupt, F., Bes, M., Martinez, J.., Counillon, E., Etienne, 2006).
SOCIAL & BEHAVIORAL FACTORS:
ECOLOGICAL MODEL
• The ecological model states that our social
environment which includes intrapersonal,
interpersonal, institutional, community, and public
policy factors, all influence the behaviors we
choose to partake in.
BEHAVIORAL FACTORS THAT
INCREASE SUSCEPTIBILITY:
• Poor hygiene
• (biting nails, leaving wounds untended and open etc.)
• Participating in risky sexual behavior
• Drug Use
• Sharing of needles
• Unsterile needles
• Participate risky behaviors
• Using public facilities
• Participating in sports
• Living in a crowded living situation
(Cohen, Shuler, McAllister, Fosheim, Brown, Abercrombie, et al., 2007)
ECOLOGICAL MODEL
• Intrapersonal Factors:
• Focuses on the individual and their knowledge and attitudes towards
certain behaviors (Schneider, 2011).
• We need to educate people about what MRSA is and what behaviors
make them more susceptible so they are convinced to change their
behaviors.
• Interpersonal Factors:
• Include peer pressure and family beliefs which influence a person’s
behaviors and tendencies (Schneider, 2011).
• Educate peer groups and family members in order for individuals to
establish healthy beliefs, attitudes, behaviors, and tendencies.
• Institutional factors:
• Institutions must help educate employees and also set standards and
enforce regulations in order to prevent the spread of MRSA within the
communities.
• Community:
• Must educate the population all about MRSA and how to prevent it.
Communities are largely responsible for providing education to the
public.
(Kreisel, K. M., Johnson, J., Stine, O., Shardell, M. D., Perencevich, E. N., Lesse, Roghmann, 2010).
ECOLOGICAL MODEL: PUBLIC POLICY
• Federal:
• MRSA Prevention Collaborative
works to address current MRSA
issues
• Affordable Care Act (ACA)
funds states to help prevent
healthcare-associated
infections (HAI).
• Require states to report HAI to
the NHSN
• CDC Prevention Epicenter
works to prepare and inform
states about how to prevent
and treat HAI
• Hand Hygiene Collaborative
• NIOSH, HCSA and NORA are
organizations that establish
standards within hospitals, the
workplace, and also
environmental and community
settings
(Department of Health and Human Services, 2009)
(CDC, NCEZID, DHQP, 2012).
PUBLIC POLICIES CONTINUED
• State
• Have health departments in Emerging Infectious Diseases (EIP)
• Enforce regulations set by the federal government within their
state (like the Hand Hygiene Collaborative)
• Report MRSA cases to NHSN
• Local
• Every community addresses MRSA differently
• Awareness and educational programs are seen within schools,
the workplace and other community facilities
• Implement the federal and state regulations within their
communities
• Use the CDC as an educational tool
• Work within institutions to promote healthy living and hygiene
practices
(Department of Health and Human Services, 2009)
(CDC, NCEZID, DHQP, 2012)
REFERENCES
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Bo Shopsin and Barry N. Kreiswirth. (2001). Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus.
Retrieved September 29, 2012 from: http://wwwnc.cdc.gov/eid/article/7/2/pdfs/70-0323.pdf.
Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases
(NCEZID) Division of Healthcare Quality Promotion (DHQP). (2012). State-based HAI prevention. Received from:
http://www.cdc.gov/hai/state-based/index.html.
Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases
(NCEZID), Division of Healthcare Quality Promotion (DHQP). (2012). Methicillin-resistant Staphylococcus Aureus
(MRSA) Infections. Retrieved September 15, 2012 from: http://www.cdc.gov/mrsa/.
Centers for Disease Control and Prevention, National Center for Emerging and ZoonoticInfectious Diseases
(NCEZID), Division of Healthcare Quality Promotion (DHQP). (2011). MRSA Statistics. Retrieved September 22, 2012
from: http://www.cdc.gov/mrsa/statistics/.
Cohen AL, Shuler C, McAllister S, Fosheim GE, Brown MG, Abercrombie D, et al. (2007). Methamphetamine use
and methicillin-resistant Staphylococcus aureus skin infections. Received October 5, 2012 from:
http://wwwnc.cdc.gov/eid/article/13/11/07-0148.htm.
Department of Health and Human Services. (2009). State of the Sector: Health Care and Social Assistance.
Retrieved October 20, 2012 from: http://www.cdc.gov/niosh/docs/2009-138/pdfs/2009-138.pdf.
del Giudice, P. P., Blanc, V. V., Durupt, F. F., Bes, M. M., Martinez, J. P., Counillon, E. E., & ... Etienne, J. J. (2006).
Emergence of two populations of methicillin-resistant Staphylococcus aureus with distinct epidemiological,
clinical and biological features, isolated from patients with community-acquired skin infections. British Journal
Kreisel, K. M., Johnson, J., Stine, O., Shardell, M. D., Perencevich, E. N., Lesse, A. J., & ... Roghmann, M. (2010). Illicit
Drug Use and Risk for USA300 Methicillin-Resistant Staphylococcus aureus Infections with Bacteremia. Emerging
Infectious Diseases, 16(9), 1419-1427. doi:10.3201/eid1609.091802
Schneider, Mary-Jane. (2011). Introduction to Public Health. (3rd Ed) Ontario, CA: Jones and Bartlett Publishers.
Shu-Hua Wang, Yosef Khan, Lisa Hines, José R. Mediavilla, Liangfen Zhang, Liang Chen, Armando Hoet, Tammy
Bannerman, Preeti Pancholi, D. Ashley Robinson, Barry N. Kreiswirth, and Kurt B. Stevenson. (2012). MethicillinResistant Staphylococcus aureus Sequence Type 239-III, Ohio, USA, 2007–2009. Retrieved September 29, 2012 from:
http://wwwnc.cdc.gov/eid/article/18/10/pdfs/12-0468.pdf.