Download Methicillin-Resistant Staphylococcus Aureus

Running head: MRSA
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Methicillin-Resistant Staphylococcus Aureus
Chris Common
Ferris State University
Disaster Nursing and Emergency Preparedness
NURS 319
Marietta Bell-Scriber
April 09, 2010
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Abstract
Incidents of infectious disease outbreaks have been common topic in the news
nationwide. Finding treatment for these diseases has proven to be a difficult task for medical
personnel. For some individuals whose bodies have become increasingly resistant to traditional
treatment regimens, the solution becomes even more difficult. Methicillin-resistant
Staphylococcus aureus (MRSA) is one form of infectious disease that has become increasingly
prevalent in recent years. A descriptive summary in the areas of transmission/isolation, clinical
presentation, diagnosis, and therapy will be discussed. An identification of factors and/or
situations that may promote this emerging disease will be supported with resources throughout
this evidenced based paper.
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Methicillin-Resistant Staphylococcus Aureus
Methicillin-resistant Staphylococcus aureus (MRSA) are a type of staphylococcus or
“staph” bacteria that are resistant to many antibiotics. Staph bacteria normally live on your own
skin and in your nose, usually without causing problems. Approximately 25% to 30% of the
population is colonized in the nose with Staph bacteria. It can also be carried in the armpit, groin,
or genital area. Staph bacteria are one of the most common causes of skin infections in the
United States (CDPH, 2009). By definition, staphylococcus is a genus of gram-positive cocci,
sometimes part of the normal flora of the skin, mucous membranes, respiratory, or
gastrointestinal tracts. Staphylococcus is also common in the general environment (UMHS,
2007). The problem exists when these bacteria mutate into strains that become resistant to
traditional medicines such as penicillin or its synthetic form, methicillin. As more antibioticresistant bacteria or “super bugs” as they are sometimes referred to as, develop, hospitals are
taking extra care to practice infection control to decrease the likelihood of spreading the bacteria
to others.
In the late 1970s, hospitals in eastern Australia saw the first outbreaks of methicillinresistant Staphylococcus aureus (MRSA). By the 1980s, MRSA had emerged in various places
throughout the world (PRHI, 2003). It is very difficult to accurately date the exact time frame as
to when this resistant form of staphylococcus was formed. These same bacteria that once were
harmless while being present on the human body are thought to have mutated due to over usage
or misusage or antibiotics. The Centers for Disease Control have identified other key problems
related to the spread of this “super bug”. Inappropriate treatment of colonization instead of
treating only active infection increases resistance. Inadequate infection prevention and control
allows for spread from infected or colonized patient and the under use of vaccines (such as
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influenza) allows fro more secondary bacterial infections in persons with vaccine preventable
disease and increased use of antibiotics to treat as mentioned earlier. Physicians and scientists
now realize the seriousness of this emerging infectious disease and must take special precautions
to prevent further spread.
When the bacteria grows on the skin and mucous membranes without causing infection it
is known as colonization, and people who are colonized with MRSA are known as carriers of
MRSA (UMHS, 2007). MRSA can cause infections such as boils, wound infection, infected and
decubitus ulcers. MRSA is a strain of Staphylococcus aureus that is distinguished from other
Staphylococcus aureus strains by its resistance to beta-lactam antibiotics. MRSA are identified in
laboratories through the use of the mecA gene test (UMHS, 2007). Although the mecA gene test
is the most accurate method for the detection of methicillin-resistant Staphylococcus aureus
(MRSA), it is not widely used at hospitals and many clinicians lack knowledge regarding the
appropriate and timely application of mecA gene test results for the selection of optimal
antimicrobial therapy (OAT) against S. aureus infections (ASM, 2008). The majority of MRSA
infections occur among patients in hospitals or other healthcare settings. However, it is becoming
more common in the community setting (CDC, 2008). Community settings refer to those persons
who acquire Staph and MRSA outside of hospitals and other healthcare facilities. The major
concern facing healthcare workers who come in contact with infected individuals is the potential
of spreading the infection to other patients. There are some individuals that are more prone for
infection. Children and elderly who have weakened immune systems are said to be at greater risk
of contracting the infection or colonizing MRSA (UMHS, 2007). That is not to say that only
immunocompromised patients are at risk. MRSA is becoming more common in healthy people.
These infections can occur among people who are likely to have cuts or wounds and who have
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close contact with one another, such as members of sports teams (UMHS, 2007). Spread may
also occur through indirect contact by touching objects (e.g., towels, sheets, wound dressings,
clothes, workout areas, or sports equipment) contaminated with Staph bacteria or MRSA
(Charmeck, 2010).
When an individual tests positive for MRSA special contact precautions must be
followed along with general infection control measures. These measures consist of frequent hand
washing by physicians, nurses and other health care workers, as the most common way hospitalacquired MRSA is transmitted to patients in through human hands. The wearing of gowns, eye
protection, and gloves and masks when appropriate also aid in reducing transmission. MRSA is
not usually spread through the air like the common cold or flu virus, unless a person has MRSA
pneumonia and is coughing (UMHS, 2007). Frequent cleaning of medical devices, instruments,
and bedding is essential anytime they have come into contact with the infected individuals. At
some facilities it is policy that a contact precautions sign be placed outside the patient’s room.
This precaution is designed to alert visitors and other healthcare workers of the patient’s
condition and also acts as a reminder of which barrier equipment will be needed prior to entering
the room. According to the Centers for Disease Control it is not recommended that all health care
workers be screened to see if they are colonized with MRSA and it is not recommended to treat
all workers that do test positive for MRSA. Culturing can detect carriers, but not who will come
down with infection or who might spread the bacteria. Treatment is often unsuccessful and can
create further resistance, and most carriers of MRSA will not become ill (CDC, 2008).
Most Staphylococcus skin infections are minor and may be easily treated. In mild cases
of skin infection the treatment will include taking an antibiotic or having the doctor drain the
infection. One might also be given an ointment to put on the infected skin or inside the nose
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along with washing one’s skin with antibiotic soap called chlorhexidine (Hibiclens) to reduce
MRSA bacteria on the skin (AAP, 2005). Staphylococcus also may cause more serious
infections, such as infections of the bloodstream, surgical sites, or pneumonia. Sometimes, a
Staphylococcus infection that starts as a skin infection may worsen (CDC, 2008). Symptoms of a
MRSA infection depend on where the infection is. Staphylococcal disease has distinctly different
clinical and epidemiological patterns in the general community, in newborns, in menstruating
women (Toxic Shock Syndrome), in institutionalized patients, and in heath care workers (AAP,
2005). If MRSA is causing an infection in a wound, that area of the skin may be red or tender. If
one develops MRSA pneumonia, a cough may develop. Community-based MRSA commonly
causes skin infections, such as boils, abscesses, or cellulitis (UMHS, 2007). Neglecting to seek
medical attention upon developing symptoms could be dangerous as MRSA infections can
become serious in a short amount of time. The incubation period is commonly 4-10 days
following exposure, however disease may not occur until several months after colonization
(AAP, 2005). Symptoms often mimic those of an insect or spider bite. Many times these lesions
are localized and discrete. However, in some cases the infection can enter the bloodstream and
may lead to much more serious conditions such as pneumonia, osteomyelitis, septicemia,
endocarditis, meningitis, or other serious diseases (UMHS, 2007). In any case where an
antibiotic is prescribed it is essential that the individual continues to take the antibiotic in its
entirety even if the infection appears to be getting better. The only time one should stop taking
the medication is if it is recommended by their physician or they develop a reaction to the
medication, in which case they should notify their physician immediately.
Methicillin-resistant Staphylococcus aureus has proven to be a dangerous infectious
disease that affects individuals of all ages and social background. The Staphylococcal bacteria
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themselves are not dangerous and can be found on the skin and mucous membranes of most
human beings. The potential for becoming infected with the resistant strain of the bacteria
depends largely on the environment that the individual is exposed to and how often the
individual was given antibiotics for viral infections. However, that is not to say that every patient
that receives a dose of antibiotics when antibiotics were not indicated will automatically develop
the resistant strain. For those that do become infected with MRSA, symptoms may not become
evident until several months after colonization. In mild cases of skin infection the treatment will
include taking an antibiotic or having the doctor drain the infection. One might also be given an
ointment to put on the infected skin or inside the nose along with washing one’s skin with
antibiotic soap. For those individuals with more severe cases that require hospitalization will be
placed in a private room to reduce the chances of spreading the bacteria to other patients. The
healthcare workers caring for the patient will follow strict contact precautions by donning a
gown, gloves, and face mask when MRSA pneumonia is suspected. Visitors or patients along
with health care providers are asked to at the very least wash their hands with soap and warm
water prior to exiting the patient’s room. As for the patient receiving treatment the single most
important factor is to take all of their prescribed antibiotics until all doses have been completed
to eliminate the possibility of their body building resistance to the antibiotic being used to fight
the infection. According to the CDC the good news is major strides have been made in recent
years to reduce the numbers of MRSA infections in healthcare settings.
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References
American Society for Microbiology. (2008). Impact of mecA Gene Testing and Intervention by
Infectious Disease Clinical Pharmacists on Time to Optimal Antimicrobial therapy for
staphylococcus aureus bacteremia at a university hospital. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446910/
Centers for Disease Control and Prevention. (2008). Community-associated MRSA information
for the public. Retrieved from
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html#5
CharMeck.org. (2010). Let’s talk about ...community-associated methicillin resistant
staphylococcus aureus. Retrieved from
http://www.charmeck.org/Departments/Health+Department/Top+News/MRSA.htm
Pittsburgh Regional Healthcare Initiative. (2003). MRSA: a short history of a monster microbe.
Retrieved from
http://www.prhi.org/docs/MRSAa%20short%20history%20of%20a%20monster%20micr
obe12-1-2003.pdf
Report of the Committee on Infectious Diseases (26 ed.). (2005). Elk Grove Village, IL:
American Academy of Pediatrics.
State of California- Health and Human Services Agency. (2009). Community-associated
(CAMRSA)/staph infections: a guideline for athletic departments. Retrieved from
http://www.cdph.ca.gov/healthinfo/discond/documents/camrsainfectionsguidelineathletic
sdepartment.pdf
University of Michigan Health System. (2007). MRSA: a guide for health care staff. Retrieved
from http://www.med.umich.edu/i/policies/ice/ICM_ip/pdf/cpexhibitc.pdf
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University of Michigan Health System. (2007). Protecting our patients against MRSA. Retrieved
from http://www.med.umich.edu/opm/newspage/2007/mrsa.htm